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LETTER TO EDITOR
Year : 2015  |  Volume : 63  |  Issue : 2  |  Page : 266-267

Azygous anterior cerebral artery with an anterior cranial fossa base meningioma


Department of Neurosurgery, NIMHANS, Bangalore, Karnataka, India

Date of Web Publication5-May-2015

Correspondence Address:
Dhaval Shukla
Department of Neurosurgery, NIMHANS, Bangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.156303

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How to cite this article:
Beniwal M, Shukla D. Azygous anterior cerebral artery with an anterior cranial fossa base meningioma. Neurol India 2015;63:266-7

How to cite this URL:
Beniwal M, Shukla D. Azygous anterior cerebral artery with an anterior cranial fossa base meningioma. Neurol India [serial online] 2015 [cited 2019 Oct 18];63:266-7. Available from: http://www.neurologyindia.com/text.asp?2015/63/2/266/156303


Sir,

A 42-year-old lady presented with headache and anosmia of nine months duration. She had progressive loss of vision, and generalized seizures. She was conscious, but had a reduced attention span. Her visual acuity was limited to perception of hand movements close to face. Her magnetic resonance imaging (MRI) of the brain revealed a large meningioma arising from the olfactory groove, and extending until the tuberculum sella [Figure 1]. The magnetic resonance angiography showed lifting of both anterior cerebral arteries (ACA) with a single distal ACA (azygous ACA) [Figure 2]. A bifrontal craniotomy and a subfrontal approach facilitated excision of the tumor. The tumor was intimately related to both the ACAs and the distal azygous ACA. It was excised and a very small portion of the tumor was left at the junction of both ACAs at the site of critical perforators [Figure 3]. The postoperative period was uneventful.
Figure 1: Sagittal MRI of the brain showing the large anterior cranial base meningioma

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Figure 2: MRA showing the azygous anterior cerebral artery (arrow)

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Figure 3: Operative photograph after resection of the meningioma showing the azygous anterior cerebral artery

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An azygous distal ACA is seen in 0-5% of humans. [1] However, an azygous ACA commonly occurs in lower primates; hence, this anomaly is referred as a "monkey's type" of ACA. [2],[3] The azygous ACA may be associated with malformations like holoprosencephaly, agenesis of corpus callosum, meningoceles, lipoma, arachnoid cyst, and porencephalic cyst. [4],[5],[6],[7] In the available literature, the association of an azygous ACA with a coexisting suprasellar tumor has not been described. The association of an azygous ACA with an anterior cranial fossa meningioma, as seen in our patient, may be coincidental. It can, however, pose a significant challenge during surgery. Large meningiomas of anterior cranial fossa base may be adherent to the ACAs and surgery may lead to injury of this vessels. When there is a single ACA, as in our case, the injury to this vessel can cause infarction of both medial frontal lobes leading to paraplegia. Presence of a vascular anomaly in a close vicinity to the tumor calls for more precision during surgery.

 
  References Top

1.
Kedia S, Daisy S, Mukherjee KK, Salunke P, Srinivasa R, Narain MS. Microsurgical anatomy of the anterior cerebral artery in Indian cadavers. Neurol India 2013;61:117-21.  Back to cited text no. 1
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2.
Belenkaya RM. Structural variants of the arteries of the base of the brain. Zhurnal Voprosy Nejrokhirurgii Imeni NN Burdenko. 1974;38:23-29.  Back to cited text no. 2
    
3.
Sarikaya B. Monkey's type of anterior cerebral artery mimicking aneurysm: CT angiography findings. Neuroanatomy 2006;5:27-29.  Back to cited text no. 3
    
4.
Szdzuy D, Lehmann R, Nickel B. Common trunk of the anterior cerebral arteries. Neuroradiology 1972;4:51-56.  Back to cited text no. 4
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5.
Danziger J, Bloch S, Van Rensburg MJ. Agenesis of the corpus callosum associated with an azygous anterior cerebral artery, a lipoma and porencephalic cyst. S Afr Med J 1972;46:739-41.  Back to cited text no. 5
[PUBMED]    
6.
Nakamura N, Ogawa A, Kayama T, Sakurai Y, Yoshimoto T, Suzuki J. [A case of agenesis of the corpus callosum accompanied by a ruptured azygous anterior cerebral artery aneurysm and lipoma-a case report]. No To Shinkei 1986;38:701-5. Japanese.  Back to cited text no. 6
    
7.
Baykal S, Ceylan S, Dinç H, Soylev E, Usul H, Akturk F. Aneurysm of an azygous anterior cerebral artery: Report of two cases and review of the literature. Neurosurg Rev 1996;19:57-9.  Back to cited text no. 7
    


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