Infraoptic Course of the Anterior Cerebral Artery Associated with an Anterior Communicating Artery Aneurysm: Anatomic Case Report and Embryological Considerations

Infraoptic Course of the Anterior Cerebral Artery Associated with an Anterior Communicating... AbstractOBJECTIVE AND IMPORTANCE:An infraoptic course of the proximal anterior cerebral artery is a rare anomaly that has been reported in 32 cases to date, often in association with cerebral aneurysms. This anomaly represents a maldevelopment in the embryogenesis of the anterior circle of Willis, resulting from the persistence of the primitive prechiasmal arterial anastomosis or an error in the development of the definitive ophthalmic artery (OphA). The case of a patient with a ruptured middle cerebral artery aneuyysm and an anterior communicating artery aneurysm associated with this anomaly is described, and the anatomic features are outlined.CLINICAL PRESENTATION:A 30-year-old male patient with a right temporalhematoma and subarachnoid hemorrhage was admitted to our department 4 days after the hemprrjaging episode, with normal neurological examination results. Angiography revealed a right with an anomalous and an anterior communicating artery aneurysm with an antomalous precommunicating tract.INTERVENTION:The patient was surgically treated 14 days after the hemorrhaging episode, through a right frontopterional craniotom; both aneurysms were excluded by clipping. The anomalous infraoptic proximaltract of the anterior cerebral artery was well documented, with its origin adjacent to the OphA. The patient remained neurologically intact after surgery and was discharged 8 days later.CONCLUSION:The anomalous infraoptic course of the proximal anterior cerebral artery was associated with a low bifurication of the ipsilateral internal carotid artery and the absence of the relationship with the origin of the OphA suggests an error in the development of the definitive OphA, with persistance of an anastomotic loop between the primitive dorsal and ventral OphAs. It is concluded that, for aneurysm surgery, careful angiographic evaluation and an understan of the neurovascular relationships in the circle of Willis are essential for a succesful postoperative course, especially when very rare vascular anomalies are treated. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Infraoptic Course of the Anterior Cerebral Artery Associated with an Anterior Communicating Artery Aneurysm: Anatomic Case Report and Embryological Considerations

Infraoptic Course of the Anterior Cerebral Artery Associated with an Anterior Communicating Artery Aneurysm: Anatomic Case Report and Embryological Considerations

ascular anomalies of the anterior Infraoptic Course of the Anterior circle of W illis are commonly ob­ served; however, some variations of the Cerebral Artery Associated with an anterior cerebral artery (ACA) complex, especially if associated with cerebral an­ Anterior Communicating Artery eurysms, are very rare (1, 7, 16, 18, 19, 23, 28, 31, 34, 40, 44). Our group recently Aneurysm: Anatomic Case Report and presented an analysis of vascular anom­ alies in a consecutive series of more than Embryological Considerations 400 patients w ith anterior communicat­ ing artery (AComA) aneurysms (7), fo­ cusing mainly on atresia of the A l tract, the presence of three distal ACAs, and S a l v a t o r e S p i n n a t o , M . D . , A l b e r t o P a s q u a l i n , M . D . , fenestration of the AComA. Fr a nc o C h i o f f i , M . D . , R e n a t o D a P i a n , M . D . In this report, an extremely rare vari­ ation of the proximal tract of the ACA, Department ot Neurosurgery, University Hospital, Verona, Italy i.e., an infraoptic course of the proximal precommunicating tract (A l) under the ipsilateral optic nerve, w ith the distal BJECTIVE AND IM PO RTA N C E: A l tract anterior to the chiasm and po­ sitioned between the optic nerves, is cerebral artery is a ra re a n o m a ly th at has b e e n repo . represents a presented. This anomaly was associated often in association w ith c e r e b r a l a n e u r^ " 1Sn . jrcle o f w illis , reSult- w ith an incidental AComA aneurysm maldevelopment in th e e m b ry o g e n e s is o f th e an terio an asto mosis or and a ruptured middle cerebral artery ingfrom the p ersisten ce o f th e prim itive p rech iasm a l a * he (MCA) aneurysm. an error in the d e v e lo p m en t o f th e de '™tive op arterv aneurysm and an case of a patient w ith a ruptured mi ® C^®o d a t e d with th is anom aly is CASE REPORT anterior co m m u n ica tin g artery aneury A 30-year-old man in previous good...
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Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199906000-00087
Publisher site
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Abstract

AbstractOBJECTIVE AND IMPORTANCE:An infraoptic course of the proximal anterior cerebral artery is a rare anomaly that has been reported in 32 cases to date, often in association with cerebral aneurysms. This anomaly represents a maldevelopment in the embryogenesis of the anterior circle of Willis, resulting from the persistence of the primitive prechiasmal arterial anastomosis or an error in the development of the definitive ophthalmic artery (OphA). The case of a patient with a ruptured middle cerebral artery aneuyysm and an anterior communicating artery aneurysm associated with this anomaly is described, and the anatomic features are outlined.CLINICAL PRESENTATION:A 30-year-old male patient with a right temporalhematoma and subarachnoid hemorrhage was admitted to our department 4 days after the hemprrjaging episode, with normal neurological examination results. Angiography revealed a right with an anomalous and an anterior communicating artery aneurysm with an antomalous precommunicating tract.INTERVENTION:The patient was surgically treated 14 days after the hemorrhaging episode, through a right frontopterional craniotom; both aneurysms were excluded by clipping. The anomalous infraoptic proximaltract of the anterior cerebral artery was well documented, with its origin adjacent to the OphA. The patient remained neurologically intact after surgery and was discharged 8 days later.CONCLUSION:The anomalous infraoptic course of the proximal anterior cerebral artery was associated with a low bifurication of the ipsilateral internal carotid artery and the absence of the relationship with the origin of the OphA suggests an error in the development of the definitive OphA, with persistance of an anastomotic loop between the primitive dorsal and ventral OphAs. It is concluded that, for aneurysm surgery, careful angiographic evaluation and an understan of the neurovascular relationships in the circle of Willis are essential for a succesful postoperative course, especially when very rare vascular anomalies are treated.

Journal

NeurosurgeryOxford University Press

Published: Jun 1, 1999

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