Bubbles and Troubles: A Case of Azygous ACA with Bilateral ICA Aneurysm, Besides the Usual Distal ACA Aneurysm

Dibya Jyoti Mahakul

doi:doi:10.11648/j.ijn.20210501.16

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Bubbles and Troubles: A Case of Azygous ACA with Bilateral ICA Aneurysm, Besides the Usual Distal ACA Aneurysm

Dibya Jyoti Mahakul

Published in International Journal of Neurosurgery (Volume 5, Issue 1)

Received: 31 March 2021 Accepted: 15 April 2021 Published: 30 April 2021

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Abstract

Azygous ACA is one of the rare anatomic variants of anterior cerebral artery. Predisposition to aneurysm development is attributed to the alteration in flow dynamics. Such hemodynamic alteration is most commonly seen in the anterior circulation, causing distal ACA aneurysm to be the most commonly associated vascular pathology. Although neurosurgical literature is replete with anatomical reports of such cases, there has been no case reports where bilateral ICA aneurysms are also present with the distal ACA aneurysm. In this case, the presence of hypoplastic left A1 segment might predispose the other segments of Circle of Willis to hemodynamic alterations. Thus, whenever one comes across an azygous ACA in association with an additional anomaly he should be vigilant enough to look for other pathologies beyond the commonly encountered distal ACA aneurysm. The presence of azygous ACA also poses a technical challenge due to the risk of ischemic insult to anterior regions of bilateral hemispheres during temporary clipping of the single A2 trunk. In addition to it, the presence of a hypoplastic A1 segment also makes the approach to the giant aneurysm in ICA segment more technically demanding as cross flow is not adequate. So, the presence of multiple anatomic anomalies not just increases the number of vascular pathologies but also enhances the challenges that the surgeon has to face in planning the strategic approach to tackle all the lesions.

Published in	International Journal of Neurosurgery (Volume 5, Issue 1)
DOI	10.11648/j.ijn.20210501.16
Page(s)	24-27
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Azygous ACA, Distal ACA Aneurysm, Hypoplastic A1 Segment, Bilateral ICA Aneurysm

References

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[2]	M. A. Stefani, F. L. Schneider, A. C. Marrone, A. G. Severino, A. P. Jackowski, and M. C. Wallace, “Anatomic variations of anterior cerebral artery cortical branches,” Clinical Anatomy, vol. 13, no. 4, pp. 231–236, 2000.
[3]	Tahir RA, Haider S, Kole M, Griffith B, Marin H. Anterior Cerebral Artery: Variant Anatomy and Pathology. J Vasc Interv Neurol. 2019 May; 10 (3): 16-22.
[4]	Niizuma H, Kwak R, Uchida K, Suzuki J: Aneurysms of the azygos anterior cerebral artery. Surg Neurol 15: 225-228, 1981.
[5]	Kanemoto Y, Tanaka Y, Nonaka M, Hironaka Y: Giant aneurysm of the azygos anterior cerebral artery-case report. Neurol Med Chir (Tokyo) 40: 472-475, 2000.
[6]	Hayashi M, Kobayashi H, Kawano H, Handa Y, Kabuto M: Giant aneurysm of an azygos anterior cerebral artery: report of two cases and review of the literature. Neurosurgery 17: 341-344, 1985.
[7]	Baptista AG: Studies on the Arteries of the Brain. II. the Anterior Cerebral Artery: Some Anatomic Features and Their Clinical Implications. Neurology 13: 825-835, 1963.
[8]	Lasjaunias P, et al. Surgical neuro-angiography 2006; 1Berlin-Springer.
[9]	Ferguson GG: Physical factors in the initiation, growth, and rupture of human intracranial saccular aneurysms. J Neurosurg 37: 666-677, 1972.
[10]	Sirin A, Cikla U, Uluc K, Baskaya MK. Ruptured Distal Accessory Anterior Cerebral Artery Aneurysm: A case report and literature review. Turk Neurosurg. 2017 Jul 12. doi: 10.5137/1019-5149.JTN.20424-17.1.
[11]	Auguste KI, Ware ML, Lawton MT. Nonsaccular aneurysms of the azygos anterior cerebral artery. Neurosurg Focus. 2004 Nov 15; 17 (5): E12. doi: 10.3171/foc.2004.17.5.12. PMID: 15633977.
[12]	Potter, J. M. (1959): Redistribution of blood to the brain due to localized cerebral arterial spasm. Brain 82, 367-376.
[13]	de Sousa, Camila Soares Moreira et al. “Thrombosis of the Azygos Anterior Cerebral Artery.” Case reports in radiology vol. 2017 (2017): 5409430. doi: 10.1155/2017/5409430.
[14]	Rangel-Castilla L, Siddiqui AH. Azygous Anterior Cerebral Artery Acute Occlusion Managed With Endovascular Mechanical Thrombectomy: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown). 2019 Apr 1; 16 (4): 514-515. doi: 10.1093/ons/opy183.
[15]	Jagetia A., Kumar PN., Sinha S., et al. Saccular bilobed aneurysm of an azygos anterior cerebral artery. Journal of Clinical Neuroscience Volume 14, Issue 8, August 2007, Pages 777-779. doi: 10.1016/j.jocn.2006.02.005.

