AcomA Aneurysms Research Articles

Fenestrated clipping of previously coiled posterior-superiorly projecting anterior communicating artery aneurysms: How I do it.

Anterior communicating artery (ACOM) aneurysms are among the most common aneurysms associated with aneurysmal subarachnoid hemorrhage (International Study of Unruptured Intracranial Aneurysms I (N Engl J Med 339:1725-1733, 1998), Wiebers (Lancet 362:103-110, 2003)). Surgical clipping of posterior-superiorly projecting ACOM aneurysms can be challenging, as the ipsilateral A2 can interfere with clip trajectory and ACOM perforating vessels obstructed from view. Intraluminal coils can further increase the difficulty of the procedure. The relevant surgical anatomy with illustration is presented. A video detailing our technique on an illustrative case is provided. Surgical clipping of posterior-superiorly projecting ACOM aneurysms can require complex clip configurations. We describe the key steps of posterior-superiorly projecting ACOM aneurysm clipping through a lateral supraorbital craniotomy and fenestrated tandem clipping.

Distribution of rupture sites and blebs on intracranial aneurysm walls suggests distinct rupture patterns in ACom and MCA aneurysms.

The mechanisms behind intracranial aneurysm formation and rupture are not fully understood, with factors such as location, patient demographics, and hemodynamics playing a role. Additionally, the significance of anatomical features like blebs in ruptures is debated. This highlights the necessity for comprehensive research that combines patient-specific risk factors with a detailed analysis of local hemodynamic characteristics at bleb and rupture sites. Our study analyzed 359 intracranial aneurysms from 268 patients, reconstructing patient-specific models for hemodynamic simulations based on 3D rotational angiographic images and intraoperative videos. We identified aneurysm subregions and delineated rupture sites, characterizing blebs and their regional overlap, employing statistical comparisons across demographics, and other risk factors. This work identifies patterns in aneurysm rupture sites, predominantly at the dome, with variations across patient demographics. Hypertensive and anterior communicating artery (ACom) aneurysms showed specific rupture patterns and bleb associations, indicating two pathways: high-flow in ACom with thin blebs at impingement sites and low-flow, oscillatory conditions in middle cerebral artery (MCA) aneurysms fostering thick blebs. Bleb characteristics varied with gender, age, and smoking, linking rupture risks to hemodynamic factors and patient profiles. These insights enhance understanding of the hemodynamic mechanisms leading to rupture events. This analysis elucidates the role of localized hemodynamics in intracranial aneurysm rupture, challenging the emphasis on location by revealing how flow variations influence stability and risk. We identify two pathways to wall failure-high-flow and low-flow conditions-highlighting the complexity of aneurysm behavior. Additionally, this research advances our knowledge of how inherent patient-specific characteristics impact these processes, which need further investigation.

Anterior Communicating Artery Aneurysms: Surgical Strategy and Outcome based on Proposed Newer Classification

Background: The ruptured anterior communicating artery aneurysm is the most frequent intra-cranial aneurysm treated at any neurosurgical department. These aneurysms arise from either the A1-A2-Acom artery junction or Acom artery. The surgical outcome depends on the age of the patient, time duration between ictus and surgery, and Hunt and Hess grade at admission. In this article, we intend to analyze the surgical outcome based on our proposed classification with our overall experience of Acom aneurysm. Methods: A retrospective review of our surgical database with 250 patients of ruptured Acom was done, and the location, morphology, and direction of aneurysm, along with other clinical parameters including the demographic profile, radiological findings, and intra-operative details, were studied. We classified the Acom based on both site of origin and morphology (Type I, junctional on the dominant side; Type II, fusiform with an ill-defined neck and branching pattern; Type III, saccular true Acom A) and secondarily as described in the literature on the basis of the direction of fundus (Type A–E). The clinical parameters were compared among the above groups using Fischer-exact and one-way analysis of variance test. Results: A total of 250 patients (M: F =113:137) were included (mean age 52.1 ± 11.5 standard deviation years). 55.2% patients had left A1 dominance. Type I Acom A was commonly found on the left dominant circulation (P = 0.00). The difference in aspect ratio of Type I (2.0 ± 0.8) and Type II (1.8 ± 0.52) aneurysms was insignificant (P = 0.28). However, a significant difference in post-operative vasospasm among different types of aneurysms was found (P < 0.05). The Type I Acom A were anteriorly directed, while Type II and III were posteriorly directed (P = 0.001). The mean follow-up of the study was 44.4 ± 25.7 months, with age (P = 0.007) and Hunt and Hess grade (P = 0.001) at admission correlating with surgical outcome. Conclusion: Classifying the Acom A pre-operatively based on site and morphology, location, and direction of fundus helps in surgical planning and prognosis. The junctional ‘Type IA aneurysms’ are most common and possess a high intra-operative rupture rate. The anteriorly directed aneurysms have a better prognosis, and visual complaints are usually associated with anterior-inferiorly directed aneurysms.

