Work

Missing A1 Unmasked During Surgery for Ruptured Anterior Communicating Artery (ACoA) Aneurysm: Navigating the Unexpected

Year: 2025

Type: article

Abstract: The infraoptic anterior cerebral artery (ACA) is a rare vascular anomaly that is often regarded as merely an anatomical curiosity. We report the case of a 54-year-old hypertensive man who presented with subarachnoid hemorrhage (World Federation of Neurological Surgeons (WFNS) Grade 4) due to rupture of a bilobed anterior communicating artery (ACoA) aneurysm. CT angiography confirmed the aneurysm, and the patient underwent right pterional craniotomy and clipping. Intraoperatively, the right A1 segment was absent in its usual supraoptic location and was instead found coursing beneath the optic nerve, consistent with a Wong type II infraoptic ACA. The aneurysm was successfully clipped with preservation of perforators, and postoperative angiography confirmed complete occlusion. This case highlights the importance of recognizing an infraoptic A1 variant in patients with a "missing" A1 segment on imaging or during ACoA aneurysm surgery, as failure to identify this anomaly may compromise surgical safety and completeness.

Source: Cureus

DOI: 10.7759/cureus.96372

Authors: A Sathia Prabhu, Karthik Nandam, Praveen Ravichandran

Institution: Jawaharlal Institute of Post Graduate Medical Education and Research

Language: English

Topic: Intracranial Aneurysms: Treatment and Complications

Subfield: Neurology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W4416042169