Common origin of the anterior choroidal artery and posterior communicating artery with a concomitant aneurysm at the internal carotid artery-posterior communicating artery junction: A case report

The anterior choroidal artery (AChA) is one of the main arteries, and it can exhibit several anomalies, among which is the common origin of the AChA and posterior communicating artery (PcomA); however, this is relatively rare. In the case that the AChA originates from the PcomA, it is highly uncommon for a concomitant aneurysm to develop at the internal carotid artery (ICA)-PcomA junction. The present study reports such a case. A 58-year-old female developed a headache with nausea and vomiting. Computed tomography (CT) revealed a subarachnoid hemorrhage. CT angiography and digital subtraction angiography (DSA) revealed a right ICA-PcomA aneurysm, with the AChA arising from the proximal segment of the PcomA. The aneurysm was clipped in the hybrid operating room. DSA confirmed that the aneurysm had been clipped completely, and that the PcomA and AChA had been retained. Following surgery, the patient recovered well without any sequelae. CT angiography revealed no recurrence of the aneurysm at the 3-month follow-up. On the whole, as demonstrated by the case presented herein, when the AChA and PcomA have a common origin, the AChA and PcomA should be retained during concomitant aneurysm clipping at the ICA-PcomA to prevent severe infarction complications. Surgical clipping during hybrid surgery is a suitable choice.