Fenestrated A1 segment of right anterior cerebral artery associated to duplicated anterior communicating artery

Sonda, Ildo; Basso, Luciano Silveira

doi:10.2399/ana.14.039

Cited by 4 publications

(3 citation statements)

References 10 publications

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“…[23,26] At around the 18-43 mm stage of human embryologic development, the distal ACA forms plexiform anastomoses with the primitive olfactory artery (POA), which, ultimately, divides into lateral (future MCA) and medial (future ACA) olfactory arteries. [33] ese plexiform anastomoses between the ACA and POA ultimately coalesce into one AComA, but remnants from a failure of fusion of these anastomoses or an avascular remnant between the primitive precursors or a partial duplication of the A1 segment could result in A1 segment fenestrations that predispose to ACA aneurysms. [11,29] Hypoplasia of the contralateral A1 segment has been reported to have an incidence of 42.8%.…”

Section: Discussionmentioning

confidence: 99%

Microneurosurgical management of aneurysms of the A1 segment of the anterior cerebral artery: Anatomy and surgical technique

Campero

Baldoncini

Santos

et al. 2022

Surgical Neurology International

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Background: Aneurysms of the A1 segment of the anterior cerebral artery (ACA) are rare and have characteristics differentiating them from other intracranial aneurysms. Their microsurgical management is challenging and requires different strategies. In this article, we review the surgical anatomy of the A1 segment of the ACA with cadaveric dissections and describe the microsurgical management of complex A1 aneurysms with illustrative cases. Methods: A right pterional craniotomy and Sylvian dissection were performed on a formalin-fixed and silicone-injected cadaver head to depict the key anatomic structures and surgical corridors for microsurgical clipping of A1 segment aneurysms. The microneurosurgical management of ruptured and unruptured aneurysms of the A1 segment of the ACA is described with case illustrations. Results: The A1 segment of the ACA can be subdivided into proximal, middle, and distal subsegments, the former having abundant perforating branches. Both patients treated with microsurgical clipping had excellent and durable outcomes and postoperative cerebral angiograms showed complete aneurysm occlusion. Conclusion: Small A1 aneurysms may require early treatment as their rupture risk appears to be higher. A1 aneurysms are usually embedded in perforators, especially those arising from the proximal A1 subsegment, and require careful distal to proximal microdissection and strategic placement of the aneurysm clip blades. The approach, arachnoid dissection, and angles of attack are carefully planned after accounting for the aneurysm dome projection, precise location of the aneurysm neck and perforators, and the presence or absence of subarachnoid hemorrhage.

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Section: Discussionmentioning

confidence: 99%

Microneurosurgical management of aneurysms of the A1 segment of the anterior cerebral artery: Anatomy and surgical technique

Campero

Baldoncini

Santos

et al. 2022

Surgical Neurology International

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“…4,6,8,14 Durante la etapa embrionaria de 18 a 43 mm, el segmento distal de la ACA forma una anastomosis plexiforme con la arteria olfatoria primitiva. 24 El fracaso de la fusión del mismo, un remanente avascular que intercepta los precursores primitivos o la duplicación parcial de la arteria A1 puede conducir a fe-nestración del segmento A1 de la ACA. 25,26 La angulación de la arteria en el punto de bifurcación de la fenestración A1 se traduce en una mayor superficie del vaso expuesta al flujo sanguíneo turbulento que puede conducir a su dialatación aneurismática, como han propuesto algunos autores.…”

Section: Discussionunclassified

Clipado Microquirúrgico de Aneurismas del Segmento A1: Anatomía y estrategias quirúrgicas

Baldoncini¹

2021

Rev. Argent. Neuroc.

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Introducción:Los aneurismas originados del segmento proximal de la arteria cerebral anterior, son extremadamente infrecuentes. El objetivo del siguiente trabajo es el análisis de la anatomía de la arteria cerebral anterior en su segmento A1, describiendo las estrategias quirúrgicas en dos pacientes. Material y Métodos:En una cabeza adulta formolizada se realize un abordaje pterional derecho y disección del valle silviano, exponiendo las principales estructuras vasculares. Se presentan además dos pacientes jovenes operados de aneurismas en la arteria cerebral anterior, segmento A1. Resultados:En el trabajo anatómico de laboratorio se lograron exponer las estructuras vasculares, detallando especialmente el segmento A1 de la arteria cerebral anterior y sus ramos colaterales. En ambos pacientes se logró el correcto clipado microquirurgico, con oclusión completa del aneurisma y buenos resultados postoperatorios. Discusión:Algunas de las características de estos aneurismas que los diferencian del resto son las arterias perforantes que los rodean, el riesgo de ruptura en tamaños pequeños, las variantes y anomalias vasculares entre otras. Dependiendo la proyección del aneurisma y la relación de este con las arterias lenticuloestriadas, se debe elegir la mejor trayectoria para el clipado entre los ángulos vasculares de la zona. Conclusiones:La localización anatómica preoperatoria adecuada y la planificación quirúrgica son la clave para el manejo exitoso de esta patología.

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“…However some authors believe fenestration can be induced by the transarterial course of a nerve, a bony structure or enlarged vasa vasorum along the path of the artery. [8910]…”

Section: Discussionmentioning

confidence: 99%

Unilateral fenestrated A1 segment of anterior cerebral artery multiple aneurysms: Case reports and literature review

Mamadaliev¹,

Kato

Talari

et al. 2019

Asian J Neurosurg

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Fenestrated A1 segment of right anterior cerebral artery associated to duplicated anterior communicating artery

Cited by 4 publications

References 10 publications

Microneurosurgical management of aneurysms of the A1 segment of the anterior cerebral artery: Anatomy and surgical technique

Microneurosurgical management of aneurysms of the A1 segment of the anterior cerebral artery: Anatomy and surgical technique

Clipado Microquirúrgico de Aneurismas del Segmento A1: Anatomía y estrategias quirúrgicas

Unilateral fenestrated A1 segment of anterior cerebral artery multiple aneurysms: Case reports and literature review

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