J Korean Neurosurg Soc.  2009 Dec;46(6):568-571. 10.3340/jkns.2009.46.6.568.

Saccular Aneurysm at the Anterior Communicating Artery Complex Associated with an Accessory Middle Cerebral Artery : Report of Two Cases and Review of the Literature

• Kang DH
• Park J
• Park SH
• Hamm IS

• KMID: 2190211
• DOI: http://doi.org/10.3340/jkns.2009.46.6.568

Abstract

Accessory middle cerebral artery (MCA) is an infrequent vascular anomaly of the brain. Cerebral aneurysms associated with this anomalous artery are also very rare. To our knowledge, there have only been ten previous reports of an aneurysm associated with accessory MCA. The authors present two patients with accessory MCA-related aneurysms. A 38-year-old male and a 59-year-old female both presented with sudden-onset severe headache. In both patients, computed tomography (CT) scan revealed subarachnoid hemorrhage. A subsequent angiogram demonstrated an accessory MCA arising from the anterior cerebral artery (ACA) and a saccular aneurysm at the anterior communicating artery (ACoA) complex associated with an accessory MCA. Surgical clipping allowed for complete exclusion of the aneurysm from the arterial circulation. Based on our review of the ten cases of aneurysms associated with accessory MCA documented in the literature, we suggest that accessory MCA-related aneurysms can be classified according to whether the accessory MCA originates from the proximal A1 segment or from the ACoA complex. We also emphasize the importance of precise interpretation of preoperative angiograms and intraoperative precaution in determining the presence of this anomalous artery prior to temporary clip placement.

Keyword

Accessory middle cerebral artery; Aneurysm; Anterior communicating artery complex

MeSH Terms

Adult
Aneurysm
Anterior Cerebral Artery
Arteries
Brain
Female
Headache
Humans
Intracranial Aneurysm
Male
Middle Aged
Middle Cerebral Artery
Subarachnoid Hemorrhage
Surgical Instruments