Sexual Dysfunction after Clipping of Ruptured Intracranial Aneurysms.

Sexual dysfunction significantly affects interpersonal relationships and overall quality of life. It remains a matter of concern for risk assessment and counseling in patients with ruptured intracranial aneurysms. To assess the sexual dysfunctions in patients undergoing clipping for ruptured intracranial aneurysms and comparative evaluation among different anterior circulation aneurysms. We prospectively included 40 male patients of ruptured intracranial aneurysms of anterior circulation (age range: 20-60 years; sexually active preoperatively), managed with craniotomy and clipping. We evaluated the sexual outcome in patients with excellent Glasgow outcome score (GOS) five at a minimum one year of follow-up. Patients with GOS-5 status at follow-up were broadly classified into two groups: Anterior communicating artery aneurysm (Acom), and non-Acom) aneurysms. We valued sexual outcome with Subjective Sexual Arousal Scale for Men at follow-up, and compared in the two groups. Mean age of patients was 44.78 ± 9.51 years. Besides 20 Acom aneurysms, other groups included 11 middle cerebral artery aneurysms, five internal carotid artery aneurysms, three posterior communicating artery aneurysms, and one distal anterior cerebral artery aneurysm. The mean follow-up was 24.45 ± 13.58 months. Patients with non-Acom aneurysms had an overall better outcome in the sexual performance domain "P = 0.015," mental satisfaction domain "P = 0.009," and sexual assertiveness domain "P = 0.007." However, there was no statistical difference in partner communication domain "P = 0.593," and partner relationship domain "P = 0.378." Overall, the sexual outcome was inferior in patients treated for Acom aneurysms compared to other anterior circulation aneurysms. In cases of aneurysmal subarachnoid hemorrhage, sexual dysfunctions are common even after good clinical outcomes. The study revealed prominent differences in outcomes on the sexual quality of life in patients harboring Acom aneurysms as compared to anterior circulation aneurysms located off-midline.

Description of the effect of ACA-A1 segment hypoplasia on aneurysm formation in ACOM aneurysms with DSA

Description of the effect of ACA-A1 segment hypoplasia on aneurysm formation in ACOM aneurysms with DSA

Correlation Between Aneurysm Dome Direction and Patient Outcomes Following Surgery for Ruptured Anterior Communicating Artery Aneurysms.

Background Anterior communicating (Acom) artery aneurysms are the most common type of intracranial aneurysms. Despite the enormous advancements in the field of endovascular surgery for intracranial aneurysms, open surgical clipping of aneurysms remains the most durable management of Acom aneurysms. There have been various studies based on the clinical-radiological profile and outcome of open clipping for intracranial aneurysms, but the correlation of the direction of the aneurysm with the surgical outcome remains incompletely defined. Aim To analyze the correlation between the direction of the aneurysm dome and patient outcomes after surgery for ruptured Acom artery aneurysms. Materials and methods CT angiography of the brain was done in all patients pre-operatively as part of the standard treatment protocol. Retrospective data was collected from an inter-departmental computerized database, which included the patient's details, history, investigations, a course in the hospital from admission to discharge, and an operative note by the surgeon. Prospective data was collected from patients with ruptured Acom artery aneurysms. We analyzed the relationship between the direction of the dome of the Acom aneurysm and preoperative, intraoperative, and postoperative variables. Results Of the 48 patients who underwent surgery for ruptured aneurysms, 34 (70.8%) were female and 14 (29.2%) were male. Among the 27 cases with anteriorly projecting aneurysms, 11 (40.7%) experienced postoperative complications. Of the five cases with posteriorly projecting aneurysms, two (40%) experienced postoperative complications. One-third of cases of the inferior dome direction and 10% of cases of the superior direction of the dome of aneurysm were also found to have postoperative complications. However, using the chi-square test, the association between postoperative complications and the direction of the aneurysm was determined to be statistically non-significant (p-value = 0.93). Conclusion The findings of our investigation indicate that aneurysms with superior projection exhibit the lowest likelihood of experiencing intraoperative rupture. However, it was seen that the outcome was influenced by dome projection throughout the three-month follow-up. The findings of our study indicate that aneurysms with a superior orientation exhibit the least likelihood of experiencing intraoperative rupture.

