Abstract
Anterior choroidal artery (AChA) aneurysms are rare and can present a particular anatomical challenge in that they often incorporate the origin of the AChA. The success of aneurysm treatment in this location depends on completely occluding the aneurysm and preserving the AChA parent vessel to avoid a devastating AChA infarct, with deficits that can include hemiplegia and hemianopsia. This chapter presents the case of a female patient with an unruptured AChA aneurysm treated with microsurgical clipping. In addition to meticulous microsurgical technique based on anatomic knowledge, intraoperative monitoring including somatosensory evoked potentials, motor evoked potentials, and indocyanine green angiography is an important adjunct for a successful aneurysm occlusion without complications.