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Dibya Jyoti Mahakul. (2021). Bubbles and Troubles: A Case of Azygous ACA with Bilateral ICA Aneurysm, Besides the Usual Distal ACA Aneurysm. International Journal of Neurosurgery, 5(1), 24-27. https://doi.org/10.11648/j.ijn.20210501.16

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ACS Style

Dibya Jyoti Mahakul. Bubbles and Troubles: A Case of Azygous ACA with Bilateral ICA Aneurysm, Besides the Usual Distal ACA Aneurysm. Int. J. Neurosurg. 2021, 5(1), 24-27. doi: 10.11648/j.ijn.20210501.16

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AMA Style

Dibya Jyoti Mahakul. Bubbles and Troubles: A Case of Azygous ACA with Bilateral ICA Aneurysm, Besides the Usual Distal ACA Aneurysm. Int J Neurosurg. 2021;5(1):24-27. doi: 10.11648/j.ijn.20210501.16

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@article{10.11648/j.ijn.20210501.16,
  author = {Dibya Jyoti Mahakul},
  title = {Bubbles and Troubles: A Case of Azygous ACA with Bilateral ICA Aneurysm, Besides the Usual Distal ACA Aneurysm},
  journal = {International Journal of Neurosurgery},
  volume = {5},
  number = {1},
  pages = {24-27},
  doi = {10.11648/j.ijn.20210501.16},
  url = {https://doi.org/10.11648/j.ijn.20210501.16},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijn.20210501.16},
  abstract = {Azygous ACA is one of the rare anatomic variants of anterior cerebral artery. Predisposition to aneurysm development is attributed to the alteration in flow dynamics. Such hemodynamic alteration is most commonly seen in the anterior circulation, causing distal ACA aneurysm to be the most commonly associated vascular pathology. Although neurosurgical literature is replete with anatomical reports of such cases, there has been no case reports where bilateral ICA aneurysms are also present with the distal ACA aneurysm. In this case, the presence of hypoplastic left A1 segment might predispose the other segments of Circle of Willis to hemodynamic alterations. Thus, whenever one comes across an azygous ACA in association with an additional anomaly he should be vigilant enough to look for other pathologies beyond the commonly encountered distal ACA aneurysm. The presence of azygous ACA also poses a technical challenge due to the risk of ischemic insult to anterior regions of bilateral hemispheres during temporary clipping of the single A2 trunk. In addition to it, the presence of a hypoplastic A1 segment also makes the approach to the giant aneurysm in ICA segment more technically demanding as cross flow is not adequate. So, the presence of multiple anatomic anomalies not just increases the number of vascular pathologies but also enhances the challenges that the surgeon has to face in planning the strategic approach to tackle all the lesions.},
 year = {2021}
}

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TY  - JOUR
T1  - Bubbles and Troubles: A Case of Azygous ACA with Bilateral ICA Aneurysm, Besides the Usual Distal ACA Aneurysm
AU  - Dibya Jyoti Mahakul
Y1  - 2021/04/30
PY  - 2021
N1  - https://doi.org/10.11648/j.ijn.20210501.16
DO  - 10.11648/j.ijn.20210501.16
T2  - International Journal of Neurosurgery
JF  - International Journal of Neurosurgery
JO  - International Journal of Neurosurgery
SP  - 24
EP  - 27
PB  - Science Publishing Group
SN  - 2640-1959
UR  - https://doi.org/10.11648/j.ijn.20210501.16
AB  - Azygous ACA is one of the rare anatomic variants of anterior cerebral artery. Predisposition to aneurysm development is attributed to the alteration in flow dynamics. Such hemodynamic alteration is most commonly seen in the anterior circulation, causing distal ACA aneurysm to be the most commonly associated vascular pathology. Although neurosurgical literature is replete with anatomical reports of such cases, there has been no case reports where bilateral ICA aneurysms are also present with the distal ACA aneurysm. In this case, the presence of hypoplastic left A1 segment might predispose the other segments of Circle of Willis to hemodynamic alterations. Thus, whenever one comes across an azygous ACA in association with an additional anomaly he should be vigilant enough to look for other pathologies beyond the commonly encountered distal ACA aneurysm. The presence of azygous ACA also poses a technical challenge due to the risk of ischemic insult to anterior regions of bilateral hemispheres during temporary clipping of the single A2 trunk. In addition to it, the presence of a hypoplastic A1 segment also makes the approach to the giant aneurysm in ICA segment more technically demanding as cross flow is not adequate. So, the presence of multiple anatomic anomalies not just increases the number of vascular pathologies but also enhances the challenges that the surgeon has to face in planning the strategic approach to tackle all the lesions.
VL  - 5
IS  - 1
ER  -

