Accessory Anterior Cerebral Artery Research Articles

Coil embolization for ruptured distal anterior cerebral artery aneurysm at the supracallosal portion: Two case reports

Background: Distal anterior cerebral artery (ACA) aneurysms occur more frequently in the genu portion and much less frequently in the supracallosal portion (A4–A5). This report describes two cases of ruptured cerebral aneurysms occurring at the supracallosal portion successfully treated with coil embolization. Case Description: Case 1 involved a 61-year-old female with sudden-onset headache and vomiting attributed to subarachnoid hemorrhage (SAH). Digital subtraction angiography (DSA) revealed a bihemispheric ACA and aneurysm in the supracallosal portion. Coil embolization was performed, and the patient was discharged without neurological deficit. Case 2 involved a 35-year-old man with severe headache and disturbance of consciousness caused by SAH. DSA showed an aneurysm in A4 of the accessory ACA, and coil embolization was performed. After rehabilitation, he was discharged with a modified Rankin scale score of 2. Conclusion: Coil embolization for a ruptured aneurysm at the supracallosal portion can yield good results if the patient is appropriately selected.

Unruptured aneurysm arising from fenestrated anterior cerebral artery, associated with accessory anterior cerebral artery and accessory middle cerebral artery, with a quasi-moyamoya disease of neurofibromatosis type 1: case report

Unruptured aneurysm arising from fenestrated anterior cerebral artery, associated with accessory anterior cerebral artery and accessory middle cerebral artery, with a quasi-moyamoya disease of neurofibromatosis type 1: case report

Assessment of Arterial Configurations of the Suprachiasmatic Region from the Endoscopic Endonasal Perspective: A Cadaveric Anatomical Study

Endoscopic endonasal surgery has proved to offer a practical route to treat suprasellar lesions, including tumors and vascular pathologies. Understanding the different configurations of the anterior cerebral communicating artery (ACoA) complex (ACoA-C) is crucial to properly navigate the suprachiasmatic space and decrease any vascular injury while approaching this region through an endonasal approach. An endoscopic endonasal transplanum-transtubercular approach was performed on 36 cadaveric heads (72 sides). The variations of the ACoA-C and feasibility of reaching its different components were analyzed. The surgical area exposure of the lamina terminalis was also quantified before and after mobilization of the ACoA-C. The typical ACoA-C configuration was found in 41.6% of specimens. The following 2 main variations were identified: accessory anterior cerebral artery segment 2 (5, 13.9%) and common trunk of anterior cerebral artery with absence of ACoA (5, 13.9%). Of 101 recurrent arteries of Heubner, 96 (95.0%) were identified within 4 mm proximal or distal to the ACoA. The mean lamina terminalis exposure area was 33.1 ± 16.7 mm2, which increased to 59.9 ± 11.9 mm2 after elevating the ACoA. A considerable amount of variation of the ACoA-C can be found through an endoscopic endonasal transplanum-transtubercular approach. These configurations determine the feasibility of lamina terminalis exposure and the complexity of reaching the ACoA. Assessment of ACoA morphology and its adjacent structures is crucial while approaching the suprachiasmatic through a transnasal corridor.

A Case of Multiple Aneurysms Associated with an Accessory Anterior Cerebral Artery

A Case of Multiple Aneurysms Associated with an Accessory Anterior Cerebral Artery

A cadaveric study of anterior communicating artery

Background: Anterior communication artery is a collateral channel that connects the right and left anterior cerebral arteries in the circle of Willis. This helps in stabilizing the cerebral blood flow. Different types of variations of this artery were reported in the previous studies. The hemodynamic changes in the blood flow produced by variations induce strain at the sites of bifurcation, which may result in the formation of aneurysms. This commonly occurs at the meeting point of anterior communicating artery (ACoA) with the anterior cerebral artery. The anatomical variations in this portion may complicate the planning and performance of surgery which in turn will lead to postoperative complications. Methodology: The study was conducted in 60 specimens of the brain in the department of anatomy, Government Medical college, Calicut. The artery was carefully dissected and observed. Photographs were taken. The observations were tabulated. Results: Variations were noted in 15 specimens (25%). Duplication of the artery was noted in 6 specimens (10%), hypoplasia in 3 specimens (5%), V-type artery in 1 specimen, and X-type in 6 specimens (10%). There was no triplication or plexiform type noted. An accessory anterior cerebral artery was noted in 3 specimens (5%). Conclusions: As the ACoA acts a collateral channel that stabilizes the cerebral blood flow, when there is any vascular occlusion in any components of the circle, the knowledge of these anatomical variations becomes significant. As the radiological and neurosurgical interventions are increasingly performed, nowadays, the surgeons and radiologists should be aware of these variations in the cerebral arteries.

