Arteriovenous malformation with associated multiple flow-related distal anterior cerebral artery aneurysms: A case report with poor outcomes

Background: Low-grade arteriovenous malformations (AVMs) associated with multiple flow-related distal anterior cerebral artery (DACA) aneurysms are rare occurrences. Here, we present a case of a frontal AVM with three associated DACA aneurysms arising from a single feeder. Case Description: A 36-year-old male presented to us in the ER with acute-onset dysphasia and altered mental status. Head computed tomography and angiogram showed a spontaneous intracerebral hemorrhage with intraventricular extension and revealed a Spetzler Martin Grade II AVM, being fed by two feeders, with the major feeder from the DACA bearing three flow-related aneurysms. As the patient awaited digital subtraction angiography, his Glasgow Coma Scale dropped and he underwent emergency embolization with Onyx. This was followed by external ventricular drainage. The patient’s neurological status did not improve, and he died following a complicated clinical course. Conclusion: Multiple DACA aneurysms are a case of both clinical and anatomical rarity and to avoid complications in the clinical course, one must be judicious about the time spent between symptom onset and embolization.

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Treatment of a Fusiform Anterior Cerebral Artery Aneurysm With an A3-A3 Bypass: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opaa143 ◽

2020 ◽

Vol 19 (4) ◽

pp. E385-E385

Author(s):

Benjamin K Hendricks ◽

Robert F Spetzler

Keyword(s):

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Video Recording ◽

Artery Aneurysm ◽

Neurological Status ◽

Institutional Review ◽

Bypass Patency ◽

Surgical Field ◽

Distal Anterior Cerebral Artery ◽

Cerebral Artery Aneurysm

Abstract Distal anterior cerebral artery (ACA) aneurysms remain a relatively rare and challenging entity for both open microsurgical and endovascular treatments. These lesions provide a significant surgical challenge because of the narrow interhemispheric surgical field, limited proximal control, common fixation of the aneurysm to the adjacent cingulate gyrus, and possible involvement of an unpaired azygos A2. These challenges result in a known association between distal ACA aneurysms and higher operative morbidity. This video demonstrates indirect obliteration of a prior ruptured fusiform right A2 aneurysm utilizing an A3-to-A3 side-to-side anastomotic bypass with aneurysm trapping. An anterior interhemispheric approach was used for exposure of bilateral ACAs, arteriotomies, microanastomosis, and trapping of the aneurysmal right A2 segment. Postoperatively, the patient's neurological status returned to baseline, and imaging demonstrated evidence of bypass patency with no residual filling of the fusiform aneurysmal segment. This video verifies the feasibility and efficacy of the A3-to-A3 anastomotic bypass for treatment of distal ACA aneurysms. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

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Distal Anterior Cerebral Artery Aneurysms: Advantages of Bifrontal Basal Anterior Interhemispheric Approach Over Unilateral Approach

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0033-1336206 ◽

2013 ◽

Vol 74 (S 01) ◽

Author(s):

Rajesh Chhabra ◽

Sunil Gupta ◽

Sandeep Mohindra ◽

N. Khandelwal

Keyword(s):

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Unilateral Approach ◽

Interhemispheric Approach ◽

Anterior Interhemispheric Approach ◽

Distal Anterior Cerebral Artery

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Occlusion of an “accessory” distal anterior cerebral artery during treatment of anterior communicating artery aneurysms

Journal of Neurosurgery ◽

10.3171/jns.1991.74.1.0133 ◽

1991 ◽

Vol 74 (1) ◽

pp. 133-135 ◽

Cited By ~ 5

Author(s):

Kevin Gibbons ◽

Leo N. Hopkins ◽

Roberto C. Heros

Keyword(s):

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Anterior Communicating Artery ◽

Case Histories ◽

Content Type ◽

Anterior Communicating Artery Aneurysms ◽

Artery Segment ◽

Distal Anterior Cerebral Artery ◽

Clip Occlusion ◽

Fine Print

✓ Two cases are presented in which clip occlusion of a third distal anterior cerebral artery segment occurred during treatment of anterior communicating artery aneurysms. Case histories, angiograms, operative descriptions, and postmortem findings are presented. The incidence of this anomalous vessel is reviewed. Preoperative and intraoperative vigilance in determining the presence of this anomaly prior to clip placement is emphasized.

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