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

Abstract

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.

A Case of Rare Anterior Cerebral Artery Anomaly in a Patient With Massive Aneurysmatic Subarachnoid Hemorrhage

“…При инфраоптическом отхождении А1 сегмента ПМА артерия исходит из офтальмического (параклиноидного) сегмента ВСА на уровне отхождения глазной артерии, проходит под ипсилатеральным зрительным нервом кпереди от зрительного перекреста, а затем поворачивает вверх между зрительными нервами и впадает в ПСоА [3]. Данный тип строения А1 сегмента ПМА встречается крайне редко, однако почти всегда сочетается с церебральными аневризмами и другими внутричерепными сосудистыми аномалиями [4].…”

Bilateral infraoptic origin of the anterior cerebral artery: illustrative case

“…2,3 Approximately 55 cases of the rare variant have been published, with fewer than 10 cases reporting bilateral infraoptic ACA origins. 4,5 There have been a number of reports linking this variant to its association with aneurysms in the region of the anterior communicating artery (ACoA). 2,[6][7][8] While the relevance of this anatomical variant has been reported in cases of endovascular or microsurgical treatment of aneurysms, it has not been described in cases of skull base tumor resection.…”