Fusiform Lenticulostriate Artery Aneurysm with Subarachnoid Hemorrhage: The Role for Superselective Angiography in Treatment Planning

• Published in: Interventional neuroradiology 2010-09, Vol.16 (3), p.259-263
• Main Authors: Kochar, P.S., Morrish, W.F., Hudon, M.E., Wong, J.H., Goyal, M.
• Format: Article
• Language: English
• Subjects: Aneurysm, Ruptured - diagnostic imaging; Aneurysm, Ruptured - surgery; Basal Ganglia Cerebrovascular Disease - diagnostic imaging; Basal Ganglia Cerebrovascular Disease - surgery; Cerebral Angiography - instrumentation; Cerebral Angiography - methods; Humans; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - surgery; Male; Middle Aged; Original; Preoperative Care; Subarachnoid Hemorrhage - diagnostic imaging; Subarachnoid Hemorrhage - surgery; Tomography, X-Ray Computed
• ISSN: 1591-0199; 2385-2011
• DOI: 10.1177/159101991001600305

Aneurysms of the lenticulostriatal perforating arteries are rare and either involve the middle cerebral artery-perforator junction or are located distally in basal ganglia. We describe a rare ruptured fusiform lenticulostriatal perforating artery aneurysm arising from a proximal M2 MCA branch, discerned on superselective microcatheter angiography, presenting solely with subarachnoid hemorrhage (SAH). A 50-year-old previously healthy man presented with diffuse SAH and negative CT angiogram. Cerebral angiogram demonstrated a 2 mm fusiform aneurysm presumably arising from the right lateral lenticulostriate perforator but the exact origin of the perforator was unclear. Superselective angiography was required to precisely delineate the aneurysm and its vessel of origin and directly influenced treatment planning (surgical trapping). Superselective microcatheter angiography provides both an option for endovascular therapy as well as more accurate delineation for surgical planning for these rare aneurysms.