Abstract
Background
The most common neurovascular variant is the fetal posterior cerebral artery (FPCA), in which the P1 branch is absent or hypoplastic, and the majority of P2 supply is derived from the anterior circulation. While there are reports of hyperplastic anterior choroidal arteries (AChA) with supply to the temporo-occipital and calcarine regions, no reports of a duplicated FPCA exist.
Methods
This case report describes a patient with a ruptured right FPCA aneurysm. Digital subtraction angiogram (DSA) revealed an artery with origin distal to the FPCA associated with the aneurysm. This was not consistent with a typical AChA. The FPCA associated with the aneurysm had the typical origin, course, and supply of a FPCA. The distal FPCA had a similar course of a typical FPCA with significant supply to the typical PCA territory. The patient underwent successful clipping of the aneurysm, and the duplicated FPCA was identified during the craniotomy.
Results
The features of this duplicate FPCA, which has not been previously described, are discussed in comparison to another variant, the hyperplastic, anomalous AChA. The artery described in this report does not fit the typical criteria of this AChA variant. Therefore, the authors outline this variant as a duplicated FPCA.
Conclusion
Recognition of variant cerebrovascular anatomy is vital to neurosurgeons and interventional neuroradiology specialists. FPCA aneurysms require special management considerations and are often more challenging to treat. This report discusses a duplicated FPCA. To our knowledge, this is the first description of this variant. A duplicated FPCA carries important management considerations in the management of neurovascular pathology.
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The main manuscript were primarily prepared by Jonathan Fisher, MD and Keannette Russell, MS. The radiographic findings and imaging were prepared by Jonathan Fisher, MD and Justin Mascitelli, MD. All authors reviewed the manuscript.
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This report does not require ethical approval from the review board at our institution. We would like to disclose that we have been unable to obtain informed from the patient described in the study. Therefore, we have removed demographic characteristics to de-identify the subject. We do not believe these characteristics change the value of the report.
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The authors attempted to contact the patient and the patient’s family numerous times. The patient has been lost to follow-up and does not respond to attempted communications. Therefore, the authors have removed identifying demographic information from this work.
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Fisher, J., Russell, K. & Mascitelli, J. Duplicated fetal posterior cerebral artery in a patient with a ruptured fetal posterior cerebral artery aneurysm: a cerebrovascular variant. Surg Radiol Anat 45, 35–38 (2023). https://doi.org/10.1007/s00276-022-03052-0
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DOI: https://doi.org/10.1007/s00276-022-03052-0