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LETTERS TO EDITOR
Year : 2019  |  Volume : 67  |  Issue : 2  |  Page : 598-599

A ruptured isolated orbitofrontal artery aneurysm


1 Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
2 Department of Neurosurgery, The Central District People's Hospital of Leshan, China

Date of Web Publication13-May-2019

Correspondence Address:
Dr. Li Jin
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu - 610 041
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.258044

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How to cite this article:
Xiaodong N, Zhihong H, Qing M, Jin L. A ruptured isolated orbitofrontal artery aneurysm. Neurol India 2019;67:598-9

How to cite this URL:
Xiaodong N, Zhihong H, Qing M, Jin L. A ruptured isolated orbitofrontal artery aneurysm. Neurol India [serial online] 2019 [cited 2019 May 24];67:598-9. Available from: http://www.neurologyindia.com/text.asp?2019/67/2/598/258044




Sir,

Aneurysms arising from the orbitofrontal artery (OFA) are very rare. Due to the specific anatomical features of OFA, the origin of the aneurysm can be wrongly judged with the digital subtraction angiography (DSA) examination before surgery. A 74-year old woman presented with sudden onset of severe headache. At admission, she was drowsy and complained of severe headache. The neurological examination was unremarkable. The head computed tomographic scan revealed a diffuse subarachnoid hemorrhage (SAH) located predominantly in the anterior interhemispheric fissure. The DSA revealed a small saccular (2 × 3 mm) aneurysm originating from the middle portion of the left OFA [Figure 1]a,[Figure 1]b,[Figure 1]c,[Figure 1]d,[Figure 1]e,[Figure 1]f,[Figure 1]g.
Figure 1: (a) Preoperative axial computed tomography showing subarachnoid hemorrhage located predominantly in the anterior interhemispheric fissure; (b) Conventional and (c) three-dimensional digital subtraction angiography showing an aneurysm (arrow) arising from the left orbitofrontal artery; (d) Intraoperative picture showing an aneurysm arising from the middle portion of orbitofrontal artery; (e) Intraoperative picture after aneurysm clipping; (f) Postoperative CT scan showing no significant infarction; (g) Postoperative CT angiography showing complete occlusion of the aneurysm. AN=Aneurysm, OFA=Orbitofrontal artery, Rt=Right, Lt=Left

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A left pterional craniotomy was performed. A small aneurysm was identified arising from the left OFA and projecting inferiorly in the optic chiasmal cistern. The saccular aneurysm was clipped with preservation of the OFA. The postoperative course was uneventful. The patient recovered well without any neurological deficits. The postoperative CT scan showed no significant infarctions [Figure 1]f. Aneurysms arising from the OFA are relatively rare. They are usually associated with vascular malformations and multiple aneurysms.[1],[2] To date, only one case of isolated OFA aneurysm has been reported, and the aneurysm was partially thrombosed.[3] In our case, the aneurysm was originating from the middle portion of the OFA and projecting inferiorly in the optic chiasmal cistern. The aneurysm was clipped and the parent artery was preserved. The OFA commonly arises from the A2 segment about 5 mm from the anterior communicating artery (ACoA) junction.[3] The artery courses perpendicularly over the gyrus rectus and across the olfactory tract, supplying the gyrus rectus, olfactory tract and bulb, and the medial part of the orbital surface of the frontal lobe.[4] Based on the anatomical features, OFA can be mistaken for the recurrent artery of Heubner (RAH), which usually originates within 4 mm of the ACoA junction and courses along the A1 segment. At surgery, it is important to distinguish an OFA from a RAH. Due to the complexity of OFA aneurysms and the surrounding vessels, a preoperative detailed assessment and an intraoperative careful identification of important vessels, such as RAH, are necessary to avoid injury of them.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Murai Y, Yamashita Y, Ikeda Y, Node Y, Teramoto A. Ruptured aneurysm of the orbitofrontal artery associated with dural arteriovenous malformation in the anterior cranial fossa-case report. Neurol Med Chir (Tokyo) 1999;39:157-60.  Back to cited text no. 1
    
2.
Xue MH, Chun HW, Li J, Song YL. Multiple aneurysms of distal anterior cerebral artery associated with a cerebral arteriovenous malformation. Neurol India 2010;58:968-70.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Bhat DI, Shukla DP, Devi BI. Partially thrombosed distal orbitofrontal artery aneurysm mimicking an A1 segment aneurysm. J Neurosci Rural Pract 2014;5:436-7.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Mavridis IN, Kalamatianos T, Koutsarnakis C, Stranjalis G. The microsurgical anatomy of the orbitofrontal arteries. World Neurosurg 2016;89:309-19.  Back to cited text no. 4
    


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