PMC9837483_01
case 1. A : Two-dimensional digital subtraction angiography (2d-dSA) image suggesting a saccular aneurysm (arrow) arising from the internal carotid artery (IcA) at the origin of the anterior choroidal artery (AchA) (arrowheads). b : Volume-rendered three-dimensional (3d) rotational angiography image showing the origin of the AchA (arrowheads) at the base of the saccular lesion. c : Intraoperative photograph revealing a minor AchA emitting from infundibular widening with the major AchA at its base. d : Illustration corresponding to panel (c).
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Digital subtraction angiography (DSA) indicated a saccular (dome height, 4 mm; neck width, 2 mm) aneurysm with a high aspect ratio arising from the left ICA at the origin of the AChA (Fig. 1A). The AChA was identified at the proximal base of the aneurysm (Fig. 1B). However, contrary to expectation, a perforating artery, which immediately divided into three branches, was observed arising from the dome of the saccular lesion (Fig. 1C and D).
PMC9837483_02
case 2. A : Two-dimensional digital subtraction angiography image showing an anterior choroidal artery (AchA) aneurysm (arrow). b : Volumerendered 3-dimensional rotational angiography image showing the origin of the AchA (arrowheads) at the proximal base of the saccular lesion. c : Intraoperative photograph revealing a minor AchA emitting from the dome of the saccular lesion with the major AchA at its base. Vascular outpouchings are seen in two areas. d : Illustration corresponding to panel (c). e : Intraoperative photograph showing the aneurysm clips repairing the aneurysmal changes.
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The right carotid angiography indicated a round saccular (dome height, 5 mm; neck width, 4 mm) aneurysm arising from the ICA at the origin of the AChA (Fig. 2A). The AChA was identified at the proximal base of the aneurysm (Fig. 2B). However, a perforating artery was observed emitting from the dome of the saccular lesion (Fig. 2C and D). The two vascular outpouchings were both clipped, while the remaining infundibular widening and duplicate AChA were preserved (Fig. 2E).