Safety and Efficacy of Flow Diverters for Treatment of Unruptured Anterior Communicating Artery Aneurysms: Retrospective Multicenter Study

BackgroundThe anterior communicating artery (AComm) region is the most common site of intracranial aneurysms, with increased rupture risk compared with other locations. Overall, flow diverters present as a safe and...

Possible Delayed Foreign Body Reactions against Titanium Clips and Coating Materials after Unruptured Cerebral Aneurysm Surgery.

Delayed foreign body reactions to either or both clipping and coating materials have been reported in several small series; however, studies in the titanium clip era are scarce. This study aims to survey the contemporary status of such reactions to titanium clips and coating materials. Among patients who received a total of 2327 unruptured cerebral aneurysmal surgeries, 12 developed delayed intraparenchymal reactions during outpatient magnetic resonance imaging (MRI) follow-up. A retrospective investigation was conducted. The patients' average age was 58.6 (45-73) years, and 11 were women. The aneurysms were located in the middle cerebral artery (n = 7), internal carotid artery (n = 4), or anterior communicating artery (AComA, n = 1). In 10 patients, additional coating with tiny cotton fragments was applied to the residual neck after clipping with titanium clips; however, only the clipping with titanium clips was performed in the remaining two. The median time from surgery to diagnosis was 4.5 (0.3-60) months. Seven (58.3%) patients were asymptomatic, and three developed neurological deficits. MRI findings were characterized by a solid- or rim-enhancing lobulated mass adjacent to the clip with surrounding parenchymal edema. In 11 patients, the lesions reduced in size or disappeared; however, in one patient, an AComA aneurysm was exacerbated, necessitating its removal along with optic nerve decompression. In conclusion, cotton material is a strongly suspected cause of delayed foreign body reactions, and although extremely rare, titanium clips alone may also induce such a reaction. The prognosis is relatively good with steroid therapy; however, caution is required when the aneurysm is close to the optic nerve, as in AComA aneurysms.

Ruptured Anterior Communicating Artery Aneurysms Concomitant with Small Intracranial Hematoma: Evacuating Hematoma or Not?

To identify whether intracranial hematoma (ICH) evacuation improves the prognosis of patients with ruptured anterior communicating artery (AcomA) aneurysms concomitant with small ICHs (≥10 mL and <25 mL). Data on patients diagnosed with small ICHs secondary to ruptured AcomA aneurysms who underwent surgery in our department between January 2010 and February 2018 was retrospectively analyzed. The patients were divided into two groups based on whether the hematoma was evacuated. The modified Rankin Scale (mRS) was used to assess prognosis six months after onset. The study recruited 58 patients, 19of whom underwent aneurysm clipping and ICH evacuation. While 33 patients underwent aneurysm clipping, 6 patients underwent coiling embolism without ICH evacuation. The average ICH volume was 15.27±4.07 mL. In the hematoma-evacuated group, 13 (68.4%) patients had unfavorable outcomes (mRS scores of 4 to 6). In the non-evacuated hematoma group, 13 (33.3%) patients had unfavorable outcomes (P = 0.001), postoperative infarction occurred in 11 (57.9%) patients in the hematoma evacuation group and 9 (23.1%) patients in the other group (P = 0.009). ICH evacuation was associated with unfavorable outcomes and postoperative infarction in ruptured AcomA aneurysms with concomitant small hematomas (<25 mL). Aneurysm clipping or coiling without ICH evacuation may be a safe and effective choice; however, further investigation is needed.

