scholarly journals Fenestrations of the Basilar Artery Demonstrated on Magnetic Resonance Angiograms: An Analysis of 212 Cases

2013 ◽  
Vol 19 (4) ◽  
pp. 461-465 ◽  
Author(s):  
Keiji Sogawa ◽  
Yoichi Kikuchi ◽  
Toshihiro O'Uchi ◽  
Michihiro Tanaka ◽  
Tomio Inoue

Fenestration of the basilar artery (BA) is a rare variant of the intracranial artery, well demonstrated in autopsy and angiographic studies. Some angiographic series show a high incidence of associated aneurysms at the basilar fenestration site. The purpose of this study is to report the incidence of BA fenestration, its configurations, associated aneurysms, and arterial anomalies in a large series of intracranial MR angiograms (MRAs). A total of 16,416 MRAs were retrospectively reviewed to identify the location, size and associated intracranial arterial anomalies of BA fenestrations. All images were obtained with the time-of-flight (TOF) technique. Of the 16,416 MRAs, 215 fenestrations were found in 212 cases (1.29%). Most fenestrations were located in the proximal BA. The average length of the fenestration was 4.6 mm; the largest was 15.6 mm. No aneurysm was found at the site of the fenestration. Thirteen aneurysms were found in nine cases at locations other than the BA: seven in the middle cerebral artery (MCA), one in the anterior cerebral artery (ACA), one in the anterior communicating artery (Acom), one in the vertebral artery (VA), one at the carotid siphon, and two at the internal carotid-posterior communicating artery (IC-PC). Arterial anomalies in other locations were found in 26 cases. BA fenestrations were found in 1.29% of the 16,416 cases studied. There were no aneurysms at the BA fenestration site. Aneurysms at the BA fenestration site may be an exceedingly rare phenomenon.

2005 ◽  
Vol 57 (suppl_4) ◽  
pp. ONS-E400-ONS-E400 ◽  
Author(s):  
Kaya Kılıç ◽  
Metin Orakdöğen ◽  
Aram Bakırcı ◽  
Zafer Berkman

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.


2010 ◽  
pp. 504-517
Author(s):  
George Samandouras

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.


1976 ◽  
Vol 44 (3) ◽  
pp. 378-382 ◽  
Author(s):  
Stephen Nutik ◽  
Domenico Dilenge

✓ The angiographic and anatomical features of an anomalous communication between the intradural internal carotid artery and the anterior cerebral artery are described. Essential features of the anastomosis include an origin at, or close to, the origin of the ophthalmic artery, a course ventral to the ipsilateral optic nerve and anterior to the optic chiasm, and a termination near the anterior communicating artery. Although rare, the condition should be considered as an entity. The incidence of associated berry aneurysm and other congenital vascular anomalies is high.


Author(s):  
Jae Ho Kim ◽  
Kyung-Yul Lee ◽  
Sang Woo Ha ◽  
Sang Hyun Suh

Purpose: The purpose of this study was to evaluate the prevalence and risk factors of unruptured intracranial aneurysms (UIAs), which can help establish guidelines of treatment for asymptomatic Korean adults using 3T magnetic resonance angiography (MRA).Materials and Methods: Our Institutional Review Board approved this retrospective study, and informed consent was waived. All patients consisted of healthy individuals who underwent brain MRA using 3T magnetic resonance imaging between January 2011 and December 2012 as part of a routine health examination. Patient data and follow-up results were obtained from medical records.Results: A total of 2,118 individuals (mean age=53.9±9.6 years, male:female=1,188:930) who had undergone brain MRA were enrolled in the study. UIAs were found in 80 patients with 105 UIAs (3.77%). Female predominance (55% in UIA versus 43.47% in non-UIA, P=0.0416) and hypertension were more common in the UIA group (43.75% <i>vs</i>. 28.8%, P=0.004, respectively). The mean size of the aneurysms was 3.10±1.62 mm, and they were all saccular in shape and asymptomatic. The UIAs were most common in the internal carotid artery (59.1%), internal carotid-posterior communicating artery (15.2%), middle cerebral artery (9.5%), anterior communicating artery (8.6%), anterior cerebral artery (4.8%), and vertebral artery (2.9%). Twenty-eight of 80 patients (35%) had multiple aneurysms. The incidence of UIAs increased significantly with age (P=0.014).Conclusion: In single center experience, we demonstrated the characteristics and prevalence of UIAs in asymptomatic adults, which may help establish guidelines or therapeutic standards for UIAs.


