Abstract
Introduction
Cerebral subarachnoid hemorrhage may result from rupture of saccular aneurysms at
uncommon location [excluding the anterior communicating artery (ACOM)] of the anterior
cerebral artery (ACA). The purpose of this study was to evaluate the usefulness of
helical computed tomography angiography (CTA) in detection and characterization of
intracranial aneurysms at such uncommon locations before emergent surgical clipping.
Materials and methods
Between 1998 and 2003, records for 50 consecutive patients who underwent emergent
surgical clipping for intracranial aneurysms were reviewed. Eighteen of these patients
had aneurysms in the ACA. After those patients with unequivocal ACOM aneurysms were
excluded, eight patients with eight aneurysms in an uncommon location of the ACA were
recruited to this study. Plain computed tomography (CT) and CTA were performed in
eight patients, and digital subtraction angiographies were done in three patients.
Each aneurysm was evaluated for the detection, quantification, and characterization
of the aneurysms with 2D multiplanar reformatted and 3D volume-rendering techniques.
Results
There were two small aneurysms arising from the A1 segment, one from the A2 segment,
two at the junction of triplicated ACAs, two at the junction of A2 and A3 segments,
and one at the junction of A2 and A3 segments of the azygos ACA. The average diameter
of the aneurysmal sac was 4.44 mm (range, 2.7–7.0 mm), and the aneurysmal neck averaged
2.59 mm (range, 1.2–3.5 mm) in size. The smallest aneurysm measured 2.2×1.8×2.7 mm
(neck, 1.2 mm) in the A1 segment of the left ACA. Three patients had intracerebral
hematoma, seven had intraventricular hemorrhage, and three had acute hydrocephalus.
Conclusion
Aneurysms in uncommon locations of ACAs exhibited characteristic features. Rupture
of these aneurysms can cause intracerebral hematoma, intraventricular hemorrhage,
and/or acute hydrocephalus. Noninvasive CTA can reliably detect and characterize intracranial
aneurysms at such uncommon location for planning of emergent surgical intervention.
Keywords
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Article info
Publication history
Published online: November 30, 2005
Accepted:
September 7,
2005
Received in revised form:
September 7,
2005
Received:
August 10,
2005
Identification
Copyright
© 2006 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