Selective clipping of giant anterior communicating artery aneurysms remains a reliable therapeutic option

BackgroundGiant anterior communicating artery (AcomA) aneurysm represent a significant surgical challenge. Our study aimed to discuss the therapeutic strategy in patients with a giant AcomA aneurysm treated by selective neck clipping through a pterional approach. MethodsAmong all operated patients from an intracranial aneurysm between January 2015 and January 2022 (n = 726) in our institution, three patients with a giant AcomA aneurysm treated by neck clipping were included. Early (<7days) outcome was noted. Early postoperative CT scan was performed in all patients to detect any complications. Early DSA was also performed to confirm giant AcomA aneurysm exclusion. The mRS score was recorded 3 months after treatment. The mRS≤ 2 was considered as a good functional outcome. Control DSA was performed one year after treatment. ResultsIn the three patients, after a large frontopterional approach, a selective exclusion of their giant AcomA aneurysm was obtained after a partial pars orbitalis of the inferior frontal gyrus resection. Ischemic lesion was noted in 1 patient and chronic hydrocephalus in 2 patients with ruptured aneurysm. The mRS score after 3 months was good in 2 patients. Long term complete occlusion of the aneurysm were noted in the three patients. ConclusionSelective clipping of a giant AcomA aneurysm is a reliable therapeutic option after a careful evaluation of local vascular anatomy. An adequate surgical exposure is frequently obtained through an enlarged pterional approach with an anterior basifrontal lobe resection, especially in an emergency situation and/or in case of high position of anterior communicating artery.

Determination of indications for early surgical treatment in patients with ruptured anterior communicating artery aneurysms

Aim. To analyze and determine the optimal indications for microsurgical operative interventions in the shortest possible time from the subarachnoid hemorrhage onset to prevent anterior communicating artery (AcomA) aneurysm re-rupture and bleeding. Materials and methods. 280 patients with brain aneurysms were examined at the Uzhhorod Regional Center of Neurosurgery and Neurology and the City Hospital of Urgent and Emergency Medical Care under Zaporizhzhia City Council. Among them, 98 patients (48 males and 50 females) were diagnosed with AcomA aneurysms. The age of patients with AcomA aneurysms was from 20 to 72 years (mean age 47.8 ± 11.0 years). Aneurysms were verified using head and neck computed tomography angiography (a Toshiba Astelion scanner, 2016, No. 4СС162106), selective cerebral angiography (an angiography system General Energy Optima IGS 330, 2019, No. 80071260314), and brain magnetic resonance angiography (an i_Open 0,36 T magnetic resonance tomograph, 2005, No. Toc102633006). Cerebral hemodynamics was assessed using transcranial dopplerography (“Philips HD7” ultrasound diagnostic system, 2014, No. 69935). Results. In the first three days after the onset of subarachnoid hemorrhage, 18 (18 %) patients were admitted with ruptured aneurysms of this location, 62 (62 %) within 4–8 days, 12 (12 %) patients within 9–14 days, later than 14 days – 6 (6 %). All 98 patients underwent microsurgical clipping of AcomA aneurysms. Due to severe cerebral edema, decompressive craniectomy was performed in two patients. The results of surgical treatment were evaluated according to the modified Rankin scale at the time of hospital discharge and were as follows: in 65 (65 %) patients – good; in 18 (18 %) – moderate disability; in 4 (4 %) – serious disability. 11 (11 %) patients died. Conclusions. The treatment outcomes in patients with ruptured AcomA aneurysms were significantly dependent on factors related to increased risk of re-rupture: the presence of large-sized intracerebral hematoma, the aneurysm index exceeding 2, and multi-chamber aneurysm.

315 Use of Flow Diverter in the Treatment of Anterior Communicating Artery Aneurysms: A Multicenter Experience (FEAR ME study)

