Abstract
The authors describe a case of aneurysm arising from the fenestrated proximal anterior cerebral artery (A1 segment).
A 52-year-old female suddenly developed severe headache and vomiting, followed by disturbance of consciousness. At the other hospital, the patient was diagnosed subarachnoid hemorrhage by CT scan and lumbar puncture. On the 2nd day, she was translated to our hospital for the operation.
Angiographies demonstrated an aneurysm arising from the A1 segment with spastic irregular vascular wall. Therefore, the operation was performed immediately. When the neck of aneurysm was clipped, the small fenestration was found out at the A1 segment of the distal of it.
On the retrospective examination, the small fenestraton was just found out in the irregular wall of the A1 segment by the subtraction film of the left oblique C.A.G.
The patient had temporary mental disturbance due to suspected vascular accident at the 7th day after the operation. Although, she recovered soon without neurological deficit, but CT scan demonstrated low density area on the left anterior lobe.
In the literatures, the aneurysm at the fenestrated A1 segment has been reported only 8 cases. As these cases compared with out case, the relation of position between the neck of aneurysm and fenestration is not similar.
As an another characteristic in these reported cases, the rate of poor prognosis due to vasospasm is high (50%). This results suggest that the vasospasm is related to the fenestrated vascular wall.
