Multiple Anterior and Posterior Circulation Intracranial Fenestrations presenting With Aneurysmal Subarachnoid Hemorrhage

Abstract

Background and Importance : Intracranial artery fenestrations are very rare, however, when found, there is a high association with cerebral aneurysms. Clinical Presentation : This report describes a patient with multiple anterior and posterior circulation intracranial artery fenestrations and an anterior communicating artery aneurysm presenting with a thunderclap headache found to have a subarachnoid hemorrhage (SAH). The patient was treated with open surgery via clipping after a diagnostic angiography and did very well. Conclusion : There is an association between cerebral fenestrations and aneurysms, but it has not been studied in a prospective manner. This case is unusual in that the patient had both anterior and posterior circulation fenestrations, which is uncommon. Clinicians should have a high index of suspicion in patients being evaluated for SAH who have a cerebral artery fenestration with no aneurysm found.

Double unilateral fenestration of the anterior cerebral artery in the pre-communicating segment: a report of a unique case

“…In general, arterial "fenestration is described if the (cerebral) artery is doubled in one ˮ part of its trunk into two independent channels with their own tunica intima and tunica media and, sometimes with a tunica adventitia, and after the appropriate course these channels reform the original artery [2,4,15].…”

“…Fenestrations of single cerebral arteries of the carotid (CS) and vertebrobasilar (VBS) systems (ICA, ACA, middle/posterior cerebral arteries, anterior/posterior communicating arteries, vertebral arteries, basilar artery, and posterior inferior cerebellar arteries) in single or multiple appearances have been described [2,4,14], or associated with each other [15].…”

“…The theories about the origin and pathoanatomical significance of the cerebral artery fenestration cited in [15] are still controversial. We will present two fenestrations of the right A1 segment without aneurysm(s) or other pathology in a cadaver in the eighth decade of age.…”