Unilateral absence of the internal carotid artery associated with anterior communicating artery aneurysms: Systematic review and a proposed management algorithm

Abstract

Background: Absence or hypoplasia of the internal carotid artery (ICA) is a rare congenital anomaly that is mostly unilateral and highly associated with other intracranial vascular anomalies, of which saccular aneurysm is the most common. Blood flow to the circulation of the affected side is maintained by collateral pathways, some of which include the anterior communicating artery (Acom) as part of their anatomy. Therefore, temporary clipping during microsurgery on Acom aneurysms in patients with unilateral ICA anomalies could jeopardize these collaterals and place the patient at risk of ischemic damage. In this paper, we review the literature on cases with a unilaterally absent ICA associated with Acom aneurysms and provide an illustrative case. Methods: We combined our experience of one case of a unilaterally absent ICA associated with an Acom aneurysm with the 33 existing publications on the same subject in the literature, for a total of 40 cases. We provide a detailed systematic literature review of this association of vascular anomalies, exploring different aspects regarding the collateral pathways and how they impact management strategies and propose a management algorithm to deal with such association. Results: The mean age was 48.2 ± 16.5 years. The aneurysmal rupture was the most common presentation (75%). Agenesis was observed in 70% of patients, followed by hypoplasia (20%) and, finally, aplasia (10%). Lie Type A was the most common pattern of collaterals (50%), with Types B and D being of almost equal proportions. Most aneurysms were located at the A1-Acom junction contralateral to the anomalous side (Fisher’s Exact test; P = 0.03). One case of temporary clipping was reported in the literature. Conclusion: Acom aneurysms in patients with unilateral ICA anomalies, given they are more commonly present contralaterally, could be of acquired etiology, warranting periodic screening in asymptomatic patients. Temporary clipping might be safe in patients with Type D collateral pattern, while those with Types A or B may require intraoperative rupture risk assessment and a tailored management plan to avoid disrupting collateral flow and causing ischemia.

Academic productivity of Iraqi medical students in the field of neurosurgery: A literature review

“…Table 1 shows the productivity of Iraqi medical students with their publications' number and type of authorship. [2][3][4][5][6][7][8][9][10][11][12][15][16][17][18][19][20][21][22][23][24][25]28,[31][32][33][34][35][36][37][39][40][41][42][43][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60]…”

“…Table 1 shows the productivity of Iraqi medical students with their publications’ number and type of authorship. [ 2 - 12 , 15 - 25 , 28 , 31 - 37 , 39 - 43 , 45 - 61 , 63 , 65 , 67 - 69 , 72 , 73 ]…”

“…Mustafa Ismail [2][3][4]6,7,9,12,16,24,32,[48][49][50][51][52][53][54][55][56]58,59,72] 22 9 first author\13 co-author Aktham O. Al-Khafaji [2,5,9,10,15,19,23,31,34,37,41,45,52,53,56] 15 3 first author\12 co-author Saja A. Albanaa [10,20,21,22,35,37,39,40,42,43,46] 11 1 first author\10 co-author Teeba A. Adnan [2,4,6,7,…”

PubMed-indexed neurosurgical research productivity of Iraq-based neurosurgeons

“…Between 2003 and 2021, a total of 52 PubMed indexed papers were published from Iraq. [1,2,[4][5][6][7][8][9][10]20,24,[21][22][23][24][25][26][27][28][29][30][31][32][33][34] All publications have been clustered in the period of 2012-2021. From 2012 to 2016, only four papers were published, one per year.…”

Internal carotid artery agenesis presenting with ruptured Acom aneurysm: Rare case report

“…Although ICA agenesis is rare, with the reported incidence of ICA development anomalies being less than 0.01% [ 5 ], its knowledge to hybrid neurovascular surgeon is imperative, as its treatment can be challenging. It occurs almost equally among male and females with common age at presentation being 5 th and 6 th decade and anomalies on the left side is more common than the right [ 1 ].…”