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Cent Eur Neurosurg 2010; 71(2): 96-98
DOI: 10.1055/s-0029-1202358
Case Report

© Georg Thieme Verlag KG Stuttgart · New York

Fusiform Aneurysm of the Proximal Anterior Cerebral Artery (A1)

G. Mariniello1 , D. Vecchione1 , G. Di Martino1 , F. Briganti2 , R. Donzelli1 , F. Maiuri1
  • 1Department of Neurological Sciences, University “Federico II” of Naples, Naples, Italy
  • 2Service of Neuroradiology, University “Federico II” of Naples, Naples, Italy
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Publication History

Publication Date:
02 December 2009 (online)

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Abstract

Objective: Fusiform aneurysms of the A1 segment of the anterior cerebral artery (ACA) are exceptional, with only 15 reported cases. This article presents an additional case treated by microsurgical trapping. The aim is to discuss the treatment of these aneurysms based on the aneurysm morphology and the anatomy of the ACA complex.

Case Report: A 52-year-old woman with subarachnoid hemorrhage (Hunt-Hess grade II) showed an aneurysm of the proximal part of the A1 segment of the left ACA involving the whole circumference of the arterial wall on computerized tomography angiography and digital angiography. There was good collateral blood flow from the right ACA to the distal left ACA. A left pterional craniotomy allowed us to expose a large aneurysm of the proximal part of the A1 segment; the artery entered into the aneurysm sac and could not be identified at the level of the aneurysm. Trapping of the aneurysm was performed with a distal clip placed just before the origin of the artery of Heubner. No neurological deficits were observed postoperatively.

Conclusion: Clipping of fusiform aneurysms of the A1 segment using an encircling clip is the treatment of choice but, more often, this is impossible. Trapping of the aneurysm with preservation of the perforating branches (mainly the Heubner artery) may be easily performed when collateral blood flow from the contralateral ACA is sufficient.

Key words

fusiform aneurysm - anterior cerebral artery - A1 segment - trapping

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Correspondence

Dr. G. Mariniello

Department of Neurological Sciences

University “Federico II” of Naples

80131 Naples

Italy

Phone: +39/81/746 25 84

Fax: +39/81/746 24 88

Email: giumarin@unina.it