Introduction: Duplication of the anterior communicating artery (AcomA) in the circle of Willis (CoW) anastomotic network is a recognized anatomical variant. However, complex interconnections between segments are not as frequently reported.
Research Question/Objective: This case documents an unusual V-shaped AcomA configuration with a fenestrated A1/A2 anterior cerebral artery (ACA) junction observed in an elderly female cadaver. Materials and Methods: The CoW of an 87-year-old female donor body was dissected to demonstrate the arterial network. The donor’s cause of death was attributed to failure to thrive, with contributing conditions including a hip fracture and chronic kidney disease.
Results: Dissection of the CoW revealed duplication of the AcomA, consisting of separate superior and inferior transverse communicating vessels. These duplicated AcomA segments were connected by a short vertical anastomotic channel, creating an overall V-shaped configuration. The split in the artery lumen created a fenestrated A1/A2 junction where the ACA and AcomA meet. Both communicating vessels were patent and of similar diameter, and the vertical connection provided direct communication between the AcomA and A1/A2 union. No aneurysmal changes or other gross vascular abnormalities were identified. The remaining components of the CoW demonstrated otherwise typical morphology.
Discussion: This V-shaped AcomA with a fenestrated A1/A2 junction represents a rare and anatomically complex variant that may alter hemodynamic flow at the level of anterior cerebral circulation and has proven to be a diagnostic pitfall in diagnosing unruptured aneurysms by Tsukada, et al. This CoW variation has been reported with an incidence of <4.5% across 2329 vessels in the current literature by Triantafyllou, et al. However, we hypothesize the prevalence is significantly less due to the inclusion of two other variations within the reported data.
Significance and Implications: Awareness of CoW anatomical variation, particularly those involving hypoplasia and duplication, is important for clinicians performing surgical or endovascular interventions involving the anterior communicating complex. These variations may have a profound effect on surgical approach, difficulty, accuracy of endovascular coil or aneurysm clip placement, and postoperative complications. Thus, awareness of CoW variations are implicated in surgical accuracy and clinical outcomes.
Research Question/Objective: This case documents an unusual V-shaped AcomA configuration with a fenestrated A1/A2 anterior cerebral artery (ACA) junction observed in an elderly female cadaver. Materials and Methods: The CoW of an 87-year-old female donor body was dissected to demonstrate the arterial network. The donor’s cause of death was attributed to failure to thrive, with contributing conditions including a hip fracture and chronic kidney disease.
Results: Dissection of the CoW revealed duplication of the AcomA, consisting of separate superior and inferior transverse communicating vessels. These duplicated AcomA segments were connected by a short vertical anastomotic channel, creating an overall V-shaped configuration. The split in the artery lumen created a fenestrated A1/A2 junction where the ACA and AcomA meet. Both communicating vessels were patent and of similar diameter, and the vertical connection provided direct communication between the AcomA and A1/A2 union. No aneurysmal changes or other gross vascular abnormalities were identified. The remaining components of the CoW demonstrated otherwise typical morphology.
Discussion: This V-shaped AcomA with a fenestrated A1/A2 junction represents a rare and anatomically complex variant that may alter hemodynamic flow at the level of anterior cerebral circulation and has proven to be a diagnostic pitfall in diagnosing unruptured aneurysms by Tsukada, et al. This CoW variation has been reported with an incidence of <4.5% across 2329 vessels in the current literature by Triantafyllou, et al. However, we hypothesize the prevalence is significantly less due to the inclusion of two other variations within the reported data.
Significance and Implications: Awareness of CoW anatomical variation, particularly those involving hypoplasia and duplication, is important for clinicians performing surgical or endovascular interventions involving the anterior communicating complex. These variations may have a profound effect on surgical approach, difficulty, accuracy of endovascular coil or aneurysm clip placement, and postoperative complications. Thus, awareness of CoW variations are implicated in surgical accuracy and clinical outcomes.