Anterior Communicating Artery Aneurysms: An Overview

Abstract

AComA aneurysms are most commonly found at the A1-A2 junction on the dominant side. The angle of the arteries at the bifurcation and the direction of blood flow are factors of hemodynamic stress in the apical region where these aneurysms often develop. They exist at the bifurcation of dominant A1, A2 and AComA and usually point in the direction away from the dominant A1. They are more prone to rupture and demonstrate the highest incidence of post-operative morbidity among anterior circulation aneurysms. Consideration of aneurysm morphology may be used to guide approaches in AComA aneurysms. Resection of the gyrus rectus in combination with a pterional approach was popularized by Yasargil and it became the standard for treatment or exposure of AComA aneurysms, although other skull base approaches are also widely used. Clip selection is of extreme importance and the preservation of blood flow to the perforators should be emphasized. Adequate dissection and exposure of the entire "H" complex prior to clipping is the key to a successful outcome. Separating the perforators from the neck or dome of the artery and preserving the parent vessel presents a substantial challenge to the surgeon when the aneurysm is behind the parent artery, making it difficult to achieve a good outcome.

X-Configured Stent-Assisted Coiling in the Endovascular Treatment of Complex Anterior Communicating Artery Aneurysms: A Novel Reconstructive Technique

“…To achieve endovascular reconstruction of the complex AcomA aneurysms, adjunctive stent placement has been used to facilitate coil embolization, though it is more limited than that in other aneurysm locations. 18 AcomA aneurysms are not only challenging for the endovascular techniques but also for microsurgical clipping 19 and demonstrate the highest incidence of postoperative morbidity among anterior circulation aneurysms. Both A2s emanating from the aneurysm, in addition to the wide base of the aneurysm where the AcomA is partly incorporated within the sac, may pose technical challenges during the microsurgery.…”

Stent-Assisted Embolization of Wide-Neck Anterior Communicating Artery Aneurysms: Review of 21 Consecutive Cases

“…1,2 The microsurgical clipping of AcomA aneurysms is complex. 3 Although several articles have reported successful embolization of AcomA aneurysms with minimal complications, endovascular treatment for wide-neck AcomA aneurysms remains technically challenging. [4][5][6] Various adjunctive techniques have been used to facilitate coil embolization of these lesions, including neck remodeling by using balloons or microguidewires, and simultaneous deployment of coils.…”

Use of temporary arterial occlusion during anterior cerebral artery aneurysm repair

“…AComm aneurysms are most commonly found at the A1-A2 junction on the dominant side 1 . The angle of the arteries at the bifurcation and the direction of blood flow are factors of hemodynamic stress in the apical region where these aneurysms often develop.…”

“…The angle of the arteries at the bifurcation and the direction of blood flow are factors of hemodynamic stress in the apical region where these aneurysms often develop. They exist at the bifurcation of dominant A1, A2 and AComm and usually point in the direction away from the dominant A1 1 .…”