J Cerebrovasc Endovasc Neurosurg.  2014 Dec;16(4):368-373. 10.7461/jcen.2014.16.4.368.

An Unruptured Anterior Communicating Artery Aneurysm with Bilateral Infraoptic Anterior Cerebral Arteries. Case Report and Review of the Literature

• Chua MH
• Thomas AJ
• Fusco MR
• Ogilvy CS

• KMID: 1738343
• DOI: http://doi.org/10.7461/jcen.2014.16.4.368

Abstract

Variations of the anterior cerebral artery-anterior communicating artery complex are commonly identified in aneurysm surgery. An infraoptic course of the anterior cerebral artery is exceedingly rare. Robison first described this anomaly from an anatomic dissection in 1959. A unilateral anomalous infraoptic anterior cerebral artery is more common than anomalies of bilateral infraoptic anterior cerebral arteries. We present the case of an unruptured aneurysm at the anterior communicating artery in a patient with bilateral infraoptic anterior cerebral arteries, identified by computed tomography angiography and verified during surgery. Implications for aneurysm formation and surgical treatment are discussed.

Keyword

Anterior cerebral artery; Aneurysm; Vascular surgical procedure

MeSH Terms

Aneurysm
Angiography
Anterior Cerebral Artery*
Arteries
Humans
Intracranial Aneurysm*
Vascular Surgical Procedures

Figure

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  Fig. 1 Preoperative computed tomography angiogram demonstrates the ACoA aneurysm (A) and low bifurcation of the internal carotid artery (B, C). Reconstructed images show the aneurysm, which projects posteriorly (D).

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  Fig. 2 Axial (A) and sagittal (B) imaging demonstrate the aneurysm, which projects posteriorly.

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  Fig. 3 View from right pterional craniotomy shows an infraoptic A1 segment. The ACA projects medially underneath the optic nerve and arises anterior to the optic chiasm (A) in the pre-chiasmatic space (B).

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