Variation of Arteries Forming Circle of Willis in Adult Human Cadavers

Introduction: Circle of Willis is a large arterial anastomosis between internal carotid and vertebrobasilar arterial system. It is the principal collateral channel for constant blood flow to brain. Any changes in its morphology may cause vascular insufficiency of variable severity. Knowledge about its anomalies may elucidate occurrence of cerebrovascular disorders, its presentation, treatment, prognosis and prevention. Methods: An observational study on 107 fresh cadavers was conducted at Maharajgunj Medical Campus from September 2016 to August 2017. After dissection of the scalp and removal of the vault and dura mater, the brain was obtained. Then the Circle of Willis was identified and observed for its completeness, symmetry, presence, origin and number of arteries forming it and the obtained data were documented, photographed and analyzed. Results: Out of 107 cadavers, variations were noted among 15 (14%): out of which 10 were male and 5 female. Twelve cadavers had single variation while 3 had two variations. Accessory anterior cerebral artery was found in 7 (38.90%), fetal origin of right posterior communicating artery in 2 (11.10%), fetal origin of left posterior communicating artery in 4 (22.20%), early bifurcation of left posterior cerebral artery in 1 (5.60%), variant anterior communicating artery in 2 (11.10%), fused anterior cerebral artery in 1 (5.60%) and aneurysm in 1(5.60%) subjects were found. Conclusion: Variations were noted among 15 cadavers (14%), 12 cadavers had single variation while 3 had two variations. The most common variation seen was accessory anterior cerebral artery found in 7 cadavers (38.90%). Most of the variations were found in midline anteriorly followed by right side.

Variation of Arteries Forming Circle of Willis in Adult Human Cadavers

Introduction Circle of Willis is a large arterial anastomosis between internal carotid and vertebrobasilar arterial system. It is the principal collateral channel for constant blood flow to brain. Any changes in its morphology may cause vascular insufficiency of variable severity. Knowledge about its anomalies may elucidate occurrence of cerebrovascular disorders, its presentation, treatment, prognosis and prevention.
 MethodsAn observational study on 107 fresh cadavers was conducted at Maharajgunj Medical Campus from September 2016 to August 2017. After dissection of the scalp and removal of the vault and dura mater, the brain was obtained. Then the Circle of Willis was identified and observed for its completeness, symmetry, presence, origin and number of arteries forming it and the obtained data were documented, photographed and analyzed.
 ResultsOut of 107 cadavers, variations were noted among 15 (14%): out of which 10 were male and 5 female. Twelve cadavers had single variation while 3 had two variations. Accessory anterior cerebral artery was found in 7 (38.90%), fetal origin of right posterior communicating artery in 2 (11.10%), fetal origin of left posterior communicating artery in 4 (22.20%), early bifurcation of left posterior cerebral artery in 1 (5.60%), variant anterior communicating artery in 2 (11.10%), fused anterior cerebral artery in 1 (5.60%) and aneurysm in 1(5.60%) subjects were found.
 ConclusionVariations were noted among 15 cadavers (14%), 12 cadavers had single variation while 3 had two variations. The most common variation seen was accessory anterior cerebral artery found in 7 cadavers (38.90%). Most of the variations were found in midline anteriorly followed by right side.

Ruptured Distal Accessory Anterior Cerebral Artery Aneurysm: A case report and literature review.

Aneurysms of the distal anterior cerebral artery (dACA) are rare, consisting only 2-6% of all intracranial aneurysms. dACA aneurysms are often associated with anomalies such as azygous, bihemispheric and triplication of ACA. Among these anomalies accessory anterior cerebral artery (accACA) is an anatomical variant found in 3.3% to 15% of the population. Here we report a case of a 60-year-old female who presented with a Hunt and Hess grade II, Fisher grade III subarachnoid hemorrhage secondary to a ruptured saccular aneurysm originating from the pericallosal-callosomarginal artery bifurcation at the A3 segment of the accessory ACA and underwent an uncomplicated microsurgical clipping.

Relationship of Distal Anterior Cerebral Artery Aneurysm Arising from the Supracallosal Portion and Accessory Anterior Cerebral Artery

Median artery of the corpus callosum(MACC)refers to the median artery of the triplicate anterior cerebral artery(ACA). When MACC distributes to one or to both hemispheres, it is known as the accessory ACA. We performed detailed angiographic analysis of 32 consecutive patients operated upon for distal ACA(DACA)aneurysms, and noted that all DACA aneurysms occurring in the supracallosal portion were accompanied by an accessory ACA as vascular malformation. Such relationship between accessory ACA and DACA aneurysm in the supracallosal portion has not been previously reported.

