Published online Apr 16, 2015. doi: 10.12998/wjcc.v3.i4.377
Peer-review started: September 22, 2014
First decision: December 17, 2014
Revised: January 16, 2015
Accepted: February 4, 2015
Article in press: February 9, 2015
Published online: April 16, 2015
Multiple saccular or giant aneurysms of azygos anterior cerebral artery (AACA) at the distal segments A2-A5 are very rarely reported. Distal anterior cerebral artery (DACA) aneurysms represent approximately 2%-7% of all cerebral aneurysms. We present the case of an Albanian 62-year-old male, admitted at our service after sudden onset of severe headache and vomiting. Computerized tomography (CT) of the head showed hemorrhage in the front of corpus callosum. CT angiography followed by digitally subtracted angiography (DSA) documented a large necked aneurysm with three lobes at the origin of calloso-marginal artery and a single DACA, also known as AACA. A frontal parasagittal craniotomy was performed. Obliteration of the aneurysm was done only by separate clipping of each three lobes at the respective neck. Postoperative DSA demonstrated complete exclusion of the aneurysm and a regular flow of AACA. The patient recovered uneventfully. Despite it is a rare occurrence, an aneurysm of distal segments of anterior cerebral artery A2-A5, concomitant to AACA should be studied with DSA. In the era of embolization, conserving good microsurgical skills is fundamental for dealing with multilobar cerebral aneurysms, associated with rare anatomical variations.
Core tip: This is a detailed description of radiological and surgical findings in a very rare case of trilobed aneurysm of distal anterior cerebral artery. The characteristics of this aneurysm are exposed and its difficult exclusion by separate three clips is argued with a thorough discussion of the literature.