A rare anatomical variant: median anterior cerebral artery fenestration associated with an azygous infra-optic anterior cerebral artery

Wong, George Kwok Chu; Wang, Ki; Yu, Simon C.H.; Poon, Wai Sang

doi:10.1016/j.jocn.2010.02.016

Cited by 7 publications

(6 citation statements)

References 5 publications

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“…Three cases were treated by coil embolization with a simple technique in two cases and with a stent-assisted technique in one case. 3 , 26 , 27) Ruptured ACoA aneurysms with IOA were frequently (44%) associated with other congenital vessel anomalies ( Table 1 ), 3 – 5 , 9 – 23 , 26 – 28 , 30 , 32 , 34) and the present case was the first one of an IOA aneurysm with an anomalous branching of a RAH from the aneurysm.…”

Section: Literature Reviewmentioning

confidence: 58%

“…As to the surgical approach, 23 of 27 cases of ACoA aneurysms were treated by clipping via a pterional approach and an orbitozygomatic approach. The side of a pterional approach was basically the same side as that of IOA, 4 , 5 , 9 , 10 , 11 , 13 – 16 , 19 , 22 , 23 , 30 , 32 , 34) and relatively high-positioned ACoA aneurysms tended to be operated via an orbitozygomatic approach or an AIH including our case. 4 , 6 , 21) In the present case, complete obliteration of the aneurysm could not avoid the sacrifice of the RAH and resulted in cerebral ischemia in the RAH territory, causing mild cognitive dysfunction.…”

Section: Discussionmentioning

confidence: 78%

“…Besides, RAH was reported to be multiple in 28% of 2300 cadaveric cases by Bonasia et al 38) Therefore, it is important to carefully evaluate the perianeurysmal anatomical structures before surgical and endovascular treatment. 2 , 39) Surgical clipping via a pterional approach has been reported to be safe, 4 , 5 , 9 , 10 , 11 , 13 – 16 , 19 , 22 , 23 , 30 , 32 , 34) but an AIH is also suggested to be reasonable and effective as to full exposure of the perianeurysmal anatomical structures including potential anomalies of the ACA, ACoA, and its perforators. 7) Alternatively, endovascular treatment of ACoA aneurysms with IOA may be equally feasible depending on their accessibility and morphology, although the importance and limitation of precise detection and preservation of these vessels remain as with surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

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A Ruptured Anterior Communicating Artery Aneurysm with Infra-optic Course of the Anterior Cerebral Artery: A Case Report and a Short Review

Tanaka

Ishida

Tanioka

et al. 2021

NMC Case Report Journal

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Infra-optic course of the anterior cerebral artery (IOA) is rare and approximately 55 cases of this anomaly have been described. We present a case of a ruptured anterior communicating artery (ACoA) aneurysm arising at the junction between the left IOA and the bilateral A2 segments, at which the right A1 segment was absent. One of the recurrent arteries of Heubner branched off directly from the aneurysmal dome, and was obstructed at aneurysmal neck clipping via an anterior interhemispheric (AIH) approach. In this report, accompanied anatomical variations and surgical approaches for ACoA aneurysms with IOA are reviewed. An IOA is frequently associated with other vascular anomalies, and the origin of functionally important recurrent arteries of Heubner is also variable. Preoperative accurate evaluation of vessel structures and the maximal exposure at surgery are very important. Pterional approach from the ipsilesional side is reportedly to be safe, but interhemispheric approach is also suggested to be effective as to full exposure to recognize the perianeurysmal anatomical structures including potential vessel anomalies.

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Section: Literature Reviewmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

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A Ruptured Anterior Communicating Artery Aneurysm with Infra-optic Course of the Anterior Cerebral Artery: A Case Report and a Short Review

Tanaka

Ishida

Tanioka

et al. 2021

NMC Case Report Journal

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“…Fenestrations of the ACA usually involve the A1 segment [ 29 , 30 , 31 , 32 ]. Bilateral A1 fenestrations were also reported [ 32 , 33 ], as well as the double fenestration of the A1 segment [ 34 ] and the fenestration of a median artery of the CC [ 35 ]. Fenestrated azygos ACAs were also found [ 36 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

