Funnel Shaped Anterior Communicating Artery Fenestration Mistaken for an Aneurysm: A Cautionary Tale

This report portrays a case of a funnel shaped anterior communicating artery (ACoA) fenestration which was mistaken as a small A1 aneurysm in a subarachnoid hemorrhage case. Although tridimensional rotational digital subtraction angiography improves aneurysm diagnosis specially at the ACoA complex,...

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Bibliographic Details
Published in:World neurosurgery 2023-08, Vol.176, p.202-203
Main Authors: Menéndez-Girón, Sebastián, Domínguez, Carlos J., Rodríguez-Hernández, Ana
Format: Article
Language:English
Subjects:
3D angiography
Adult
Aneurysm
Aneurysm, Ruptured - surgery
Anterior Cerebral Artery - diagnostic imaging
Anterior Cerebral Artery - surgery
Anterior communicating artery
Cerebral Angiography - methods
Child
Diagnostic error
Humans
Intracranial Aneurysm - complications
Intracranial Aneurysm - diagnostic imaging
Intracranial Aneurysm - surgery
Otologic Surgical Procedures - adverse effects
Subarachnoid Hemorrhage - diagnostic imaging
Subarachnoid Hemorrhage - etiology
Subarachnoid Hemorrhage - surgery
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Summary:This report portrays a case of a funnel shaped anterior communicating artery (ACoA) fenestration which was mistaken as a small A1 aneurysm in a subarachnoid hemorrhage case. Although tridimensional rotational digital subtraction angiography improves aneurysm diagnosis specially at the ACoA complex, current spatial resolution might leave behind a considerable percentage of ACoA fenestrations. This may lead to diagnostic errors and unnecessary treatments risking iatrogenic complications. Luckily for our patient, a concomitant aneurysm warranted clipping and subsequent surgical exploration of the ACoA complex revealed the pitfall, thus preventing further action. Interestingly, another group of authors who reported similar misdiagnosis with ACoA aneurysms were able to prevent a third error, thanks to the experience acquired with 2 prior cases. Therefore, this clinical image aims to raise wider awareness of the need for very cautious consideration of imaging depicting small and/or atypical aneurysms in the ACoA complex.
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2023.04.122