2023 Volume 51 Issue 5 Pages 453-457
A 25-year-old woman was admitted to our hospital with the primary complaint of a sudden headache and disturbed consciousness. Computed tomography (CT) scanning indicated a left thalamic hemorrhage and hydrocephalus. Angiograms revealed a characteristic vasculature suggestive of moyamoya disease, while a microaneurysm was observed in the right thalamoperforating artery (TPA), branching off from the right posterior cerebral artery. Preservation of the parent artery is difficult when performing embolization of a microaneurysm. As such, we administered endovascular treatment following identification of the collateral vascular network on cone-beam CT. During the procedure, a microcatheter was navigated into the right TPA; however, we were unable to advance it into the dome of the microaneurysm because the proximal portion of the microaneurysm was tortuous. However, on cone-beam CT, we noted that the distal portion of the right TPA was supplied by the posterior choroidal arteries. We, therefore, occluded the proximal portion of the right TPA using a coil, and the microaneurysm almost disappeared. Post-embolization magnetic resonance imaging (MRI) showed no ischemic lesions. The patient was discharged without any more neurological deficits following placement of a ventriculo-peritoneal shunt.
While managing this case, we were able to recognize the vascular structure of the microaneurysm and the collateral vascular network between the TPA and the posterior choroidal arteries using conebeam CT. We, therefore, suggest that cone-beam CT can be used to evaluate the vascular structure of microaneurysms and vascular anastomosis, despite a complicated collateral vascular network. Conebeam CT is, thus, a useful treatment strategy.
