Multiple separated and multi-lobular aneurysms of the anterior communicating artery complex

ABSTRACT

The anterior communicating artery complex [ACoA] is the most common site of occurrence of intracranial aneurysms, harboring about 30 percent of these lesions. Multiple aneurysms account for 20 percent of all cerebral aneurysms. Multiple aneurysms on the same artery correspond to 2.8 percent of aneurysms, usually found in the internal carotid artery or middle cerebral artery. Multiple aneurysms of the ACoA are very rare and there are only a few cases reported in the literature. In cases of multiple aneurysms of the anterior communicating artery complex, not all lesions may be detected on preoperative radiological studies, due to the complex angio-archiecture around the ACoA. Careful dissection is mandatory to ensure the completeness of aneurysm surgery. Multiple separated and multi-lobular aneurysms of the anterior communicating artery are unusual lesions and should be studied as a special topic. The authors present four cases of these rare aneurysms, namely three multiple separated aneurysms and one multi-lobular aneurysm of the ACoC. Three of these patients presented with subarachnoid hemorrhage [SAH]. There were no familial or arteriovenous malformation.related aneurysms reported in our series. We propose a new classification for this type of aneurysm on the ACoA. The literature is reviewed. The results, physiopathology and management are dis cussed.