INTRODUCTION: The anterior communicating artery (AcomA) is among the most common s ites of intracranial aneurysms and has an increased risk of rupture compared to other locations. The safety and efficacy of flow diverters utilization for aneurysm treatment have been demonstrated for many locations, less consistently for AcomA Complex. We present the most extensive analysis in the neurosurgical literature for flow diverter treatment in AcomA aneurysms. METHODS: Databases from nine centers were retrospectively reviewed for AcomA aneurysms treated with flow diverters. Demographic information, clinical presentation, radiographic characteristics, procedural complications, and post-procedure outcomes were obtained. RESULTS: A total of 181 patients harboring 186 AcomA aneurysms were treated between January 2012 to December 2021. Ninety-one were female (54.1%), median age was 61[51 – 68]. Most aneurysms were unruptured and located at the AcomA itself. Half of the cohort had similar anterior cerebral artery sizes (51.8%). The most common morphology was saccular (91.9%), with a branch involvement in 30.4% of cases. Median vessel diameter was 2.35 mm, and Pipeline Flex was the most prevalent device (39.8%). Median follow-up time was 16 months, with a complete occlusion rate of 85.6% in the last follow-up. Functional independence (mRS 0-2) was reported in 96.7% of patients at the last follow-up. Major complication rate was 2.2%, and mortality rate was 2.2% (4/181). CONCLUSIONS: Our results suggest that flow diverter is a useful tool as treatment modality for AcomA aneurysms. Mid-term results indicated favorable aneurysm occlusion rates and a lower complication rate. Additional prospective studies with longer follow-up and independent adjudication are warranted to assess these results better.

557 Results of Microsurgical Clipping of Unruptured Anterior Communicating Artery Aneurysms (ACOMa) Using the Pretemporal Minimal Durotomy Approach

INTRODUCTION: Recent reports suggest the superiority of microsurgical clipping of ACOMa compared to endovascular treatments. We present our experience with the pretemporal minimal durotomy (minimal brain exposure) approach in 168 patients. METHODS: Data of 168 patients were prospectively collected and retrospectively reviewed. The pretemporal approach with the removal of the posterior roof of the orbit and the anterior clinoid process with a minimized subfrontal durotomy allowed broad exposure to the ACOMa complex and minimal exposure to the surrounding brain. The technique allowed early proximal control and 360-degree visualization of the aneurysm and its surroundings. RESULTS: The average aneurysm size was 6.4 mm. Total clip occlusion was achieved in 100%, confirmed by intraoperative indocyanine green videography and post-operative computer tomography angiography/cerebral angiography. At discharge, 93.5% were modified Rankin Scale (mRS) 0-2, and 99.0% were mRS 0-2 at 1 year follow up. There was zero mortality, and one patient with a giant aneurysm had a stable residual on follow-up. CONCLUSIONS: Microsurgical clipping of ACOM aneurysms using the pretemporal minimal durotomy approach results in more durable outcomes than endovascular technique with excellent functional outcomes and should be strongly considered as a first treatment option, especially in aneurysms that have anatomic endovascular disadvantages that have a high likelihood of recurrence.

Sex-related differences in symptom presentation of patients with aneurysmal subarachnoid hemorrhage.

Background: In patients with myocardial infarction, atypical symptoms at onset have been demonstrated in women. We aimed to investigate the presence of sex-related differences in symptom presentation in patients with aneurysmal subarachnoid hemorrhage (aSAH) to enable earlier diagnosis and treatment. Methods: We assessed symptoms on admission to hospital in 343 patients with aSAH in this retrospective single-center cohort-study. Univariate statistical analysis was performed by comparing sexes including the whole study population and subgroups (dichotomized using Fisher scale 1-2 vs. 3-4, WFNS grade 1-3 vs. 4-5, and anterior vs. posterior circulation aneurysms, respectively). Results: The majority of patients was female (63.6%, n=218, vs. 36.4%, n=125), the mean age 57.4 years (standard deviation (SD) 13.3) with older women compared to men (59.2, SD 13.8, vs. 54.4, SD 11.6; p=0.003). Anterior communicating artery (AcomA) aneurysms were most common (30.9%, n=106), predominantly in men (43.2%, n=54, vs. 23.9%, n=52; p=0.0002), whereas posterior communicating artery (PcomA) aneurysms were more frequent in women (19.3%, n=42, vs. 8.8%, n=11; p=0.005). Exercise-induced headache was more often reported by men (10.4%, n=13, vs. 5%, n=11; p=0.04) in all patients as well as in the subgroup of WFNS 1-3. Anisocoria was more frequent in women within the subgroup of severely impaired consciousness (WFNS 4-5; 25.3%, n=22, vs. 10.7%, n=6; p=0.032). For all other symptoms, there was no evidence for sex-specific differences in the whole study group as well as in subgroups. Conclusion: Our results show no evidence for relevant sex-related differences in symptom presentation at onset in aSAH patients. Women presenting with an acute onset anisocoria should be screened even more carefully for an underlying ruptured Pcom aneurysm.

