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Case Reports
. 2012:3:43.
doi: 10.4103/2152-7806.94928. Epub 2012 Apr 16.

Bilateral A1 fenestrations: Report of two cases and literature review

Erinç Aktüre  1 , Anıl Arat, David B Niemann, M Salamat Salamat, Mustafa K Başkaya
Affiliations
Case Reports

Bilateral A1 fenestrations: Report of two cases and literature review

Erinç Aktüre et al. Surg Neurol Int. 2012.

Abstract

Background: Bilateral fenestration of the A1 segment of anterior cerebral artery (ACA) is an uncommon anomaly. Our objective is to describe two cases with this anomaly and to review the literature.

Case description: A 50-year-old woman presented with subarachnoid hemorrhage from a ruptured A1 aneurysm. Angiography revealed bilateral A1 segment fenestration as well as an aneurysm on the proximal end of fenestration on the right side. The second case is that of an 86-year-old woman who was found to have bilateral fenestration of A1 segment at autopsy.

Conclusion: Bilateral A1 fenestration is an uncommon anomaly that may be associated with an aneurysm. In surgical clipping of such cases, extreme caution should be exercised to inspect both arms of the fenestration since both may have multiple perforators as demonstrated in our autopsy specimen. This will be the first published pictorial demonstration of these perforators arising from the arms of fenestration.

Keywords: A1 segment; aneurysm; anterior cerebral artery; bilateral fenestration; central nervous system.

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Figures

Figure 1
Figure 1
Volume rendered 3-dimensional computerized tomographic angiography (3D CTA) images show bilateral A1 fenestrations (a) (arrows) and saccular aneurysm involving proximal end of the right A1 fenestration (b) (arrowhead). Postoperative digital subtraction angiography shows complete obliteration of the aneurysm involving proximal end of the right A1 fenestration (c) (arrowhead). 3D views of the left carotid circulation obtained from rotational angiogram show the left-sided fenestration (d) (arrow)
Figure 2
Figure 2
Postmortem specimen showing bilateral A1 fenestrations. Note that one large perforator originates from the large arm of the left fenestration on the left side and two from the large arm of the fenestration on the right side. Also, note very prominent right recurrent artery of Heubner on the right and again very prominent anterior communicating artery perforator. Inlet picture on left bottom corner shows magnified view of two of the perforating branches (arrowheads) originating from the small arm of the left A1 fenestration after the specimen is stained with luxol fast blue to overcome the transparency
See this image and copyright information in PMC

References

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