Intracranial aneurysms arising from the distal anterior choroidal artery (AChA) are uncommon entities, with less than 30 cases reported. A 4-year-old boy was admitted to the Emergency Department with a sudden onset of severe headache and vomiting. CT scan of the head showed signs of intraventricular hemorrhage (IVH) and subarachnoid hemorrhage (SAH). Cerebral angiography revealed a right AChA aneurysm arising from a distal intraventricular branch with an associated microarteriovenous malformation (microAVM). Following a multidisciplinary assessment, the patient underwent surgical clipping. An ipsilateral transcortical transparietal approach was utilized. Early postoperative deficits were not found, and good clinical and radiological outcomes were assessed at long-term follow-up. Postoperative cerebral angiography showed complete exclusion and resection of both aneurysm and AVM. Surgery for intracranial aneurysms in this location can be challenging; however, good surgical and neurological outcomes can be achieved. The present work highlights the value of multidisciplinary assessment in the decision-making process in complex pediatric neurovascular pathology, especially when facing rare cases like this one, which represents the youngest case of a ruptured distal AChA aneurysm reported in the literature.

起源于远端脉络膜前动脉 (AChA) 的颅内动脉瘤并不常见，报告的病例不到 30 例。一名 4 岁男孩因突然剧烈头痛和呕吐被送入急诊室。头部 CT 扫描显示脑室内出血 (IVH) 和蛛网膜下腔出血 (SAH) 的迹象。脑血管造影显示右侧 AChA 动脉瘤起源于远端脑室内分支，并伴有相关的微动静脉畸形 (microAVM)。经过多学科评估，患者接受了手术夹闭。采用同侧经皮层经顶入路。没有发现术后早期缺陷，长期随访评估了良好的临床和放射学结果。术后脑血管造影显示动脉瘤和 AVM 均完全排除和切除。这个位置的颅内动脉瘤手术可能具有挑战性。然而，可以实现良好的手术和神经学结果。目前的工作强调了多学科评估在复杂儿科神经血管病理学决策过程中的价值，尤其是在面临这样的罕见病例时，这是文献中报道的最年轻的远端 AChA 动脉瘤破裂病例。