[A case showing the infraoptic course of the anterior cerebral artery associated with anterior cerebral artery aneurysm].

A ruptured anterior cerebral artery aneurysm with anomalous right infraoptic course of the anterior cerebral artery (ACA) was reported. A 40-year old male was admitted because of SAH episode, and computerized tomography (CT) on the day of admission revealed hemorrhage in both Sylvian and interhemispheric fissures. Four-vessel angiography was performed on the same day. A saccular aneurysm was demonstrated in the region of the anterior communicating artery (ACoA), and anomalous artery, which originated from the intradural right carotid artery at the level of the right ophthalmic artery was found to be running medially and superiorly. It supplied the bilateral callosomarginal arteries and the unpaired pericallosal artery. The fenestration of the vertebral artery, duplication of bilateral superior cerebellar arteries, and an occipital artery arising from the right internal carotid artery at the C3 level were found. Surgery was performed on the first day of admission, and the anterior interhemispheric approach was selected. The anomalous branch of the right ICA ran beneath the right optic nerve, ascended between the optic nerves, and supplied the ACoA system. The left hypoplastic A1 segment entered the ACoA. However, the right A1 segment could not be found. The aneurysmal neck, situated between the bilateral callosomarginal arteries and the unpaired pericallosal artery, was clipped with Sugitas curved clip. The postoperative course was uneventful and a follow-up angiograph revealed successful obliteration of the aneurysm.