Ruptured Distal Medial Lenticulostriate Artery Aneurysm Treated With Transcortical-Transventricular Approach

Michael Young, Peter Schaible, Khaled Asi, Keith Schaible, Michael Young, Peter Schaible, Khaled Asi, Keith Schaible

Abstract

We report a case of a 48-year-old female who presented with abulia and headaches. Head CT (HCT) demonstrated a left caudate intracerebral hemorrhage (ICH) with extension into the left lateral ventricle. Diagnostic cerebral angiogram showed a left distal medial lenticulostriate artery (MLSA) aneurysm with remote left parietal Spetzler-Martin grade 3 arteriovenous malformation (AVM). The patient underwent an endoscope-assisted transcortical-transventricular approach to the distal MLSA aneurysm with complete excision and evacuation of the intraventricular hemorrhage (IVH) postoperatively; the patient had no further neurologic deficits and recovered well from her initial hemorrhage. Ruptured MLSA aneurysms are a very rare cause of spontaneous ICH. Urgent treatment of these aneurysms is needed to prevent further rebleeding. We present a novel operative technique utilizing an endoscope-assisted transcortical-transventricular approach to a ruptured distal MLSA aneurysm with successful excision of the aneurysm.

Keywords: arteriovenous malformation; caudate nucleus hemorrhage; endovascular; intraventricular hemorrhage; medial lenticulostriate artery aneurysm; open surgical approach; ruptured aneurysm; transcortical transventricular.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1. Initial head CT demonstrating left… — **Figure 1. Initial head CT demonstrating left caudate nucleus intracerebral hemorrhage with left lateral ventricle intraventricular hemorrhage (arrow)**
CT: computed tomography

Figure 2. CTA demonstrating left parietal arteriovenous… — **Figure 2. CTA demonstrating left parietal arteriovenous malformation (arrow)**
CTA: computed tomography angiography

Figure 3. AP cerebral angiogram demonstrating left… — **Figure 3. AP cerebral angiogram demonstrating left distal MLSA aneurysm (arrow)**
AP: anteroposterior; MLSA: medial lenticulostriate artery

Figure 4. Lateral cerebral angiogram demonstrating left… — **Figure 4. Lateral cerebral angiogram demonstrating left distal MLSA aneurysm (arrow)**
MLSA: medial lenticulostriate artery

Figure 5. MLSA aneurysm approached via transcortical-transventricular… — **Figure 5. MLSA aneurysm approached via transcortical-transventricular approach**
MLSA: medial lenticulostriate artery

**Figure 6. Excised MLSA aneurysm**
MLSA: medial lenticulostriate artery

Figure 7. Postoperative head CT demonstrating complete… — **Figure 7. Postoperative head CT demonstrating complete resolution of left caudate nucleus intracerebral hemorrhage and left lateral ventricle intraventricular hemorrhage (arrow)**
CT: computed tomography

Figure 8. Anteroposterior postoperative cerebral angiogram demonstrating… — **Figure 8. Anteroposterior postoperative cerebral angiogram demonstrating no further filling of the left MLSA aneurysm (arrow)**
MLSA: medial lenticulostriate artery

Figure 9. Lateral postoperative cerebral angiogram demonstrating… — **Figure 9. Lateral postoperative cerebral angiogram demonstrating no further filling of the left MLSA aneurysm (arrow)**
MLSA: medial lenticulostriate artery

References

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Source: PubMed

Ruptured Distal Medial Lenticulostriate Artery Aneurysm Treated With Transcortical-Transventricular Approach

Abstract

Conflict of interest statement

Figures

References

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