PMC4597292_01
Three-dimensional computed tomography angiogram, superoinferior view (a and b) showing a saccular aneurysm (black arrow) arising from the left A1 segment of the anterior cerebral artery at the origin of the common trunk (black dotted arrow) of the fronto-orbital artery (black arrowheads) and frontopolar artery (black arrows). An aneurysm is located just on the midline and behind the anterior communicating artery. Three-dimensional computed tomography angiogram, oblique view (c), showing an elongated and tortuous left A1 segment of the anterior cerebral artery. The common trunk (white dotted arrow) shares a fronto-orbital artery and runs along the inferior surface of the ipsilateral frontal lobe (black arrowheads). Three-dimensional computed tomography angiogram, lateral view (d), showing an aneurysm located in the highest place on the vessel. The common trunk (white dotted arrow) shares a frontopolar artery, which runs anteriorly and medially along the surface of the left hemisphere toward the frontal pole (white arrows). ACA: Anterior cerebral artery, AN: Aneurysm, A1: A1 segment of the anterior cerebral artery, CT: Computed tomography, IC: Internal cerebral artery, M1: M1 segment of the middle cerebral artery, FOA: Fronto-orbital artery, FPA: Frontopolor artery
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F1
Three-dimensional CT angiography revealed an elongated and tortuous left A1 segment of the ACA and a saccular AN arising from the left A1 segment of the ACA at the origin of the cortical branch, defining its location just on the midline and behind the anterior communicating artery (ACoA) [Figure 1].
Intraoperative photographs showing the aneurysm (black arrow) and its relationship to the left distal A1 segment, left A2 segment of the anterior cerebral artery, anterior communicating artery, and the common trunk of the frontopolor artery and fronto-orbital artery (black dotted arrow) (a and b). A small cortical incision is made in the gyrus rectus allowing visualization of the proximal aneurysmal neck (b). The common trunk of the fronto-orbital artery and the frontopolor artery from the A1 segment of the anterior cerebral artery shares Heubner's artery (black arrowheads) (c). Intraoperative indocyanine green angiogram showing the patency of both the A1 (proximal A1 segment) (white arrow) and the common trunk of the frontopolor artery and frontopolor artery (white arrowheads) (d). ACA: Anterior cerebral artery, ACoA: Anterior communicating artery, CN: Cranial nerve, FOA: Fronto-orbital artery, FPA: Frontopolor artery, Lt: Left, Rt: Right
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F2
Bifrontal craniotomy was performed, and the interhemispheric fissure was opened widely to expose the ACoA, the bilateral distal A2, and the A3 segment of the ACA [Figure 2].