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Author Information

Dibya Jyoti Mahakul

Department of Neurosurgery, Fortis Hospital, Shalimarbagh, New Delhi, India

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APA Style

Dibya Jyoti Mahakul. (2021). Bubbles and Troubles: A Case of Azygous ACA with Bilateral ICA Aneurysm, Besides the Usual Distal ACA Aneurysm. International Journal of Neurosurgery, 5(1), 24-27. https://doi.org/10.11648/j.ijn.20210501.16

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ACS Style

Dibya Jyoti Mahakul. Bubbles and Troubles: A Case of Azygous ACA with Bilateral ICA Aneurysm, Besides the Usual Distal ACA Aneurysm. Int. J. Neurosurg. 2021, 5(1), 24-27. doi: 10.11648/j.ijn.20210501.16

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AMA Style

Dibya Jyoti Mahakul. Bubbles and Troubles: A Case of Azygous ACA with Bilateral ICA Aneurysm, Besides the Usual Distal ACA Aneurysm. Int J Neurosurg. 2021;5(1):24-27. doi: 10.11648/j.ijn.20210501.16

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@article{10.11648/j.ijn.20210501.16,
  author = {Dibya Jyoti Mahakul},
  title = {Bubbles and Troubles: A Case of Azygous ACA with Bilateral ICA Aneurysm, Besides the Usual Distal ACA Aneurysm},
  journal = {International Journal of Neurosurgery},
  volume = {5},
  number = {1},
  pages = {24-27},
  doi = {10.11648/j.ijn.20210501.16},
  url = {https://doi.org/10.11648/j.ijn.20210501.16},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijn.20210501.16},
  abstract = {Azygous ACA is one of the rare anatomic variants of anterior cerebral artery. Predisposition to aneurysm development is attributed to the alteration in flow dynamics. Such hemodynamic alteration is most commonly seen in the anterior circulation, causing distal ACA aneurysm to be the most commonly associated vascular pathology. Although neurosurgical literature is replete with anatomical reports of such cases, there has been no case reports where bilateral ICA aneurysms are also present with the distal ACA aneurysm. In this case, the presence of hypoplastic left A1 segment might predispose the other segments of Circle of Willis to hemodynamic alterations. Thus, whenever one comes across an azygous ACA in association with an additional anomaly he should be vigilant enough to look for other pathologies beyond the commonly encountered distal ACA aneurysm. The presence of azygous ACA also poses a technical challenge due to the risk of ischemic insult to anterior regions of bilateral hemispheres during temporary clipping of the single A2 trunk. In addition to it, the presence of a hypoplastic A1 segment also makes the approach to the giant aneurysm in ICA segment more technically demanding as cross flow is not adequate. So, the presence of multiple anatomic anomalies not just increases the number of vascular pathologies but also enhances the challenges that the surgeon has to face in planning the strategic approach to tackle all the lesions.},
 year = {2021}
}

Copy | Download

TY  - JOUR
T1  - Bubbles and Troubles: A Case of Azygous ACA with Bilateral ICA Aneurysm, Besides the Usual Distal ACA Aneurysm
AU  - Dibya Jyoti Mahakul
Y1  - 2021/04/30
PY  - 2021
N1  - https://doi.org/10.11648/j.ijn.20210501.16
DO  - 10.11648/j.ijn.20210501.16
T2  - International Journal of Neurosurgery
JF  - International Journal of Neurosurgery
JO  - International Journal of Neurosurgery
SP  - 24
EP  - 27
PB  - Science Publishing Group
SN  - 2640-1959
UR  - https://doi.org/10.11648/j.ijn.20210501.16
AB  - Azygous ACA is one of the rare anatomic variants of anterior cerebral artery. Predisposition to aneurysm development is attributed to the alteration in flow dynamics. Such hemodynamic alteration is most commonly seen in the anterior circulation, causing distal ACA aneurysm to be the most commonly associated vascular pathology. Although neurosurgical literature is replete with anatomical reports of such cases, there has been no case reports where bilateral ICA aneurysms are also present with the distal ACA aneurysm. In this case, the presence of hypoplastic left A1 segment might predispose the other segments of Circle of Willis to hemodynamic alterations. Thus, whenever one comes across an azygous ACA in association with an additional anomaly he should be vigilant enough to look for other pathologies beyond the commonly encountered distal ACA aneurysm. The presence of azygous ACA also poses a technical challenge due to the risk of ischemic insult to anterior regions of bilateral hemispheres during temporary clipping of the single A2 trunk. In addition to it, the presence of a hypoplastic A1 segment also makes the approach to the giant aneurysm in ICA segment more technically demanding as cross flow is not adequate. So, the presence of multiple anatomic anomalies not just increases the number of vascular pathologies but also enhances the challenges that the surgeon has to face in planning the strategic approach to tackle all the lesions.
VL  - 5
IS  - 1
ER  -

Copy | Download