VascularCharacteristics of aneurysms arising from the horizontal portion of the anterior cerebral artery
Section snippets
Materials and methods
Our strategy for treatment of cerebral aneurysms is as follows: aneurysms causing SAH will be eliminated by a clipping procedure as soon as possible. Furthermore, patients with various complaints will undergo a careful examination of the brain, primarily by magnetic resonance imaging (MRI). Thus, the majority of our patients will routinely undergo ordinary axial MRI and MRA. The individuals who are diagnosed with an asymptomatic aneurysm of more than 3 mm in diameter or those who simply request
Summary of cases manifested with SAH
Three cases were SAH-related and are summarized in Table 1 (top). The ages of these patients ranged from 43 to 71 years (mean, 57 years old); there were two women and one man. The shape of the aneurysms was saccular in all three cases and their maximum diameter ranged from 3.4 to 5.0 mm (mean, 4.0 mm). Angiography and surgery revealed that the aneurysms were located at the distal corner of the origin of the medial lenticulostriate artery (LSA) in two cases and the recurrent artery of Heubner
Comparison between SAH group and the asymptomatic group
The characteristics of the aneurysms are classified and summarized according to the cases with and without SAH (Table 1). The shape of the aneurysm was saccular in all cases. The diameter of the aneurysm in cases with SAH tended to be larger compared to those without SAH; however, there was no statistically significant difference. There seemed to be no difference between these groups in regard to the location of the aneurysm, relationship to the perforating artery, or relationship to A1
Discussion
A1 aneurysms are relatively rare, accounting for only about 1% of all cerebral aneurysms 1, 3, 12, 15. We experienced three cases of SAH because of ruptured A1 aneurysms; the maximum diameter of these aneurysms was less than 5.0 mm. In a study of a large number of aneurysm cases, the average diameter of the ruptured aneurysms was reported to be 8.2 mm [5]. The median diameter of our three SAH cases was 4.0 mm—significantly smaller than the majority of those reported in the literature.
Conclusion
The average size of A1 aneurysm in our three cases with SAH was 4.0 mm in maximum diameter, smaller than aneurysms occurring in other common locations that present with SAH. This suggests that A1 aneurysms require surgical elimination even if they are small and unruptured. Most of the A1 aneurysms in our series developed at the distal corner of the origin of a perforating artery.
Three of the nine cases were associated with other vascular malformations, suggesting there may be some congenital
References (16)
- et al.
Surgical treatment of aneurysms of the anterior cerebral artery
Neurosurg Clin N Am
(1998) - et al.
Giant aneurysm at the origin of the accessory middle cerebral artery
Surg Neurol
(1995) - et al.
Angiographic classification of aneurysms of the horizontal segment of the anterior cerebral artery
Surg Neurol
(1985) - et al.
Aneurysmal subarachnoid hemorrhage in a patient with bilateral A1 fenestrations associated with an azygos anterior cerebral artery
J Neurosurg
(1996) - et al.
Data. I
Ruptured proximal anterior cerebral artery (A1) aneurysm located at an anomalous branching of the fronto-orbital arterya case report
J Korean Med Sci
(1997)- et al.
Size of intracranial aneurysms
Neurosurgery
(1983) - et al.
Asymptomatic familial cerebral aneurysms
Neurosurgery
(1998)
Cited by (57)
Successful endovascular treatment of a ruptured saccular aneurysm arising from a fenestrated proximal anterior cerebral artery
2024, Interdisciplinary Neurosurgery: Advanced Techniques and Case ManagementRadiological and clinical outcomes of endovascular coiling of proximal A1 aneurysms
2020, Journal of Clinical NeuroscienceCitation Excerpt :In addition, the recurrence and retreatment rates of endovascular coiling were relatively high, with the number of rupture recurrences being significant. In general, proximal A1 aneurysms involve one of the most difficult locations for endovascular coiling because navigating microwires or microcatheters into the aneurysm is not feasible and the microcatheter will be unstable for endovascular coiling [8,10,14–19]. Because microwires should be navigated firstly into the anterior cerebral artery and subsequently should be superselected into the posterior or posterosuperior directed proximal A1 aneurysms, these angiographic features of proximal A1 aneurysms can be unnatural and challenging for microwire navigation or microcatheter superselection.