J Cerebrovasc Endovasc Neurosurg.  2023 Sep;25(3):340-346. 10.7461/jcen.2023.E2022.07.004.

Ruptured mirror DACA aneurysm: A rare case report and review of literature

• Singh DK
• Sharma PK
• Singh AK
• Chand VK

• KMID: 2546172
• DOI: http://doi.org/10.7461/jcen.2023.E2022.07.004

Abstract

Bilateral distal anterior cerebral artery (DACA) aneurysms also called “kissing aneurysms” or “mirror aneurysm” are extremely rare, accounting for only 0.2% of all intracranial aneurysms. There have only been a few examples of mirror DACA aneurysms reported in the literature. Here, we report a rare case of mirror DACA aneurysm in a middle aged female with its successful clipping. Patient was admitted with severe headache and altered sensorium. Computed tomography (CT) head was suggestive of anterior inter-hemispheric hematoma. Digital subtraction angiography (DSA) was done which was suggestive of two distal anterior cerebral artery aneurysms located at same anatomical position. It was treated through microsurgical clipping. Mirror image DACA aneurysms are rare occurrence. All patients with ruptured DACA aneurysms should have angiography with 3D reconstruction studies. This aids in determining the aneurysm’s morphology and planning treatment accordingly.

Keyword

Distal anterior cerebral artery; Aneurysm; Clipping; Coiling; Inter-hemispheric hematoma

Figure

• 

  Fig. 1. (A) Pre-operative computed tomography (CT) scan showing inter-hemispheric hematoma (black arrow). Pre-operative 3D reconstructed image of digital subtraction angiography brain showing right distal anterior cerebral artery (DACA) aneurysm (B) (white arrow) and left DACA aneurysm (C) (white arrow). Pre-operative CT angiography image showing bilateral DACA aneurysms (D) (black arrows).

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  Fig. 2. Pre-operative 2D images of digital subtraction angiography brain. (A) Antero-posterior view showing right distal anterior cerebral artery (DACA) aneurysm (black arrow), (B) Lateral view showing right DACA aneurysm (black arrow), (C) Antero-posterior view showing left DACA aneurysm (black arrow), (D) Lateral view showing left DACA aneurysm (black arrow).

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  Fig. 3. (A) Intra-operative microscopic image showing vascular clips applied to bilateral distal anterior cerebral artery DACA aneurysm (black arrows), (B) Intra-operative indocyanine Green video angiography showing the patency of the branches of bilateral distal ACA and complete exclusion of the aneurysm from the circulation, (C) Post-operative CT head after one month showing no residual hematoma. ACA, anterior cerebral artery; CT, computed tomography

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