Aneurysms associated with fenestrated anterior cerebral arteries. Report of four cases and review of the literature

Endovascular Repair of Ruptured Aneurysm Arising From Fenestration of the Horizontal Segment of the Anterior Cerebral Artery

“…27) Fenestrations may occur as a result of partial duplication, incomplete fusion, or the anomalous course of a nonvascular structure through the precursor vasculature or of a remnant of the plexiform anastomosis between the primitive olfactory artery and the ACA. 14,15, 18,20,24,25) The first autopsy case of aneurysm arising from the A 1 fenestration was described in 1962. 4) Congenital medial wall defect and hemodynamic stress are thought to be the main causes of aneurysm formation.…”

“…Most reported cases of these types of aneurysms (except some conservative examples) underwent direct surgery. 6,9,10,14, [16][17][18][19]21,25,[28][29][30] The essential points in clipping are complete dissection of the aneurysm neck and preservation of the perforators. Perforators are more abundant in the proximal half of the A 1 segment than in the distal half.…”

“…Conventionally, this type of aneurysm has been treated with direct surgery. 6,9,10,14, [16][17][18][19]21,25,[28][29][30] The present report describes a patient with ruptured A 1 aneurysm with fenestration who was treated with an endovascular technique. Three-dimensional (3D) rotational angiography and aneurysmography were helpful to characterize this complicated vascular structure.…”

Aneurysm and Fenestration of the Azygos Anterior Cerebral Artery-Case Report-

“…Fenestration might occur as a partial duplication, an incomplete fusion, an anomalous course of a nonvascular structure through the precursor vasculature, or a remnant anastomosis between the primitive olfactory artery and the ACA. 16,22) Fenestration of the A 1 segment might occur due to absence of fusion of the plexiform anastomosis present in the distal primitive ACA during the 18-to 43-mm stage of the embryo. 5) This failure would sharply increase blood flow in the right A 1 segment because of the contralateral A 1 hypoplasia, resulting in increased hemodynamic stress in the right A 1 segment.…”

“…Only 59 cases of fenestration of the proximal segment (A 1 ) of the ACA have been reported. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][20][21][22][23][24][25][26][27] Here we describe a case of ruptured aneurysm arising from a fenestrated A 1 of the right ACA with contralateral A 1 hypoplasia.…”