# Middle Cerebral Artery Aneurysm and Distal Anterior Cerebral Artery (DACA) Aneurysms Related to Azygos and an Unusual Single Pericallosal Artery Variant: A Case Report

## TL;DR

A 61-year-old woman with multiple rare cerebral artery aneurysms and unusual blood vessel anatomy was successfully treated in one surgery.

## Contribution

The paper reports a unique case of multiple rare aneurysms and ACA anatomical variations treated in a single-stage craniotomy.

## Key findings

- The patient had a ruptured A3 DACA aneurysm and multiple unruptured DACA and MCA aneurysms.
- A single-stage craniotomy successfully clipped all aneurysms despite complex anatomical variations.
- The case highlights an unusual ACA variant with an azygos A2 and a single post-bifurcation pericallosal artery.

## Abstract

The authors describe the case of multiple rare distal anterior cerebral artery (DACA) aneurysms related to a middle cerebral artery (MCA) aneurysm, an azygos, and an undescribed anterior cerebral artery (ACA) anatomical variation. A 61-year-old woman in a severe clinical state was diagnosed with subarachnoid hemorrhage (SAH) secondary to a ruptured anterior A3 DACA aneurysm. The patient also had unruptured kissing superior A3 DACA aneurysms, an atherosclerotic DACA aneurysm between the anterior and superior DACA aneurysms, and an unruptured MCA left aneurysm. Two pericallosal anatomical variations were seen: an A2 azygos and a rare single post-bifurcation (callosomarginal artery) pericallosal artery. All aneurysms were clipped using a single-staged left craniotomy with interhemispheric, subfrontal, and transsylvian access. This study demonstrates a patient with rare anatomical ACA variants and multiple complex aneurysms treated in a single-stage craniotomy.