Microanatomy of the subcallosal artery: an in-vivo 7 T magnetic resonance angiography study.

To investigate in-vivo microanatomy of the subcallosal artery branching from the anterior communicating artery (ACoA) using time-of-flight (TOF) magnetic resonance angiography (MRA) at 7 Tesla. Seventy-five subjects, including 15 healthy volunteers and 60 patients, were included in this prospective study. Three raters characterized branches from ACoA in maximum intensity projections of TOF MRA at 7 Tesla acquired with 0.22 × 0.22 × 0.41mm(3) resolution. Furthermore, course patterns and anatomical features of the subcallosal artery (maximum diameter, length, and branching angle from ACoA) were measured. Branches from the anterior communicating artery were visualized in 63 of 74 (85.1%) subjects and were identified as the subcallosal artery (93.7%) and the accessory anterior cerebral artery (6.3%). The course of the subcallosal artery was classified into 3 groups; C-shaped (55.9%), straight (16.9%), and S-shaped (27.2%). There was a significant difference between the branching angles of C-shaped and straight (p < 0.0001), between C-shaped and S-shaped (p < 0.0001), as well as between straight and S-shaped (p = 0.0113) course patterns. High-resolution in-vivo 7 T TOF MRA can delineate the microanatomy of the subcallosal artery. Three main variants of course patterns and branching angles from ACoA could be identified. • In-vivo 7 Tesla TOF MRA can delineate the subcallosal artery microanatomy • Three distinct course patterns of the subcallosal artery were identified • Branching angles from ACoA significantly differed between subcallosal artery course patterns.

Influence of the gender on cerebral vascular diameters observed during the magnetic resonance angiographic examination of willis circle

The present study evaluated the calibers and anatomic configurations based on the Magnetic Resonance analysis (MRA), assaying the cerebral vascular territories and sex-linked variations. A randomized sample of 30 angiographic examinations in adult patients of both sexes was obtained and components of the circle of Willis were identified. Branch diameters were measured on a transversal cut 5mm from the vessel origin in a typical angiographic frontal incidence. For the comparative statistical analysis, tests were divided in the groups considering the patients' sex and age. The classical Circle of Willis configuration was oberved in only 15 samples (50%). Greater calibers were observed in the arteries of the posterior circulation and multiple linear regression analysis established that the caliber of the posterior circulation was influenced by an independent variable related to the gender. Additional variations included unilateral and bilateral fetal and hypoplasic Posterior communicating arteries. In the anterior cerebral artery (ACA), the presence of an accessory developed ACA, an ACA giving branches to the distal portion of the two hemispheres and a third median ACA the variants were observed. Gender influenced the variations on internal diameters of posterior circulation vessels, with larger measurements in men.

Accessory anterior cerebral arteryと交通する異常血管に生じた破裂紡錘状脳動脈瘤の1例

Accessory anterior cerebral artery (accessory ACA) is a type of median artery of anomalous triplicate ACA. Aneurysmal formation at accessory ACA is extremely rare. We report a case of ruptured fusiform aneurysm at the anomalous bridging vessel connecting lt. A2 and accessory anterior cerebral artery. A 32-year-old female presented with severe headache. Neurological examination was normal. Computed tomography showed diffuse subarachnoid hemorrhage. Left carotid angiography demonstrated the aneurysm arising from the anomalous bridging vessel. The shape of the anomalous bridging vessel looked like an aneurysm originating from lt. A2 and the dome attaching to the accessory ACA. We performed trapping for the fusiform aneurysm at the anomalous bridging vessel. The patient was ambulatory on discharge.

Ａｃｃｅｓｓｏｒｙ ａｎｔｅｒｉｏｒ ｃｅｒｅｂｒａｌ ａｒｔｅｒｙに発生した破裂末梢性前大脳動脈瘤の１症例

We report a case of a ruptured accessory anterior cerebral artery (AccACA) aneurysm in a 77-year-old man suffering from intracerebral hemorrhage in the right frontal lobe. Angiography demonstrated a triplicated anterior cerebral artery and an aneurysm located above the corpus callosum growing from the distal portion of the AccACA. The aneurysm was clipped by direct surgery and he was discharged without neurological deficit. AccACA are not so rare, but cases of AccACA aneurysm are extremely rare. In introducing this case, we discuss AccACA and AccACA aneurysm.