1992 ◽  
Vol 76 (3) ◽  
pp. 455-458 ◽  
Author(s):  
Michiyasu Suzuki ◽  
Takehide Onuma ◽  
Yoshiharu Sakurai ◽  
Kazuo Mizoi ◽  
Akira Ogawa ◽  
...  

✓ This study reviews aneurysms of the proximal segment (A1) of the anterior cerebral artery in 38 patients (23 men and 15 women) and their surgical, angiographic, and clinical management. Thirty-seven aneurysms were saccular and one was fusiform. The incidence of A1 aneurysms among a total of 4295 aneurysm cases treated was 0.88%. Multiple aneurysms occurred in 17 patients (44.7%) of the 38 cases; in 10 (58.8%), there was bleeding from the A1 aneurysm. The aneurysms were classified into five categories according to the mode of origin of the aneurysm in relation to the A1 segment: in 21 cases, aneurysms originated from the junction of the A1 segment and a perforating artery; in eight, from the A1 segment directly; in six, from the proximal end of the A1 fenestration; and in two, from the junction of the A1 segment and the cortical branch. One patient had a fusiform aneurysm. Computerized tomography (CT) of these aneurysms revealed bleeding extending to the septum pellucidum similar to that of anterior communicating artery aneurysms. When performing radical surgery it is very important to recognize the characteristics of A1 aneurysms, including multiplicity, a high incidence of vascular anomalies (especially A1 fenestration), and their similarity to anterior communicating artery aneurysms on CT.


2004 ◽  
Vol 10 (1_suppl) ◽  
pp. 77-82
Author(s):  
T. Ohmomo ◽  
A. Kurata ◽  
S. Suzuki ◽  
K. Fujii

With the recent improvement of endovascular techniques, intra-arterial local fibrinolytic therapy has become widely available for treatment of acute embolic stroke and there is some evidence that it could be superior to conventional approaches1–6. However, because of high mortality and morbidity, strokes involving the internal carotid artery (ICA) and featuring acute thromboembolic occlusion remain problematic7. We have successfully performed intra-arterial local fibrinolytic therapy via the anterior communicating artery through the contra-lateral ICA in two consecutive cases of thromboembolic occlusion of the ICA, anterior cerebral artery (ACA) and middle cerebral artery (MCA), and obtained satisfactory results. We here present details of this new technique applied for the two cases and discuss the efficacy of this method compared with conventional approaches.


2016 ◽  
Vol 32 (2) ◽  
pp. 56-62
Author(s):  
Md Amir Hossain ◽  
Sharif Uddin Khan ◽  
Kazimohibur Rahman ◽  
Sirajeeshafiqul Islam ◽  
Khairulkabir Patwary ◽  
...  

Background: Anterior cerebral artery is an important terminal branch of internal carotid artery. It forms the anterior component of circle of Willis along with the anterior communicating artery. It is known for the frequent variations. The knowledge of anatomical variations in anterior cerebral artery is of considerable help to clinicians and interventionists. Method: Morphology and variations of the anterior cerebral arteries and the anterior communicating artery were studied in 90 patients undergone digital subtraction angiography (DSA). Results: Variations were found in 33% (n=30). Variations of the segments in relation with size, course, communications and terminations of the anterior cerebral artery (ACA) were noted. These were divided into different groups like hypoplasia, aplasia, duplication and fenestrations. Hypoplasia/Aplasia of proximal anterior cerebral artery (A1) was 24.5% in right side and 9% in left side. Anterior communicating artery (AComA) was found absent in 9% and fenestration in 9%. Callosomarginal artery was found absent in 2.2% in right side and 4.5% in left side. In right callosomarginal artery 6% had abnormal origin and 3.5% abnormal in left side.Pericallosal artery was present 100% on both sides. Conclusion: Variations of anterior cerebral artery complex anatomy is found common in Bangladeshi population. Bangladesh Journal of Neuroscience 2016; Vol. 32 (2): 56-62


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