2020 Volume 29 Issue 1 Pages 38-43
We report here an extremely rare case of ruptured aneurysm arising from persistent primitive ventral ophthalmic artery (PPVOA). A 57-year-old woman presented with an unruptured right internal carotid-posterior communicating artery aneurysm and underwent clipping surgery. We found an anomalous origin ophthalmic artery arising from the anterior cerebral artery accompanying a very small aneurysm at the origin during the surgery. The very small aneurysm enlarged and ruptured suddenly on postoperative day 5, and was successfully treated with clipping plus wrapping. This temporary clip caused PPVOA wall thinning and fusiform dilatation, and was treated with wrapping.
This is the first report, to the best of our knowledge, that includes a ruptured aneurysm arising from the origin of PPVOA. Histological weakness in the vessel walls, such as decreased thickness or defects of the tunica media, may be found in congenital vascular anomalies or persistent primitive arteries. In the case described here, it has been considered that the same histological weakness has been contained. It was therefore concluded that microscopic operative stress led to an aneurysmal enlargement and rupture and PPVOA wall thinning and dilatation. We must be aware of vessel weakness in cases of congenital vascular anomalies or persistent primitive arteries.
