Anomalous Internal Carotid Anastomosis to Contralateral Anterior Cerebral Artery

ABSTRACT:Background:Many anomalies and variants in vascular anatomy have been reported in relation to the anterior cerebral artery (ACA). Patients andPatients and Methods:We encountered an apparently novel anomaly in a 30-year-old man admitted for disturbance of consciousness following a traffic accident. Computed tomography revealed an acute subdural hematoma and subarachnoid hemorrhage.Results and conclusions:No vascular abnormalities related to the hemorrhage were detected by conventional angiography, so we concluded that the bleeding was of traumatic origin. Anomalous origin of the ACA was disclosed incidentally, with both A1 segments arising from the right internal carotid artery; no normal A1 segment of the left ACA was visualized. We discuss possible bases for this anomalous origin.

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Sphenopalatine ganglion stimulation for vasospasm after experimental subarachnoid hemorrhage

Journal of Neurosurgery ◽

10.3171/2010.6.jns091525 ◽

2011 ◽

Vol 114 (4) ◽

pp. 1104-1109 ◽

Cited By ~ 14

Author(s):

Masataka Takahashi ◽

Zhen-Du Zhang ◽

R. Loch Macdonald

Keyword(s):

Subarachnoid Hemorrhage ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Cerebral Artery ◽

Evans Blue ◽

Internal Carotid ◽

Anterior Cerebral Artery ◽

Sphenopalatine Ganglion ◽

Doppler Flowmetry ◽

The Right

Object Sphenopalatine ganglion stimulation activates perivascular vasodilatory nerves in the ipsilateral anterior circle of Willis. This experiment tested whether stimulation of the ganglion could reverse vasospasm and improve cerebral perfusion after subarachnoid hemorrhage (SAH) in monkeys. Methods Thirteen cynomolgus monkeys underwent baseline angiography followed by creation of SAH by placement of autologous blood against the right intradural internal carotid artery, the middle cerebral artery (MCA), and the anterior cerebral artery. Seven days later, angiography was repeated, and the right sphenopalatine ganglion was exposed microsurgically. Angiography was repeated 15 minutes after exposure of the ganglion. The ganglion was stimulated electrically 3 times, and angiography was repeated during and 15 and 30 minutes after stimulation. Cerebral blood flow (CBF) was monitored using laser Doppler flowmetry, and intracranial pressure (ICP) was measured throughout. The protocol was repeated again. Evans blue was injected and the animals were killed. The brains were removed for analysis of water and Evans blue content and histology. Results Subarachnoid hemorrhage was associated with significant vasospasm of the ipsilateral major cerebral arteries (23% ± 10% to 39% ± 4%; p < 0.05, paired t-tests). Exposure of the ganglion and sham stimulation had no significant effects on arterial diameters, ICP, or CBF (4 monkeys, ANOVA and paired t-tests). Sphenopalatine ganglion stimulation dilated the ipsilateral extracranial and intracranial internal carotid artery, MCA, and anterior cerebral artery compared with the contralateral arteries (9 monkeys, 7% ± 9% to 15% ± 19%; p < 0.05, ANOVA). There was a significant increase in ipsilateral CBF. Stimulation had no effect on ICP or brain histology. Brain water content did not increase but Evans blue content was significantly elevated in the MCA territory of the stimulated hemisphere. Conclusions Sphenopalatine ganglion stimulation decreased vasospasm and increased CBF after SAH in monkeys. This was associated with opening of the blood-brain barrier.

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Treatment of an anterior cerebral artery pseudoaneurysm secondary to a transsphenoidal surgery using stent-assisted coiling

Surgical Neurology International ◽

10.25259/sni_860_2020 ◽

2021 ◽

Vol 12 ◽

pp. 20

Author(s):

Atsushi Ishida ◽

Keizoh Asakuno ◽

Masataka Kato ◽

Hideki Shiramizu ◽

Haruko Yoshimoto ◽

...

Keyword(s):

Cerebral Artery ◽

Transsphenoidal Surgery ◽

Internal Carotid ◽

Anterior Cerebral Artery ◽

Parent Artery ◽

Case Description ◽

Artery Pseudoaneurysm ◽

First Case ◽

Collateral Vessels ◽

The Right

Background: Injury of the internal carotid artery (ICA) during transsphenoidal surgery (TSS) is a rare but critical complication. There are several reports on endovascular treatment of ICA injury during TSS. With the recent flourishing of extended TSS, injuries to the distal arteries such as the anterior cerebral artery (ACA) are more likely to occur. Case Description: In the present case, we report a pseudoaneurysm of the right ACA due to injury during extended TSS for aggressive prolactinoma. Due to the absence of collateral vessels, the pseudoaneurysm had to be obliterated while preserving the parent artery. Hence, we decided to treat the pseudoaneurysm using stent-assisted coiling (SAC). The pseudoaneurysm was completely obliterated and he was discharged without any complications. Conclusion: To the best of our knowledge, this is the first case in which an ACA pseudoaneurysm caused by injury during the TSS was treated with SAC and the parent artery was preserved.

