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Page 4 of 5 Chowdhury et al. Neuroimmunol Neuroinflammation 2018;5:39 I http://dx.doi.org/10.20517/2347-8659.2018.37

A B

C D

Figure 5. (A) Azygos ACA in which single ACA feeds into medial surface of both cerebral hemisphere. ACA: anterior cerebral artery; (B)
Bihemispheric ACA, in which two ACA , one is dominant with branches extending into contralateral hemisphere; (C and D) Accessory ACA in
which a median artery supply either one or both hemispheres. ACA: anterior cerebral artery

[6]
[1]
Though reported incidence of azygos ACA is < 1% , Ghanta et al. reported that 25% cases of distal
[7]
anterior cerebral artery (DACA) aneurysms were associated with azygos ACA. Katz et al. found 17% ACA
aneurysm among 36 DACA aneurysm cases. The nature of the aneurysm was mostly saccular. Although
[8]
saccular bilobed aneurysm of ACA was also reported by Jagetia et al. .
Both surgical clipping and endovascular coiling can be done to manage azygos ACA aneurysm. In our case,
temporary clip was applied for 5 min in proximal unpaired A2 segment. Then a dissection of the aneurysm
neck was done and finally a permanent clip was applied. There was no neurological deficit in her post-
operative period.

In conclusion, we can say that azygos aneurysm can be clipped well without any postoperative morbidity
and mortality. Though we tried to manage this case in an emergency basis, we failed due to the patient’s
poor financial condition.