Three distal anterior cerebral artery aneurysms in the same branch associated with five additional intracranial aneurysms

Abstract

Background:Multiple distal anterior cerebral artery (DACA) aneurysms appear as rare findings. Simultaneous treatment of such lesions can be particularly challenging. A report of three aneurysms on the same parent artery has not been reported before. We report a case of three DACA aneurysms treated within one microsurgical operation in a patient with eight aneurysms.Case Description:A 62-year-old woman incidentally presented with multiple various size saccular aneurysms, including tree on the left DACA. One of the DACA aneurysm was located on the A3 segment, and the other two were on the A4 and A5 segments. Ligation of all three of these aneurysms was planned in one operation. A standard anterior interhemispheric approach was utilized. Three aneurysms were successfully clipped using four clips. Intraoperative angiography confirmed aneurysm occlusion with parent artery patency preservation. The patient showed no new postoperative neurological deficit.Conclusion:Clipping multiple DACA aneurysms within a single microneurosurgical operation is a feasible treatment option. Meticulous analysis of preoperative imaging features is crucial for selecting the best, patient-specific treatment strategy.

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

“…[10] Kozyrev et al reported a case of three flow-related aneurysms occurring in A3, A4, and A5 segments of the parent left DACA, a rare occurrence, like ours, in their hospital's database of 600 patients with DACA aneurysms. [4] DACA aneurysms have an anatomic index that makes them difficult to occlude and hence, results in adverse outcomes. ese aneurysms have broad bases and wide necks with originating branches.…”

“…reported a case of three flow-related aneurysms occurring in A3, A4, and A5 segments of the parent left DACA, a rare occurrence, like ours, in their hospital’s database of 600 patients with DACA aneurysms. [ 4 ]…”

“…Flow-related aneurysms in the region of distal anterior cerebral artery (DACA) are a rare occurrence, accounting for 9% of the total intracranial aneurysms with multiple aneurysms on the same vessel are rarer. [4] DACA aneurysms are known to have a poor clinical course and greater morbidity and mortality in contrast to other intracranial aneurysms. [10] We present an unusual case of a low-grade arteriovenous malformation (AVM) with three associated DACA aneurysms arising from a single feeder to an AVM from the left callosomarginal artery.…”

Four simultaneous anterior cerebral artery aneurysms (three initially unsuspected) with surgical treatment

“…In this case, 3 aneurysms of the same DACA branch were discovered and an additional contralateral aneurysm of the right A2 trunk bifurcation. To our knowledge, there are only 2 previous case reports of at least 3 multiple aneurysms of the same DACA branch, 3 of the left and 4 of the right DACA [5,6].…”

Surgery for multiple cerebral aneurysms: Literature review and case report

“…При этом авторы отмечали, что выполнение контралатерального подхода возможно только после тщательного предоперационного планирования [53]. [57].…”