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1679 An Unusual Case of Hypoplastic Internal Carotid Artery with Segmental Aplasia of The Anterior Cerebral Artery: A Case Report and Systematic Literature Review

British Journal of Surgery ◽

10.1093/bjs/znab259.661 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

H Whitley ◽

P Skalicky ◽

J Malik ◽

F Charvat ◽

V Benes ◽

...

Keyword(s):

Carotid Artery ◽

Literature Review ◽

Internal Carotid Artery ◽

Cerebral Artery ◽

Unusual Case ◽

Clinical Decision Making ◽

Internal Carotid ◽

Anterior Cerebral Artery ◽

Ct Angiogram ◽

The Right

Abstract Aim Hypoplasia of the internal carotid artery (ICA) is a rare morphological variant with potential implications in disease and clinical decision-making. We describe an unusual case of ICA hypoplasia in a 50-year-old female who presented with an acute episode of vertigo. CT angiogram showed an unusually short common carotid artery (CCA) on the right side, hypoplasia of the right ICA, and agenesis of the A1 segment of the right anterior cerebral artery (ACA). We provide a short review of the available literature. Method The literature review was performed according to PRISMA guidelines. Three databases (Pubmed, Web of Science, and Ovid) were searched using the terms “ICA” and “Hypoplasia”. Case reports published in English in the last 10 years were considered eligible for inclusion. Reports of acquired ICA hypoplasia or ICA agenesis were excluded. Results Our systematic literature search revealed that 19 cases of congenital ICA hypoplasia have been reported in the last 10 years. Of these, 14 were unilateral hypoplasia, including nine cases in which the anomaly was on the left, and five cases in which the anomaly was on the right. Two cases had additional aplasias; one with aplasia of the ACOM and another with aplasia of segment C6 of the ICA. Conclusions We conclude that ICA hypoplasia remains a rare anomaly, despite the increasing incidence due to the availability of imaging technology. Clinicians should be aware of these variations, as they are frequently associated with haemodynamic changes, aneurysms, and fenestrations. Such variations have important implications for planning angiographic and surgical approaches.

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Complete Recovery from Blindness in Case of Compressive Optic Neuropathy due to Unruptured Anterior Cerebral Artery Aneurysm

Case Reports in Ophthalmology ◽

10.1159/000458753 ◽

2017 ◽

Vol 8 (1) ◽

pp. 157-162

Author(s):

Yurie Fukiyama ◽

Hidehiro Oku ◽

Yusuke Hashimoto ◽

Yuko Nishikawa ◽

Masahiro Tonari ◽

...

Keyword(s):

Visual Field ◽

Optic Neuropathy ◽

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Artery Aneurysm ◽

Complete Recovery ◽

Visual Field Defects ◽

Anterior Cerebral Artery Aneurysm ◽

The Right ◽

Cerebral Artery Aneurysm

It is not common for an isolated visual symptom to be the first indication of an aneurysm compressing the optic nerve. The compression can lead to blindness, and a recovery from the blindness is rare. We report a female with a left painless optic neuropathy caused by an unruptured anterior cerebral artery aneurysm. The patient had a temporal hemianopic visual field defect, which progressed to blindness in the left eye, while the right visual function was not affected. A coil embolization of the aneurysm completely restored her visual acuity to 20/20. These findings suggest that aneurysmal lesions should be ruled out in case of unilateral optic neuropathy with hemianopic visual field defects and progressive visual loss.

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Acute subdural hematoma associated with distal anterior cerebral artery aneurysm: Report of two cases

Nosotchu ◽

10.3995/jstroke.27.322 ◽

2005 ◽

Vol 27 (2) ◽

pp. 322-326 ◽

Cited By ~ 1

Author(s):

Kyozo Kato ◽

Suguru Inao ◽

Takeshi Okamoto ◽

Shigemasa Hayashi ◽

Takehiro Naito ◽

...

