Ruptured Aneurysm of a Distal Anterior Cerebral Artery Adjacent to an Anterior Communicating Artery Aneurysm: A Case Report

We present a rare case with a ruptured aneurysm of a distal anterior cerebral artery that was adjacent to an anterior communicating artery aneurysm. A 59-year-old male suddenly developed headache and dizziness, and was conveyed to our hospital. Plain CT scans revealed subarachnoid hemorrhage and intracerebral hematoma that was distributed in the right frontal lobe. CT-angiography demonstrated two aneurysms. One was found at A2 segment of right anterior cerebral artery, and the other was found at the anterior communicating artery. The aneurysms came in contact with each other. Because anterior cerebral artery aneurysm had a broad based neck, neck clipping of both aneurysms was performed. It is important to get the A1 segment of proximal to both aneurysms in this case, so we chose a basal interhemispheric approach. This approach provides a wide operative view that improves surgical safety. The postoperative course was uneventful. In this paper, we discuss the strategy of adjacent aneurysms between the distal anterior cerebral artery and anterior communicating artery.