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Case Reports
. 2024 Nov;67(6):675-681.
doi: 10.3340/jkns.2024.0069. Epub 2024 May 16.

Successive Development and Rupture of Blister-Like Anterior Communicating Artery Aneurysms at Mirror Locations

Myungsoo Kim  1 , Jaechan Park  1
Affiliations
Case Reports

Successive Development and Rupture of Blister-Like Anterior Communicating Artery Aneurysms at Mirror Locations

Myungsoo Kim et al. J Korean Neurosurg Soc. 2024 Nov.

Abstract

This is the first report of the successive development and rupture of blister-like anterior communicating artery (ACoA) aneurysms at mirror locations with a short interval. A 49-year-old man presented with an angiogram-negative subarachnoid hemorrhage with significant basal frontal interhemispheric blood. Surgical exploration revealed a blister-like aneurysm on the left side of the superior wall of the ACoA, which was treated using a microsuturing technique. On the 18th day after the initial subarachnoid hemorrhage, the second operation due to another angiogram-negative hemorrhage revealed a de novo blister-like aneurysm with a small blood clot on the posterosuperior wall of the ACoA close to the right A1/A2 junction. The rupture point and ACoA on the right side were occluded using an aneurysm clip. Follow-up digital subtraction angiogram at 4 years and computed tomography angiogram at 14 years after the surgery showed no recurrence or associated abnormality.

Keywords: Aneurysm, anterior communicating artery; Blister-like aneurysm; Craniotomy; Subarachnoid hemorrhage.

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Conflict of interest statement

Conflicts of interest

Jaechan Park has been editorial board of JKNS since May 2020. He was not involved in the review process of this original article. No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Initial radiological images on admission. A : Computed tomography scan showing a diffuse subarachnoid hemorrhage in the basal cisterns. The more pronounced collection of blood (arrow) in the inferior part of the frontal interhemispheric cistern suggests a hemorrhage from a ruptured ACoA aneurysm. B : CTA showing a small aneurysm (arrow) at the bifurcation of the right middle cerebral artery. C : CTA showing no lesion in the ACoA (arrow). ACoA : anterior communicating artery, CTA : computed tomography angiogram.
Fig. 2.
Fig. 2.
Intraoperative photographs of the first pterional craniotomy. A : Small unruptured aneurysm (arrow) at the bifurcation of the right middle cerebral artery. B : Small blood clot (double arrows) attached to the superior wall of the ACoA (arrow). C : Arterial hole (arrow) in the superior wall of the ACoA on the left side, which was exposed after careful removal of the blood clot. D : Three stitches (arrow) using 9-0 monofilament closing the arterial hole in the ACoA. ACoA : anterior communicating artery.
Fig. 3.
Fig. 3.
Radiological images after the second hemorrhage. A : Computed tomography scan demonstrating an intracerebral hemorrhage (arrow) in the right frontal base starting from the ACoA region and associated intraventricular hemorrhage in the whole ventricular system. B : Digital subtraction angiogram showing no aneurysmal bulge or stenosis in the ACoA (arrow). ACoA : anterior communicating artery.
Fig. 4.
Fig. 4.
Intraoperative photographs of the second operation. A : De novo blister-like aneurysm with a small blood clot (arrow) on the posterosuperior wall of the ACoA close to the right A1/A2 junction. B : Angled fenestrated clip that was placed through the A1 segment with the clip blades occluding the rupture point and ACoA. ACoA : anterior communicating artery.
Fig. 5.
Fig. 5.
Follow-up digital subtraction angiogram 4 years after the initial subarachnoid hemorrhage. A : Right carotid angiogram showing an angled fenestrated clip occluding the rupture point and ACoA on the right side close to the right A1/A2 junction. B : Left carotid angiogram showing an intact ACoA stump (arrow) on the left side, suggesting an intact ACoA perforator. ACoA : anterior communicating artery.
See this image and copyright information in PMC

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