Aneurysm of azygos anterior cerebral artery associated with falcine meningioma: Case Report and review of the literature
- Department of Neurological Sciences, Division of Neurosurgery, Hospital de Base, Faculdade de Medicina de São José do Rio Preto (FAMERP/SP), São Paulo, Brazil
Lucas C. Meguins
Department of Neurological Sciences, Division of Neurosurgery, Hospital de Base, Faculdade de Medicina de São José do Rio Preto (FAMERP/SP), São Paulo, Brazil
DOI:10.4103/2152-7806.200577Copyright: © 2017 Surgical Neurology International This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Lucas C. Meguins, Raquel C. T. Hidalgo, Antônio R. Spotti, Dionei F. de Morais. Aneurysm of azygos anterior cerebral artery associated with falcine meningioma: Case Report and review of the literature. 20-Feb-2017;8:25
How to cite this URL: Lucas C. Meguins, Raquel C. T. Hidalgo, Antônio R. Spotti, Dionei F. de Morais. Aneurysm of azygos anterior cerebral artery associated with falcine meningioma: Case Report and review of the literature. 20-Feb-2017;8:25. Available from: http://surgicalneurologyint.com/surgicalint_articles/aneurysm-of-azygos-anterior-cerebral-artery-associated-with-falcine-meningioma-case-report-and-review-of-the-literature/
Background:The azygos anterior cerebral artery (ACA) is an uncommon intracranial vascular anomaly of the circle of Willis. Identification of aneurysm from azygos ACA with anterior falcine meningioma is an extremely rare association. The aim of the present study is to report the case of an adult female with a ruptured aneurysm from azygos ACA in association with an anterior falcine meningioma.
Case Description:A 65-year-old female was admitted in the Emergency Department reporting sudden onset of severe headache. Computed tomography (CT) revealed an intracerebral hematoma and an expansive calcified lesion. AngioCT showed the presence of a large aneurysm in the distal portion of the azygos ACA. During the surgical procedure, it was possible to visualize the aneurysm in contact with an expansive lesion arising from the anterior third of the falx. Microsurgical clipping of the aneurysm was performed uneventfully and partial resection of the tumor was done. Histopathological analysis showed a fibrous meningioma. The patient was discharged home on the seventh postoperative day in good clinical conditions.
Conclusion:The association of aneurysm from azygos ACA and falcine meningioma is an extremely rare event and must be remembered when expansive masses are present in the vicinity of vascular lesions.
Keywords: Aneurysm, azygos anterior cerebral artery, falcine meningioma
The azygos anterior cerebral artery (ACA) is a very uncommon anomaly of the circle of Willis with an incidence of 1–4%.[
The aim of the present study is to report the case of an adult patient presenting with a large aneurysm of azygos ACA in association with a falcine meningioma.
A 65-year-old female was admitted in the Emergency Department reporting sudden onset of severe headache. Her past medical history was remarkable for arterial hypertension and diabetes mellitus type 2 on use of two antihypertensive drugs and subcutaneous insulin three times daily. On clinical assessment, she was hemodynamically stable, with a blood pressure of 130 × 90 mmHg, pulse 80, and temperature of 37.3°C. Neurological examination was essentially normal. Computed tomography (CT) [
According to Yasargil, Wilder was the first to describe the fusion of both A2 segments of ACA to a single artery and to introduce the term “arteria termatica” in 1885.[
Baptista reviewed the literature and found that, of the 2153 brains studied, 23 had azygos ACAs (1.06%).[
In 1963, Baptista presented a scale of three groups for the anatomical variations of azygos ACA.[
Azygos ACA is also known to be associated with other midline malformations including genesis of the corpus callosum, porencephalic cysts, holoprosencephaly arteriovenous malformations, and saccular aneurysms.[
We believe that many factors have contributed to the appearance of this unique case. First, the presence of long-term arterial hypertension associated with irregular use of antihypertensive drugs was a remarkable report by the patient. Arterial hypertension is a well-known risk factor for both intracranial aneurysms[
In conclusion, the association of large aneurysm from azygos ACA and falcine meningioma is an extremely rare event and must be remembered when expansive masses are present in the vicinity of vascular lesions.
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