Ruptured dissecting anterior inferior cerebellar artery aneurysm--case report

A 39-year-old woman presented with a rare dissecting aneurysm of the proximal anterior inferior cerebellar artery (AICA). She presented with sudden onset of headache and vomiting, and subsequently became comatose with acute respiratory distress syndrome. Computed tomography showed subarachnoid hemorrhage and ventricular dilation. Left vertebral angiography identified a fusiform aneurysm at the proximal portion of the left AICA. The patient underwent endovascular treatment using Guglielmi detachable coils. The aneurysm was completely embolized. Computed tomography detected no infarcted areas in the regions supplied by the AICA. She was discharged without neurological deficits.     

Two cases of distal anterior cerebral artery aneurysm associated with accessory anterior cerebral artery

An accessory anterior cerebral artery (accessory ACA) is a rare anomalous vessel arising from the anterior communicating artery as a median artery of triplicated ACA. It is considered a large median artery of the corpus callosum and distributes to one or both hemispheres. The cases of an accessory ACA aneurysm are extremely rare; however, we experienced two cases of unruptured aneurysm growing at the distal portion of an accessory ACA. Two females, aged 66 and 67 years, respectively, separately consulted our hospital as a result of chronic headaches. Brain MR angiography and following DSA in the first patient demonstrated a triplicated ACA and an aneurysm located just above the corpus callosum growing from the distal portion of the accessory ACA. MRI and MR angiography in the second patient depicted a triplicated ACA and an aneurysm from the accessory ACA as with the first case. Neck clipping of the aneurysm was performed using an interhemispheric approach in both cases. These aneurysms appeared to present the same intraoperative findings as other unruptured aneurysms growing at the usual positions.     

Ruptured anterior cerebral artery aneurysm at the origin of the accessory middle cerebral artery

A 36-year-old female patient was admitted to our hospital with a rare case of aneurysm at the origin of the accessory middle cerebral artery (MCA) manifesting as severe headache and vomiting. Neurological examination did not detect any abnormalities or consciousness disturbance. Computed tomography demonstrated diffuse subarachnoid hemorrhage. Magnetic resonance angiography showed an aneurysm in the horizontal portion of the left anterior cerebral artery (A(1)). Digital subtraction angiography and three-dimensional digital subtraction angiography demonstrated a saccular aneurysm originating at the junction of the left A(1) and accessory MCA. Another accessory MCA originated at the proximal portion of the left A(2) without an aneurysm. Two accessory MCAs were found on the left. Neck clipping was performed via a left pterional approach. One month after admission, she was discharged without neurological deficits.     

Ruptured distal middle cerebral artery aneurysm: Case report

INTRODUCTIONThis report describes a rare case of a distal middle cerebral artery (dMCA) aneurysm.PRESENTATION OF CASEThat developed a right intracerebral haematoma and subarachnoid haemorrhage. It was treated by surgical exploration and clipping via pterional approach.DISCUSSIONClinical findings and surgical approaches of dMCA aneurysm are different from proximal middle cerebral artery (MCA) aneurysms. Microneurosurgical clipping is the most effective treatment of dMCA aneurysm.CONCLUSIONWe comprehensively review the literature related to these rare aneurysms within the temporal lobe, surgical anatomy of the dMCA aneurysm.     

Ruptured cerebral aneurysm of the median artery of the corpus callosum (accessory anterior cerebral artery): case report

A rare case of ruptured cerebral aneurysm of median artery of corpus callosum (accessory anterior cerebral artery: Acc ACA) is reported. A 66-year-old hypertensive female suddenly lost consciousness for 5 minutes and later complained of severe headache. On admission, the next day, consciousness was clear and she showed no neurological deficit except for right motor weakness. CT scan revealed subarachnoid hemorrhage, and carotid angiography showed triplicated anterior cerebral artery with a saccular aneurysm on the Acc ACA. Twenty hours after the onset, an operation was performed to clip the aneurysm neck. Post-operative course was uneventful and she was discharged on the 25th postoperative day without neurological deficits. When the median artery of corpus callosum(MACC), a branch of anterior communicating artery distributes to one or to both hemispheres, it is called Acc ACA. It is thought to be a vascular anomaly and which has an incidence of 20%. However, cases of aneurysm of MACC (or Acc ACA) have not been reported and our case is considered to be the first.     

