Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 16, 2015; 3(4): 377-380
Published online Apr 16, 2015. doi: 10.12998/wjcc.v3.i4.377
Saccular trilobed aneurysm of azygos anterior cerebral artery
Arsen Seferi, Ridvan Alimehmeti, Arben Rroji, Mentor Petrela
Arsen Seferi, Ridvan Alimehmeti, Mentor Petrela, Service of Neurosurgery, University Hospital Centre “Mother Theresa”, Rruga Kongresi i Manastirit, 270 Tirana, Albania
Arben Rroji, Neuroradiology, University Hospital Centre “Mother Theresa”, Rruga Kongresi i Manastirit, 270 Tirana, Albania
Author contributions: Seferi A designed the research and wrote the manuscript; Alimehmeti R performed the literature research, contributed in writing the paper and reviewed the manuscript; Rroji A performed radiological exams and prepared photos; Petrela M operated on the case, encouraged writing the paper and reviewed the manuscript.
Ethics approval: This study has received the approval of Department of Neurology, Neurosurgery and Psychiatry ethic committee and the permission to be sent for publication.
Informed consent: The informed consent for the treatment of the patient and publication this case report is received and conserved by the authors of this article.
Conflict-of-interest: Authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Ridvan Alimehmeti, MD, PhD, Service of Neurosurgery, University Hospital Center “Mother Theresa”, Rruga Kongresi i Manastirit, 370 Dibra Street, 270 Tirana, Albania.
Telephone: +355-69-2102140 Fax: +355-42-362641
Received: September 22, 2014
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.

Keywords: Azygos, Cerebral, Aneurysm, Clipping

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.