Keyword(s):

Cerebral Artery ◽

Subdural Hematoma ◽

Anterior Cerebral Artery ◽

Artery Aneurysm ◽

Acute Subdural Hematoma ◽

Anterior Cerebral Artery Aneurysm ◽

Distal Anterior Cerebral Artery ◽

Cerebral Artery Aneurysm

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Bilateral Internal Carotid to Anterior Cerebral Artery Anastomosis with Anterior Communicating Artery Aneurysm: Technical Case Report

Operative Neurosurgery ◽

10.1227/01.neu.0000176852.33587.e9 ◽

2005 ◽

Vol 57 (suppl_4) ◽

pp. ONS-E400-ONS-E400 ◽

Cited By ~ 2

Author(s):

Kaya Kılıç ◽

Metin Orakdöğen ◽

Aram Bakırcı ◽

Zafer Berkman

Keyword(s):

Case Report ◽

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Cerebral Artery ◽

Internal Carotid ◽

Anterior Cerebral Artery ◽

Artery Aneurysm ◽

Anterior Communicating Artery

Abstract OBJECTIVE AND IMPORTANCE: The present case report is the first one to report a bilateral anastomotic artery between the internal carotid artery and the anterior communicating artery in the presence of a bilateral A1 segment, fenestrated anterior communicating artery (AComA), and associated aneurysm of the AComA, which was discovered by magnetic resonance angiography and treated surgically. CLINICAL PRESENTATION: A 38-year-old man who was previously in good health experienced a sudden onset of nuchal headache, vomiting, and confusion. Computed tomography revealed a subarachnoid hemorrhage. Magnetic resonance angiography and four-vessel angiography documented an aneurysm of the AComA and two anastomotic vessels of common origin with the ophthalmic artery, between the internal carotid artery and AComA. INTERVENTION: A fenestrated clip, introduced by a left pterional craniotomy, leaving in its loop the left A1 segment, sparing the perforating and hypothalamic arteries, excluded the aneurysm. CONCLUSION: The postoperative course was uneventful, with complete recovery. Follow-up angiograms documented the successful exclusion of the aneurysm. Defining this particular internal carotid-anterior cerebral artery anastomosis as an infraoptic anterior cerebral artery is not appropriate because there is already an A1 segment in its habitual localization. Therefore, it is also thought that, embryologically, this anomaly is not a misplaced A1 segment but the persistence of an embryological vessel such as the variation of the primitive prechiasmatic arterial anastomosis. The favorable outcome for our patient suggests that surgical treatment may be appropriate for many patients with this anomaly because it provides a complete and definitive occlusion of the aneurysm.

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Critical neurovascular brain anatomy

The Neurosurgeon's Handbook ◽

10.1093/med/9780198570677.003.0390 ◽

2010 ◽

pp. 504-517

Author(s):

George Samandouras

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Basilar Artery ◽

Internal Carotid ◽

Anterior Cerebral Artery ◽

Brain Anatomy ◽

Vertebral Arteries ◽

System P

Chapter 9.1 covers critical neurovascular brain anatomy, including internal carotid artery, the middle cerebral artery, the anterior cerebral artery, the vertebral arteries (VAs), the basilar artery (BA), and the venous system.

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Anomalous Origin of the Ophthalmic Artery From the Anterior Cerebral Artery

Neurologia medico-chirurgica ◽

10.2176/nmc.51.579 ◽

2011 ◽

Vol 51 (8) ◽

pp. 579-581 ◽

Cited By ~ 15

Author(s):

Yuhui LI ◽

Tetsuyoshi HORIUCHI ◽

Takehiro YAKO ◽

Shigetoshi ISHIZAKA ◽

Kazuhiro HONGO

Keyword(s):

Cerebral Artery ◽

Ophthalmic Artery ◽

Anterior Cerebral Artery ◽

Anomalous Origin

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Aneurysmal subarachnoid hemorrhage in a patient with bilateral A1 fenestrations associated with an azygos anterior cerebral artery

Journal of Neurosurgery ◽

10.3171/jns.1996.84.4.0681 ◽

1996 ◽

Vol 84 (4) ◽

pp. 681-684 ◽

Cited By ~ 42

Author(s):

Robert M. Friedlander ◽

Christopher S. Ogilvy

Keyword(s):

Subarachnoid Hemorrhage ◽

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Vascular Anatomy ◽

Vascular Anomaly ◽

Rare Occurrence ◽

Content Type ◽

Proximal Anterior Cerebral Artery ◽

Current Article

✓ Fenestration of the proximal anterior cerebral artery (A1 segment) is a rare occurrence. This vascular anomaly is often associated with aneurysms and other abnormalities. The current article describes the case of a 33-year-old man who presented with a subarachnoid hemorrhage secondary to a ruptured aneurysm originating from the proximal end of an A1 fenestration. This patient also had a contralateral A1 fenestration as well as an azygos anterior cerebral artery. This is the first report of such an unusual vascular anatomy. The literature is reviewed and possible embryological mechanisms are discussed.

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