Fusiform aneurysms of the anterior communicating artery: illustrative series of 5 cases with operative techniques

Abstract

Background: Fusiform anterior communicating artery (ACoA) aneurysms (ACoAAs) are rare, and a series of these aneurysms has not been reported. Large fusiform ACoAA are easily identifiable, whereas smaller ones can coexist with a saccular component.

Objective: To provide a clear-cut definition, report the incidence of these aneurysms, present a series with follow-up data, and discuss operative nuances and clip application techniques.

Methods: Review of a single-surgeon operative series of all ACoAAs to identify fusiform types. When A1 or A2 vessels entered or arose from the ACoAA, it was classified as fusiform. Follow-up imaging and clinical progress were noted.

Results: Five fusiform ACoAAs were identified. Patient age ranged from 19 to 68 years. Anatomy varied from very obvious large fusiform, to identifiable fusiform nature with a saccular component, to an irregularly shaped aneurysm with a fusiform element of the ACoA. A large fusiform aneurysm reconstructed in 1 patient recurred 11 years later as a ruptured fusiform ACoAA that was reconstructed again. One patient had a giant thrombosed aneurysm with thrombosed vessels in which A2 reconstruction was attempted with sacrifice of the ACoA. In others, simple clipping achieved obliteration of the aneurysm together with creating a normal dimension ACoA. There were no operative deaths; other than rupture intraoperatively, no other complications occurred. Postoperatively, no patient had new neurological deficits, 3 had short-term memory loss, and all were ambulatory with good speech function.

Conclusion: Review of angiograms and 3-dimensional computed tomography angiography reconstruction images can identify the complex and fusiform entity of ACoAA, which is important for preoperative planning. Experience in operative techniques and thorough knowledge of the ACoA anatomy are cornerstones to obliterate the aneurysm, maintain flow in all vessels, and surgically create an ACoA of normal caliber.