Yamauchi Shigeru, Kawakami Taichiro, Murata Keiji, Ishiguro Tomoya, Ikeda Hidetoshi, Nishio Akimasa
1 Department of Neurosurgery, Hokuto Social Medical Corporation Hokuto Hospital, Obihiro, Japan.
2 Department of Neurosurgery, Shimada Municipal Hospital, Shimada, Japan.
Interv Neuroradiol. 2018 Feb;24(1):76-81. doi: 10.1177/1591019917739841. Epub 2017 Nov 10.
Background and importance Traditionally, it has been believed that the plexal segment of the anterior choroidal artery (AChoA) can be sacrificed safely. Here, we present a case of choroid plexus arteriovenous malformation (AVM) in which the capsulothalamic artery originated from distal plexal segment of the AChoA. Clinical presentation A 45-year-old man was diagnosed with arteriovenous malformation involving the left inferior horn in screening MRI. Preceding stereotactic radiosurgery, transarterial target embolization was performed. In this procedure, 20% n-butyl-2-cyanoacrylate (NBCA) was successfully injected from the lateral plexal branch of the AChoA. After embolization, right homonymous hemianopsia developed due to cerebral infarction on the left optic radiation. This infarction was considered to be within the territory of the capsulothalamic artery. Conclusion This anomalous capsulothalamic artery might be formed by hemodynamic compromise of the brain surrounding AVM in early gestation. We must be aware of this unusual anatomical variation to avoid ischemic complication in embolization of the AChoA.
背景与重要性 传统上，人们认为脉络膜前动脉（AChoA）的丛段可以安全地牺牲。在此，我们报告一例脉络丛动静脉畸形（AVM），其中丘脑囊动脉起源于AChoA的远端丛段。临床表现 一名45岁男性在筛查MRI中被诊断为累及左颞下叶的动静脉畸形。在立体定向放射外科手术之前，进行了经动脉靶向栓塞。在此过程中，从AChoA的外侧丛支成功注入了20%的正丁基-2-氰基丙烯酸酯（NBCA）。栓塞后，由于左侧视辐射区的脑梗死出现了右侧同向性偏盲。该梗死被认为在丘脑囊动脉的供血区域内。结论 这种异常的丘脑囊动脉可能是由于妊娠早期AVM周围脑组织的血流动力学改变而形成。我们必须意识到这种不寻常的解剖变异，以避免在AChoA栓塞中出现缺血性并发症。
