Proximal Anterior Cerebral Artery Aneurysm: Case Presentation and Review of the Literature

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Purpose: Aneurysms involving the proximal segment of the anterior cerebral artery (A1) are relatively rare. We report two cases we encountered and review the literature. Cases: Two female patients were referred to our hospital. The first, a 71-year-old woman, was found unconscious and semicomatose at home. Computed tomography (CT) revealed diffuse subarachnoid hemorrhage (SAH) with intraventricular and intracerebral hemorrhage. Cerebral angiography (CAG) showed a saccular aneurysm in the right A1 and unruptured right middle cerebral artery aneurysm. The second patient was a 76-year-old woman in whom an unruptured right A1 aneurysm was found incidentally. During a 3-year observation period, the aneurysm enlarged and changed its shape. Both patients underwent surgical clipping. The first patient showed moderate disability due to SAH insult while the second showed no neurological deficits. Conclusions: A1 aneurysms are rare intracranial aneurysms, but reportedly show strong correlations with vascular anomalies. When planning surgery, use of CAG and other radiological modalities are warranted to precisely assess the origin of the aneurysm neck and any accompanying anomalies. Anatomical speculations must be confirmed intraoperatively while paying attention to perforating arteries from the A1 segment.