Unruptured distal anterior cerebral artery mirror aneurysms associated with ruptured middle cerebral artery aneurysm: case report

Vladimir Jovanović; Lukas Rasulić; Vojin Stevo Kovačević; Aleksandar Miloš Janićijević; Filip Vitošević; Andrija Savić; Marko Đurović; Goran Tasić

doi:10.2298/VSP171210119J

Vladimir Jovanović School of Medicine, University of Belgrade, Belgrade, SerbiaClinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
Lukas Rasulić School of Medicine, University of Belgrade, Belgrade, SerbiaClinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
Vojin Stevo Kovačević Faculty of Medical Sciences, University of Kragujevac, Center for Neurosurgery, Clinical Center of Kragujevac, Kragujevac
Aleksandar Miloš Janićijević Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade
Filip Vitošević Neuroradiology Department, Center for Radiology and MRI, Clinical Center of Serbia, Belgrade
Andrija Savić Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade
Marko Đurović Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade
Goran Tasić School of Medicine, University of Belgrade, Belgrade, Serbia Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade

DOI: https://doi.org/10.2298/VSP171210119J

Abstract

Introduction: Mirror ACA aneurysms are rare, especially in the absence of any congenital vascular anomaly.

Case report: We present a 49-year-old woman with diagnosed unruptured distal anterior cerebral artery (ACA) mirror aneurysms, associated with ruptured right middle cerebral artery (MCA) aneurysm. A ruptured MCA aneurysm was previously coiled in other neurosurgical center, while the mirror distal ACA aneurysms were clipped through right-sided unilateral craniotomy in our Institution.

Conclusion: There are no clear recommendations regarding the follow-up and management of unruptured distal ACA aneurysms, but they should be aggressively treated even if they are small, due to their tendency for early rupture and high incidence of intracerebral bleeding. Single stage unilateral craniotomy is recommended for surgical treatment.

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