A Case of Cerebral Infarction in the Internal Capsule Following a Resection of AVM in the Trigone of the Lateral Ventricle Fed by the Anterior Choroidal Artery

We report a case of cerebral infarction in the internal capsule following a resection of AVM in the trigone of the left lateral ventricle fed by the anterior choroidal artery. A 61-year-old man presented with mild right hemiparesis and seizure. He had had an AVM in the trigone of the left lateral ventricle since 37 years before, and had experienced a seizure and cerebral hemorrhage. Cerebral angiography showed an AVM of Spetzler-Martin’s Grade 2 fed by the anterior choroidal artery in the trigone of the left lateral ventricle. An operation was performed by the transcortical approach using a former hemorrhagic cavity. The left anterior choroidal artery feeding the nidus was cut in the left lateral ventricle, and AVM was removed together with a choroid plexus. Right hemiparesis worsened postoperatively, and MRI revealed cerebral infarction in the left internal capsule. Although it is thought that the cutting of the anterior choroidal artery in the lateral ventricle is safe, care should be taken when cutting the anterior choroidal artery even in the lateral ventricle because the branch(es) originating from the plexal segment of the anterior choroidal artery could penetrate to the cerebral parenchyma and feed the internal capsule.