Ruptured Distal Accessory Anterior Cerebral Artery Aneurysm -Case Report-

A 48-year-old man presented with an extremely rare aneurysm arising from an accessory anterior cerebral artery (ACA) manifesting as sudden onset of headache lasting for 5 days. Neurological examination on admission revealed no abnormalities. Computed tomography showed subarachnoid hemorrhage of the interhemispheric fissure and intraparenchymal hematoma of the left cingulate gyrus. Magnetic resonance and cerebral angiography revealed a saccular aneurysm of the distal portion of the accessory ACA classified as the bihemispheric type. Neck clipping of the aneurysm was performed via an interhemispheric approach 17 days after symptom onset. The patient made a good postoperative recovery without neurological deficit. Distal accessory ACA aneurysms tend to arise from the first bifurcation and supply parietal branches. The aneurysms tend to occur on the bihemispheric type of distal accessory ACA. Hemodynamic stress may contribute to formation or development of these aneurysms.

Ruptured and unruptured aneurysms of the accessory anterior cerebral artery combined with a blood blister-like aneurysm of the anterior communicating artery

Anterior communicating artery (Acom) complex and anterior cerebral artery (ACA) are the frequent sites of arterial anomalies. Aneurysms associated with triplicate ACA are rare. Blood blister-like aneurysm (BBA) of the Acom is also very rare. This report presents these two rare types of aneurysms in a 63-year old man who presented with subarchnoid hemorrhage secondary to accessory ACA aneurysmal rupture. During surgery, a BBA of the Acom was also found. Both the aneurysms were treated simultaneously. The BBA bled intraprocedurally but was repaired successfully by neck reconstruction and clipping with the preservation of the parent and the branching arteries. The ruptured accessory ACA aneurysm was clipped together with the artery which had multiple aneurysms distally. For the treatment of a complex aneurysm like this, accurate understanding of the anatomic variations, proper imaging study and extremely careful technique are essential.

Accessory anterior cerebral arteryに発生した破裂脳動脈瘤の1例

症例はaccessory anterior cerebral artery(AccACA)に発生した脳動脈瘤の破裂により脳梁部の脳内出血で発症した59歳の男性である.脳血管撮影にて, triple A2とAccACAの分岐部に発生した嚢状動脈瘤を認めた.開頭クリッピング術を行い, 神経学的異常を残さずに退院となった.AccACAはそれほど稀ではないACAの血管破格である.しかし, AccACAに発生した破裂脳動脈瘤の報告は今までに2例しかなくきわめてまれである.AccACAおよびAccACAに発生した脳動脈瘤について, 文献的考察を加えて報告した.

The accessory anterior cerebral artery: Case report and anatomic analysis of vascular anomaly

The term "accessory artery" was formulated to describe one of the developmental anomalies of the middle cerebral artery. This anomaly consisted of the incidence of a vessel that branched off close to the anterior communicating artery and supplied a part of the cortex in the region of the middle cerebral artery vascularization. A panangiography of the cerebral vessels was carried out, using the subtraction method, on a woman who suffered from subarachnoid hemorrhage. An aneurysm of the anterior communicating artery and developmental anomaly of the right anterior cerebral artery were found. During the aneurysm operation, the existence of the developmental anomaly was confirmed. It was revealed also during a control angiography. An atypical branch of the right internal carotid artery was found branching off from section C2, and passing below the right optic nerve and the anterior communicating artery. This branch ended with a division into the orbitofrontal and frontopolar artery. The atypical branch of the internal carotid artery that partly performs the function of the existing proper right anterior cerebral artery, has been defined as the accessory anterior cerebral artery.

Ruptured Distal Accessory Anterior Cerebral Artery Aneurysm: Case Report

Accessory anterior cerebral artery (ACA), which is a type of median artery of anomalous triplicate ACA, is not rare, but aneurysmal formation is extremely rare. We report a rare case with ruptured aneurysm arising from a distal accessory ACA. We discuss the characteristics and causes of this type of aneurysm and classification of this anomaly. A 63-year-old man suddenly developed severe headache and then loss of consciousness and paraplegia. Computed tomography disclosed thick and diffuse subarachnoid hemorrhage and interhemispheric hematoma. Subsequent bleeding occurred 2 hours after the first hemorrhage. Cerebral angiography disclosed a saccular aneurysm arising from the distal accessory ACA. Neck clipping of the aneurysm was performed 22 hours after the second episode, using an interhemispheric approach. Although transient paraplegia occurred 8 days after onset, the patient recovered well after surgery without neurological deficit. The characteristics of the aneurysm arising from distal accessory ACA are considered similar to those of distal ACA aneurysm. There is, however, some confusion regarding the terminology of the anterior communicating artery complex anomalies, which we discuss.