Skip to main content

A rare anomaly of the anterior communicating artery complex hidden by a large broad-neck aneurysm and disclosed by three-dimensional rotational angiography

Acta Neurochirurgica volume 150, pages 279–284 (2008)Cite this article

Summary

Double fenestration of the anterior communicating artery (ACoA) complex associated with an aneurysm is a very rare finding and is usually caused by ACoA duplication and the presence of a median artery of the corpus callosum (MACC). We present a patient in whom double fenestration was not associated with ACoA duplication or even with MACC, representing therefore, a previously unreported anatomic variation. A 43 year old woman experienced sudden headache and the CT scans showed subarachnoid haemorrhage (SAH). On admission, her clinical condition was consistent with Hunt and Hess grade II. Conventional digital subtraction angiography (DSA) was performed and revealed multiple intracranial aneurysms arising from both middle cerebral arteries (MCA) and from the ACoA. Three-dimensional rotational angiography (3D-RA) disclosed a double fenestration of the ACoA complex which was missed by DSA. The patient underwent a classic pterional approach in order to achieve occlusion of both left MCA and ACoA aneurysms by surgical clipping. The post-operative period was uneventful. A rare anatomical variation characterised by a double fenestration not associated with ACoA duplication or MACC is described. The DSA images missed the double fenestration which was disclosed by 3D-RA, indicating the importance of 3D-RA in the diagnosis and surgical planning of intracranial aneurysms.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  • BJ Alpers RG Berry (1963) ArticleTitleCircle of Willis in cerebral vascular disorders. The anatomical structure Arch Neurol 8 398–402 Occurrence Handle14012272 Occurrence Handle1:STN:280:DyaF383gsVajsw%3D%3D

    PubMed  CAS  Google Scholar 

  • J Beck S Rohde J Berkefeld V Seifert A Raabe (2006) ArticleTitleSize and location of ruptured and unruptured intracranial aneurysms measured by 3-dimensional rotational angiography Surg Neurol 65 18–25 Occurrence Handle16378842 Occurrence Handle10.1016/j.surneu.2005.05.019

    PubMed  Article  Google Scholar 

  • MR Crompton (1966) ArticleTitleThe pathogenesis of cerebral aneurysms Brain 89 797–814 Occurrence Handle5958708 Occurrence Handle10.1093/brain/89.4.797 Occurrence Handle1:STN:280:DyaF2s%2Fpt1aqtQ%3D%3D

    PubMed  Article  CAS  Google Scholar 

  • GG Ferguson (1972) ArticleTitlePhysical factors in the initiation, growth, and rupture of human intracranial saccular aneurysms J Neurosurg 37 666–677 Occurrence Handle4654696 Occurrence Handle1:STN:280:DyaE3s7ivFKrtw%3D%3D

    PubMed  CAS  Google Scholar 

  • N Hashimoto H Handa I Nagata F Hazama (1980) ArticleTitleExperimentally induced cerebral aneurysms in rats: Part V. Relation of haemodynamics in the circle of Willis to formation of aneurysms Surg Neurol 13 41–45 Occurrence Handle7361257 Occurrence Handle1:STN:280:DyaL3c7ksl2qsQ%3D%3D

    PubMed  CAS  Google Scholar 

  • R Kwak H Niizuma M Hatanaka J Suzuki (1980) ArticleTitleAnterior communicating artery aneurysms with associated anomalies J Neurosurg 52 162–164 Occurrence Handle7351555 Occurrence Handle1:STN:280:DyaL3c%2Fps1Wrtg%3D%3D Occurrence Handle10.3171/jns.1980.52.2.0162

    PubMed  CAS  Article  Google Scholar 

  • Y Nakasu S Nakasu M Kidooka J Handa (1982) ArticleTitleAneurysm at the fenestration of basilar artery – case report Nippon Geka Hokan 51 344–348 Occurrence Handle7115008 Occurrence Handle1:STN:280:DyaL383otlSmuw%3D%3D

    PubMed  CAS  Google Scholar 

  • J Namiki Y Doumoto (2003) ArticleTitleMicrosurgically critical anomaly of the anterior communicating artery complex during the pterional approach to a ruptured aneurysm: double fenestration of the proximal A2 segments Neurol Med Chir (Tokyo) 43 304–307 Occurrence Handle10.2176/nmc.43.304

    Article  Google Scholar 

  • DH Padget (1948) ArticleTitleThe development of the cranial arteries in the human embryo Contrib Embryol 32 205–262

    Google Scholar 

  • F San-Galli C Leman P Kien J Khazaal SD Phillips J Guerin (1992) ArticleTitleCerebral arterial fenestrations associated with intracranial saccular aneurysms Neurosurgery 30 279–283 Occurrence Handle1545903 Occurrence Handle1:STN:280:DyaK387oslSmsg%3D%3D Occurrence Handle10.1227/00006123-199202000-00026

    PubMed  CAS  Article  Google Scholar 

  • T Serizawa N Saeki A Yamaura (1997) ArticleTitleMicrosurgical anatomy and clinical significance of the anterior communicating artery and its perforating branches Neurosurgery 40 1211–1216 Occurrence Handle9179894 Occurrence Handle10.1097/00006123-199706000-00019 Occurrence Handle1:STN:280:DyaK2szitlCntA%3D%3D

    PubMed  Article  CAS  Google Scholar 

  • T Sugahara Y Korogi K Nakashima S Hamatake S Honda M Takahashi (2002) ArticleTitleComparison of 2D and 3D digital subtraction angiography in evaluation of intracranial aneurysms Am J Neuroradiol 23 1545–1552 Occurrence Handle12372745

    PubMed  Google Scholar 

  • JS Teal CL Rumbaugh RT Bergeron HD Segall (1973) ArticleTitleAngiographic demonstration of fenestrations of the intradural intracranial arteries Radiology 106 123–126 Occurrence Handle4682708 Occurrence Handle1:STN:280:DyaE3s%2FmvFCnsQ%3D%3D

    PubMed  CAS  Google Scholar 

Download references

Author information

Affiliations

  1. Neurocenter, Department of Neurosurgery, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany

    Jean G. de Oliveira, J. Beck, E. Hermann, R. Gerlach, A. Raabe & V. Seifert

  2. Neurocenter, Institute of Neuroradiology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany

    R. du Mesnil de Rochemont

Authors
  1. Jean G. de Oliveira
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. du Mesnil de Rochemont
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Beck
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. Hermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. Gerlach
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Raabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. V. Seifert
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jean G. de Oliveira.

Additional information

Correspondence: Jean Gonçalves de Oliveira, M.D., Rua Sena Madureira, 1123 Apto. 61, 04021-051 São Paulo – SP, Brazil.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

de Oliveira, J., du Mesnil de Rochemont, R., Beck, J. et al. A rare anomaly of the anterior communicating artery complex hidden by a large broad-neck aneurysm and disclosed by three-dimensional rotational angiography. Acta Neurochir (Wien) 150, 279–284 (2008). https://doi.org/10.1007/s00701-007-1401-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-007-1401-0

  • Keywords: Anatomical variation; aneurysm; anomaly; anterior communicating artery; double fenestration; three-dimensional angiography.