Comparative Study of Intraoperative Fluorescein and Indocyanine Green Videoangiography for Ruptured Cerebral Aneurysms Clipping: A Single Centre Study of 30 Cases.

Aim This study assesses the application of microscope integrated videoangiography techniques in aneurysm clipping surgery using Indocyanine Green and Fluorescein fluorophores and evaluates merits and demerits of each technique. Materials and Methods Total 30 patients of cerebral aneurysmal clipping were included. Standard microsurgical procedures were done. After clipping, we administered a 25 mg bolus intravenous dose of indocyanine green with microscope focused through the INFRARED 800 camera module, followed by administration of 60 mg bolus intravenous dose of fluorescein with microscope focused through the yellow 560 module and images were assessed. Results The average aneurysm size was 17 mm. In 12 patients (40%), FL-VA allowed better assessment of perforating arteries (seven cases) or distal branches (three cases) or both (two cases), when compared with ICG-VA. In one case of MCA (M1) aneurysm, ICG-VA showed no fluorescent signal in one of the distal trunks whereas FL-VA showed normal signal. In one case of ACOM aneurysm, perforators were missed on ICG-VA but were seen on FL-VA. FL-VA was able to identify inadequate aneurysm clipping in one case. In two patients, FL-VA provided the advantage of real-time manipulation of the vessels to expose the vessels and aneurysms of interest. Fluorescein detected all the perforators that were visible under white light (68/68) whereas ICG was able to detect 56 (82.35%) perforators ( p -value< 0.05). Conclusion Intraoperative ICG and Fluorescein videoangiography recognize inadequate occlusion of aneurysm, decreased flow in branches or perforators. When various study parameters were considered such as ability to assess small size perforators, branching vessels, adequacy of aneurysmal clipping, and useful information on repeat imaging, FL-VA was found superior to ICG-VA.

Procedural outcome following and Hemodynamic imaging analysis for anterior communicating artery wide-necked aneurysms by four different stents assisted coil embolization

Background: Anterior communicating artery (AcomA) aneurysm is the most common intracranial aneurysm (IA) and has the highest rupture rate. Previously, the preferred surgical treatment for intracranial aneurysms was microsurgery clipping (MC). With the gradual maturation of endovascular treatment (EVT), an increasing number of patients are inclined to treat IA with EVT. In recent years, an increasing number of scholars have suggested that the preferred treatment for wide-necked aneurysms is stent-assisted coiling (SAC). Currently, there are few studies on comparative analyses of the procedural results of SAC in AcomA aneurysms.Methods: We retrospectively reviewed all consecutively treated patients who received SAC for AcomA aneurysms between 12 February 2013, and 20 January 2021. The primary procedural outcome was the occlusion rate evaluated with the Raymond–Roy occlusion classification (RROC) assessed on DSA at follow-up. Safety assessment included 1) ischemic complications (asymptomatic ischemia; intrastent thrombosis; coils falling off plug; arterial dissection); 2) bleeding complications (SAH; ICH); and 3) death. Univariate and multivariate logistic regression analyses were performed to determine patient baseline and aneurysm characteristics associated with total aneurysm occlusion at follow-up. Hemodynamic analysis was performed in one representative case each of the four stents, and six hemodynamic parameters were chosen, including wall shear stress (WSS), cavity blood flow velocity (CBFV), residual blood in the aneurysm (RBA), neck blood flow velocity (NBFV), blood flow inflow (BFI); and inflow concentration index (ICI).Results: A total of 154 patients who underwent EVT via SAC were enrolled for comparative analysis of procedural outcomes. The median age was 55 years, and 56.49% (87) were female. At the first (6–10 months), second (12–15 months) and last (24–48 months) follow-up, complete aneurysm occlusion was observed in 94.8%, 94.8%and 94.2% of patients, respectively. There were no differences regarding the occlusion rates stratified by stent. Each stent showed a variable decrease in all hemodynamic parameters.Conclusion: Hemodynamic parameters all decreased significantly after SAC with all four different stents, and the effect of laser-cut stents on the hemodynamic decline of aneurysms appeared to be more significant than that of woven stents. No significant difference was observed in the follow-up RROC grade among the four stents.

