gms | German Medical Science

Objective: We present a case with a ruptured saccular aneurysm of the ACoA and a coexisting unusual anastomosis between both ACA distally of the clinical leading pathology. As far as to our knowledge it seems to be the first report of such an intracranial vascular anomaly, even though many authors have reported different anomalies in similar localisation.

Methods: A 63-year-old female, who had a thyroid gland operation, exercise depending angina pectoris, adiposity and a fatty liver, was admitted complaining typical SAH related symptoms: sudden onset of severe headache, nausea, vomiting since the evening of the day before. CT examinations revealed a mostly left sided subarachnoid haemorrhage. The cerebral panangiogram showed an aneurysm of the ACoA, saccular, orientated rostrally. Moreover cranially of the ACoA there seems to be an overlapping projection of both ACA, as it was initially interpreted.

Results: The operation revealed a different situation: A1 in typical localisation, just before the ACoA the artery of Heubner on both sides, a saccular aneurysm reaching rostrally from the ACoA and just over the of the aneurysm another branching very unusual vessel connecting both ACA. Clipping was performed with 3 Clips, the aneurysm was totally excluded of the circulation. The next couple of days the patient was treated in the intensive care unit, finally extubated and the tracheostoma closed again. CT showed lift-sided infarcted areas in the distribution of ACA and artery of Heubner. Finally she was transferred to the rehabilitation centre.

Conclusions: This case illustrates very clearly the importance of a thorough intraoperative preparation and and the indispensable knowledge of vascular anomalies in cerebral aneurysm surgery.