• Yoshinobu Horio, Kenji Fukuda, Shintaro Yoshinaga, Yuki Kozaki, Dai Kawano, Mitsutoshi Iwaasa, Hiroshi Abe, and Tooru Inoue.
• Department of Neurosurgery, Fukuoka University Hospital and School of Medicine, Fukuoka University, Fukuoka, Japan; Department of Emergency and Critical Care Medicine, Fukuoka University Hospital and School of Medicine, Fukuoka University, Fukuoka, Japan.
• World Neurosurg. 2020 Aug 1; 140: 10-12.

BackgroundThe premamillary artery (PMA) usually arises from the posterior communicating artery. Thus, an internal carotid artery (ICA) origin for PMA is rare. We report a rare case of a patient who presented with subarachnoid hemorrhage resulting from kissing aneurysms arising from the origin of the anterior choroidal artery and the aberrant origin of PMA and was successfully treated with coil embolization.Case DescriptionA conscious and alert 36-year-old woman arrived at our hospital with a severe headache. Computed tomography (CT) of the head showed a thin subarachnoid hemorrhage. CT angiography revealed kissing aneurysms arising from the ICA. Digital subtraction angiography showed that these kissing aneurysms had arisen from the anterior choroidal artery and the aberrant origin of the PMA. Endovascular coil embolization was performed for both aneurysms. Her clinical course was good, and she was discharged from our hospital 20 days after admission.ConclusionsTo the best of our knowledge, the present study is the first report of a ruptured saccular PMA aneurysm arising from ICA that was successfully treated with coil embolization. Three-dimensional digital subtraction angiography and cone-beam CT were useful for confirming the precise vasculature of the PMA.Copyright © 2020 Elsevier Inc. All rights reserved.

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