Ruptured ACoM Aneurysm with Anomalous Origin of Bilateral ACA from the Cavernous Segment: Case Report and Literature Review

Abstract Anterior communicating artery (ACoM) and anterior cerebral artery (ACA) are the most common locations of anomalous variations and aneurysm formation. Infraoptic origin of ACA is an extremely rare anatomical variant. This case report illustrates an extremely rare anatomical variation of bilateral infraoptic origin of ACA with ruptured ACoM aneurysmal subarachnoid hemorrhage. The authors detail this case in the light of the available literature and operative nuance in its management. For the treatment of a complex situation, accurate understanding of the anatomic variations, intraoperative three-dimensional orientation, proper imaging study, and extremely careful technique are essential.

Median artery of the corpus callosum in the context of AComA aneurysm rupture: The relevance of a perianeurysmal anatomy

It is important to understand the patient's vascular anatomy before treating cerebral aneurysms. The middle artery of the corpus callosum is one of the least common variations of the AComA complex. We describe the case of a 59-year-old woman who suffered a subarachnoid hemorrhage due to an AComA complex aneurysm that had ruptured. Fluorescein injection during the aneurysm clipping procedure revealed a partial obstruction of the middle artery, requiring repositioning of the clip. The vascular variations that our patients may exhibit at the time of aneurysm clipping must be kept in mind and understood.

Risk Factors for Intracranial Aneurysm Rupture: A Clinical Case Series and Systematic Review of the Literature.

To evaluate the patients who underwent surgery for an anterior communicating artery (AcomA) aneurysm at our institution. We analyzed our case series and systematically reviewed the literature to identify factors that could predict the rupture of an intracranial aneurysm in patients with AcomA aneurysms or any intracranial aneurysm. We conducted a cross-sectional analysis of prospectively collected data from patients who underwent surgery for AcomA aneurysms at a single institution between January 2014 and May 2023. Predictors for the rupture of intracranial aneurysm were systematically reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Pubmed and MEDLINE databases. Younger age (odds ratio (OR): 0.957, 95% confidence interval (CI): 0.920-0.995, p=0.028), presence of a daughter sac (OR: 3.209, 95% CI: 1.095-9.408, p=0.034), and ever-smoking (OR: 0.357, 95% CI: 0.137-0.930, p=0.035) were significant predictors of increased risk of rupture in patients with AcomA aneurysms. Several aneurysm- and patient-related risk factors for rupture of intracranial aneurysms were retrieved via the literature analysis. Younger age, ever-smoking, and presence of a daughter sac increased the risk of AcomA aneurysm rupture. A systematic literature review revealed several more aneurysm- and patient-related risk factors for rupture of the intracranial aneurysms. Our results could aid neurosurgeons during their decision-making process when treating patients with unruptured intracranial aneurysms.

The coexistence of anterior communicating artery aneurysm and meningioma: A literature review and illustrative case.

Anterior communicating artery (Acom) aneurysm has an association with many types of intracranial lesions. However, its association with meningioma can be challenging, which is not well addressed in the literature. Herein, we described a literature review focused on the association between Acom aneurysm and meningioma, explicitly highlighting the spatial presence between these two pathologies. We analyzed the literature according to that association with particular emphasis on location-based challenges. Furthermore, we present an illustrative case of surgically treating both lesions in one surgery utilizing the same approach. A Medline database search was conducted by the following combined formula: (Meningioma [Title/ Abstract]) AND (Aneurysm [Title/Abstract]) AND (((Anterior communicating artery [Title/Abstract]) OR (Acom [Title/Abstract])) OR Acomm [Title/Abstract]))). Additional resources were added after screening the references of the included papers. Nine patients with coexistence of Acom aneurysm and meningioma were found in the literature. The coexistence of both pathologies was found in seven females and two males. The presence of an aneurysm was found to be solitary in 66.67% (n = 6/9). Furthermore, meningioma was found to be an isolated lesion in all included cases, and in 22.2% (n = 2/9), they were located ipsilaterally. The location of the meningioma to the aneurysm seems to be in proximity. Acom aneurysm can coexist with intracranial meningioma; this association can be spatially related intracranially. Such coexistence entails a variety of nuances and challenges that neurosurgeons encounter during the management of these complex lesions.