Aneurysms Associated with Hyperplastic Anterior Choroidal Arteries: Three Cases with Literature Review

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Objective: A hyperplastic anterior choroidal artery (AchA) is a rare anomalous vessel that perfuses the posteromedial aspects of the cerebrum in place of the posterior cerebral artery. We describe 3 cases of hyperplastic AchA found among 61 patients with AchA aneurysms who underwent surgical or endovascular treatment at our institution.

Case Presentation: All 3 cases were diagnosed as hyperplastic AchA type 2 according to the Takahashi classification, indicating an anomalous branching temporal artery perfusing the medial temporal lobe. We performed coil embolization for 2 cases and surgical clipping for the third. One embolization case experienced recurrence after 3 years and underwent clipping. All procedures were conducted without complications.

Conclusion: Hyperplastic AchA can be encountered during aneurysm treatment. These cases emphasize the importance of evaluating the vascular anatomy to determine the optimal treatment strategy.