Ruptured distal middle cerebral artery aneurysm

OBJECT: Ruptured distal middle cerebral artery (MCA) aneurysms are uncommon, and their clinical and radiological features are poorly understood. To clarify characteristics of these lesions, the authors undertook a retrospective analysis of nine patients with ruptured distal MCA aneurysms. METHODS: The medical records of patients who underwent surgical repair of ruptured intracranial aneurysms between 1988 and 2002 at Shinshu University Hospital and its affiliated hospitals were retrospectively evaluated. The authors found only nine patients with a ruptured distal MCA aneurysm, and their clinical, neuroimaging, and intraoperative findings were evaluated. CONCLUSIONS: This study of nine patients with distal MCA aneurysms is the largest series to date. Eight lesions were saccular aneurysms that were clipped and the remaining one was a mycotic aneurysm that was trapped. Eight of the nine patients suffered cerebral hematomas with subarachnoid hemorrhage. All patients had good outcomes after obliteration of their aneurysm, although their preoperative condition was not good.     

Ruptured aneurysm of bihemispheric anterior cerebral artery bifurcation: case report

It is well known that distal anterior cerebral artery (ACA) aneurysms are often associated with the anomalies of the ACA, of which azygos ACA and triple ACA have frequently been described. In this report, we present a rare case with a ruptured aneurysm arising from the bifurcation of the bihemispheric ACA, a rare anomaly of the ACA. A 63-year-old male suddenly developed severe headache, consciousness disturbance, and left hemiparesis, and was admitted to our hospital. Plain CT scans revealed subarachnoid clots that were densely distributed in the supracallosal cistern. Cerebral angiography demonstrated that the left pericallosal artery supplied blood flow to the bilateral parietal lobes through the bihemispheric arteries. A saccular aneurysm was found at their bifurcation. He underwent clipping surgery through interhemispheric approach. Postoperative course was uneventful. Special care should be taken not to occlude the bihemispheric arteries supplying to the bilateral parietal lobes during surgery.     

Bilateral distal anterior cerebral artery aneurysm associated with supreme anterior cerebral artery: case report]

A 67-year-old woman presented with bilateral distal anterior cerebral artery aneurysms manifesting as consciousness disturbance. Computed tomography revealed subarachnoid hemorrhage in the interhemispheric fissure, right sylvian fissure, and a hematoma in the right frontal lobe and lateral ventricles. Angiography showed bilateral symmetrical aneurysms located on the pericallosal artery at the bifurcation of the callosomarginal artery. The operation was performed on the day the patient was admitted. The aneurysms were clipped via the interhemispheric approach, and the hematoma was aspirated. Operative view demonstrated rupture of the left aneurysm, and supreme anterior cerebral aneurysm. Postoperative angiography showed disappearance of the aneurysms and an intact bilateral anterior cerebral artery. The patient was discharged with mild organic mental syndrome. However, a few days later, she was admitted again with a high fever and died of complications due to sepsis. Pathological view showed clipped aneurysms and the connection of the bilateral distal anterior cerebral artery with the so-called supreme anterior communicating artery.     

Dissecting aneurysms of the anterior cerebral artery and accessory middle cerebral artery. Case report

A 66-year-old woman presented with dissecting aneurysms of the anterior cerebral artery (ACA) and accessory middle cerebral artery (MCA) manifesting as subarachnoid hemorrhage but without radiological evidence of the dissecting aneurysms. Intraoperative observation revealed that the vessel walls were dark purple in color, a typical finding of dissecting aneurysm. The abnormal A1 segment was trapped and the dissecting aneurysm of the accessory MCA was wrapped. In the case of SAH of unknown origin, dissecting aneurysm should always be kept in mind even if the angiogram does not show any abnormal finding. This is the first reported case of dissecting aneurysm of the accessory MCA.     

Ruptured aneurysm at a duplicated middle cerebral artery with accessory middle cerebral artery

Summary. Although many cerebral vascular anomalies are widely recognized, others are less well known or unclassified. Accessory middle cerebral artery (MCA) and duplicated MCA are among uncommon anomalies. We present a very rare case of subarachnoid haemorrhage due to rupture of a saccular aneurysm arising from a duplicated middle cerebral artery which was associated with an accessory middle cerebral artery.     

Ruptured aneurysm of the distal anterior cerebral artery: clinical features and surgical strategies

Ruptured aneurysms of the distal anterior cerebral artery (ACA) are relatively rare and surgical management provides some unique technical challenges. This retrospective analysis of 20 patients with distal ACA aneurysms evaluated the clinical features and surgical strategies. The characteristic findings were small and common concurrent aneurysms, and frequent intracerebral hematoma (ICH). Aneurysms were divided by location on the genu (n = 13), infracallosal (n = 5), and supracallosal portions (n = 2). All patients except one underwent surgery via an interhemispheric route. Unilateral craniotomy was performed for aneurysms on the genu portions without massive ICH. Bilateral craniotomies were selected for aneurysm located on the infracallosal portion or combined with massive ICH. No intraoperative rupture was observed. Favorable outcomes were achieved in 15 of 20 patients, and only one patient died. The preoperative Hunt and Kosnik grade was closely correlated with the outcome.     

