Distal aneurysm of median artery of the corpus callosum: case report

Abstract

Background. There are many variations of the developmental pathology of the anterior communicating artery with such forms as aplasia, hypoplasia, duplication, triplication and etc. The presence of the median artery of the corpus callosum is a rare pathology of the anterior part of the circle of Willis and, according to the literature the frequency is 4,5-14,2 %. About 81 % of cases, the occurrence of the median artery of the corpus callosum is combined with the presence of anterior communicating artery trifurcation. The incidence of distal anterior cerebral artery aneurysms has been estimated to be from 1.5 to 9.0 % of all intracranial aneurysms, while the median artery of the corpus callosum is rarely mentioned in the literature, the author of the article did not find cases of descriptions of distal anterior cerebral artery aneurysms in the PubMed. It should be borne in mind that when conducting radiation diagnostics, up to one third of all cases of the median artery of the corpus callosum remain undetected.Aim. To present a clinical case of successful surgical treatment of a distal aneurysm of the median artery of the corpus callosum in a patient K., 39 years old, performed using surgical neuronavigation.Materials and methods. A case report of the successful surgical management of 39-year-old patient with distal aneurysm of the median artery of the corpus callosum at the Sity Clinical Hospital No. 1 named after N.I. Pirogov of Moscow Healthcare Department. The patient had a saccular aneurysm of A2-3 segments of the median artery of the corpus callosum.Results. A microsurgical clipping of the distal aneurysm of the median artery of the corpus callosum using the right interhemispheric approach through the bifrontal craniotomy with a neuronavigational assistance was performed. The selective angiography of the intracranial arteries (10 mo after the clipping) no detected the signs of recanalization of the aneurysm.Conclusion. The deeper placement of the median artery of the corpus callosum (as compared with the anterior cerebral arteries) and the missing of anatomical landmarks complicates the surgical approach to the distal aneurysms of the median artery of the corpus callosum. The instrumentation of neuronavigation made it possible to perform minimal craniotomy and safe encephalotomy of the medial aspects of the frontal lobes (at site of the genu the corpus callosum) and reduce the operating time.