Document Detail

A rare anomaly of the anterior communicating artery complex hidden by a large broad-neck aneurysm and disclosed by three-dimensional rotational angiography.
MedLine Citation:
PMID:  18193150     Owner:  NLM     Status:  MEDLINE    
Double fenestration of the anterior communicating artery (ACoA) complex associated with an aneurysm is a very rare finding and is usually caused by ACoA duplication and the presence of a median artery of the corpus callosum (MACC). We present a patient in whom double fenestration was not associated with ACoA duplication or even with MACC, representing therefore, a previously unreported anatomic variation. A 43 year old woman experienced sudden headache and the CT scans showed subarachnoid haemorrhage (SAH). On admission, her clinical condition was consistent with Hunt and Hess grade II. Conventional digital subtraction angiography (DSA) was performed and revealed multiple intracranial aneurysms arising from both middle cerebral arteries (MCA) and from the ACoA. Three-dimensional rotational angiography (3D-RA) disclosed a double fenestration of the ACoA complex which was missed by DSA. The patient underwent a classic pterional approach in order to achieve occlusion of both left MCA and ACoA aneurysms by surgical clipping. The post-operative period was uneventful. A rare anatomical variation characterised by a double fenestration not associated with ACoA duplication or MACC is described. The DSA images missed the double fenestration which was disclosed by 3D-RA, indicating the importance of 3D-RA in the diagnosis and surgical planning of intracranial aneurysms.
Jean G de Oliveira; R du Mesnil de Rochemont; J Beck; E Hermann; R Gerlach; A Raabe; V Seifert
Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-01-14
Journal Detail:
Title:  Acta neurochirurgica     Volume:  150     ISSN:  0942-0940     ISO Abbreviation:  Acta Neurochir (Wien)     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-03-12     Completed Date:  2008-04-10     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0151000     Medline TA:  Acta Neurochir (Wien)     Country:  Austria    
Other Details:
Languages:  eng     Pagination:  279-84; discussion 284     Citation Subset:  IM    
Neurocenter, Department of Neurosurgery, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany.
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MeSH Terms
Angiography, Digital Subtraction
Anterior Cerebral Artery / abnormalities*,  physiopathology,  radiography*
Cerebral Angiography / methods*
Circle of Willis / abnormalities*,  physiopathology,  radiography*
Diagnostic Errors / prevention & control
Headache / etiology
Imaging, Three-Dimensional / methods*
Intracranial Aneurysm / pathology,  physiopathology,  radiography*
Predictive Value of Tests
Subarachnoid Hemorrhage / physiopathology,  radiography
Tomography, X-Ray Computed

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