Transcallosal and Pericallosal Courses of the Anterior Cerebral Artery

et al. 2022

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(1) Background: The anterior cerebral artery (ACA) has a precommunicating A1 segment, followed by a postcommunicating A2 segment. Anatomically, after it sends off from the callosomarginal artery (CMA), it continues as the pericallosal artery (PCalA). A detailed pattern of the anatomical variations of the PCalA are needed for practical reasons. (2) Methods: There were 45 retrospectively documented Computed Tomography Angiograms of 32 males and 13 females. (3) Results: In 90 sides, eleven different types of PCalA were documented: type 1: normal origin, above the genu of the corpus callosum (CC) (51.11%); type 2: low origin, below the rostrum of the CC (8.88%); type 3: late origin, above the body of the CC (3.33%); type 4, initial transcallosal course (3.33%); type 5, duplicated PCalA (1.11%); type 6, azygos PCalA (2.22%); type 7, absent PCalA (CMA type of ACA) (7.78%); type 8: CMA continued as PCalA (5.56%); type 9: PCalA continued as the cingular branch (1.11%); type 10: PCalA type of ACA, absent CMA (14.44%); type 11: triple PCalA, with an added median artery of the CC (1.11%). Different types of CMA were also documented: type 0, absent CMA (17.78%); type 1, CMA with frontoparietal distribution (45.56%); type 2, CMA with parietal distribution (22.22%); type 3, low origin of CMA, either from A1, or from A2 (8.88%); type 4, CMA continued as PCalA (5.56%). Ipsilateral combinations of PCalA and CMA types were classified as types A-P. In 33/45 cases (73.3%), the bilateral asymmetry of the combined anatomical patterns of PCalA and CMA was documented. Additional rare variations were found: (a) huge fenestration of A2; (b) bihemispheric ACAs (6/45 cases); (c) twisted arteries within the interhemispheric fissure. (4) Conclusions: The PCalA and CMA are anatomically diverse and unpredictable. Therefore, they should be documented on a case-by-case basis before surgical or endovascular approaches.

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“…The fenestrations of the cerebral arteries appear in all the branches but are most commonly reported in the vertebrobasilar artery ( 4 ), ACA ( 9 ), MCA ( 10 – 12 ), ACOA ( 13 ), and the posterior cerebral artery ( 14 ). In recent years, more and more people were found to suffer from fenestration, as we all know, the vessels where the fenestration is located will have hemodynamic changes, and whether this will cause the occurrence of other diseases is still unknown.…”

Section: Introductionmentioning

confidence: 99%

Retrospective analysis of image characteristics of 76 cases of cerebral vascular fenestrations

Chen

Wang

et al. 2022

Front. Neurol.

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ObjectivesThis study aims to summarize the clinical and imaging features of cerebral vascular fenestration and to explore the association between cerebral vascular fenestration and cerebral infarction and aneurysm.Materials and methodsThe computed tomography angiography (CTA), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA) imaging data of 76 cases of cerebral vascular fenestration from January 2021 and December 2021 in the Yantai Yuhuangding Hospital Affiliated to Qingdao University were analyzed. The general information was described. The location, morphology, and size of cerebral vascular fenestration were described. The association between cerebral vascular fenestration and infarction and aneurysm was analyzed.ResultsAmong 76 patients, a total of 80 fenestrations were detected (two patients had three fenestrations), and basilar artery fenestration was the most common (28/80). The fenestration <5 mm was 43/80, 5–10 mm was 12/80, and ≥10 mm was 25/80. Moreover, 19 patients had other vascular diseases: 10 with aneurysms, 5 with moyamoya diseases, and 4 with cerebral artery dissections. Except for one aneurysm at the site of the fenestration, other aneurysms were separate from the fenestrations. In addition, 37 patients had cerebral infarctions, of which 16 had cerebral infarctions in the blood supply area of the arterial fenestration. Among these 16 patients, there was more cerebral infarction in posterior circulation than in anterior circulation. However, no statistically significant differences were detected in the risk factors between the fenestration-relevant cerebral infarctions group and the non-fenestration-relevant cerebral infarctions group.ConclusionIn our study, cerebral vascular fenestration occurred most frequently in the basilar artery and may be combined with other vascular diseases. Fenestration in posterior circulation may be related to cerebrovascular diseases. Nonetheless, no clear clinical relevance was observed between fenestration and cerebral infarction. Also, we did not find a definite association between fenestration and aneurysm. For fenestration patients with cerebral infarctions, long-term antiplatelet and statin therapy may be safe and effective.

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A rare anatomical variant: median anterior cerebral artery fenestration associated with an azygous infra-optic anterior cerebral artery

Cited by 7 publications

References 5 publications

A Ruptured Anterior Communicating Artery Aneurysm with Infra-optic Course of the Anterior Cerebral Artery: A Case Report and a Short Review

A Ruptured Anterior Communicating Artery Aneurysm with Infra-optic Course of the Anterior Cerebral Artery: A Case Report and a Short Review

Transcallosal and Pericallosal Courses of the Anterior Cerebral Artery

Retrospective analysis of image characteristics of 76 cases of cerebral vascular fenestrations

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