A Case of Multiple Aneurysms Associated with an Accessory Anterior Cerebral Artery

Abstract

Aneurysms involving an accessory anterior cerebral artery (ACA), a vascular anomaly arising from the anterior communicating artery, are extremely rare. We report here a case of multiple ruptured aneurysms involving the accessory ACA, which was treated with a two-stage surgery, resulting in a satisfactory postoperative course. A 54-year-old woman presented at our hospital complaining of a severe headache. Computed tomography (CT) of the head revealed a subarachnoid hemorrhage and intracerebral hematoma at the right medial frontal lobe. CT angiography revealed aneurysms in the anterior communicating artery complex and the distal portion of the accessory ACA. The rupture of the distal aneurysm caused the hemorrhage, and thus the aneurysm was clipped. One month later, stent-assisted coil embolization of the anterior communicating artery aneurysm was performed. After a satisfactory postoperative course, the patient was discharged with a modified Rankin score of 2. Accessory ACA aneurysms involve an extremely complex morphological structure. In the case of multiple aneurysms, an adequate surgical strategy for treating each aneurysm should be adopted.