Ruptured aneurysm at the origin of the accessory middle cerebral artery: case report

The accessory middle cerebral artery is a rare vascular anomaly of the brain. We describe a case of a ruptured aneurysm at the junction of the accessory middle cerebral artery and the horizontal portion of the anterior cerebral artery. The lesion was demonstrated by angiography and confirmed at surgery. No perforating arteries arising from this accessory artery were found. There have been only four previous reports of aneurysms located at the origin of the accessory middle cerebral artery. The relevant literature is briefly reviewed.     

Aneurysm of distal anterior cerebral artery associated with azygos anterior cerebral artery

Summary An aneurysm arising from the distal anterior cerebral artery distal to the bifurcation of the azygos anterior cerebral artery is reported. A review of the literature emphasizes the rarity of this lesion.     

Ruptured distal anterior cerebral artery aneurysms presenting as acute subdural hematoma--report of three cases.

The authors report three cases of distal anterior cerebral artery aneurysm presenting as acute subdural hematoma (SDH). Two patients were comatose on admission and died of massive SDH. One patient underwent aneurysmal neck clipping in the chronic stage and returned to normal daily life. A convexity SDH continuous with a wedge-shaped interhemispheric SDH was the characteristic computed tomographic appearance in all cases. There was no accompanying subarachnoid or intracerebral hemorrhage in one case (pure SDH). These cases are 9.4% of 32 ruptured distal ACA aneurysms treated in our institute in the last 14 years, a higher incidence than reported previously.     

Surgical treatment of extracranial distal internal carotid artery dissecting aneurysm--case report.

A 53-year-old male presented with a dissecting aneurysm of the extracranial distal internal carotid artery (ICA) treated by aneurysm removal with interposition of a saphenous vein graft. The surgical approach involved sectioning of Riolan's nosegay.     

Ruptured anterior communicating artery aneurysms associated with fenestration of the anterior cerebral artery

Two patients with ruptured anterior communicating artery aneurysms associated with fenestration of the anterior cerebral artery are reported. In the literature, only 12 angiographic demonstrations of fenestration of the anterior cerebral artery have been reported. All fenestrations were limited to the distal half of the A1 portion, and seven of the 12 cases were associated with aneurysms. The high incidence of coexisting fenestration and aneurysm suggests that congenital factors may play a role in the pathogenesis of cerebral aneurysm.     

Persistent primitive hypoglossal artery aneurysm--case report

The aneurysm arising from a persistent primitive hypoglossal artery (PHA) is rare, and only 13 such cases have been reported in literature. We present a 62-year-old woman with an aneurysm of PHA at its junction with the basilar artery. The patient consulted our hospital for a transient loss of consciousness and headaches. No neurological deficit was found, but MRI and MRA showed an aneurysm of the vertebrobasilar junction. Cerebral angiogram after admission showed the aneurysm of PHA at its junction with the basilar artery. Perspective 3D-CTA and 3D-T2 weighted MR images were composed to simulate the condition and aneurysmal surgery via the transcondylar approach was carried out. The aneurysm was successfully clipped and the patient was discharged with no neurological deficits. Perspective 3 D-CTA and MRI simulation were very useful for this operation.     

Ruptured intracranial aneurysm associated with unruptured abdominal aortic aneurysm--case report

A 61-year-old male with hypertension presented with sudden onset of headache and nausea due to subarachnoid hemorrhage (SAH). He had two siblings with history of SAH due to ruptured intracranial aneurysms. Right carotid angiography on admission showed an anterior communicating artery aneurysm. At that time, the extracranial arteries were not examined. The aneurysm was clipped with no complications. A pulsating mass was palpable in the abdomen 37 days after the onset. Ultrasonography and computed tomography showed an abdominal aortic aneurysm with intraluminal thrombus, measuring 8 x 9 x 8 cm. Normal pressure hydrocephalus had already developed. The patient underwent elective abdominal aortic aneurysm resection before ventriculoperitoneal shunting. After shunting, he recovered fully. The present case indicates that unpredictable sudden enlargement of associated abdominal aortic aneurysm is possible in patients with ruptured intracranial aneurysms.