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Updated: Jan 17, 2026

Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
Surgical Anatomy of the Anterior Communicating Artery and Its Implications in Aneurysm Management: A Systematic
Katerina Dimitriou1, George Triantafyllou1,2, Ioannis Paschopoulos1
1Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Greece.
Abstract:
The anterior communicating artery (AComA) is a common location for intracranial aneurysms and is known for its complex anatomic variability. Understanding its morphology is essential for accurate diagnosis and safe neurosurgical or endovascular procedures. This systematic review aims to compile current research on the surgical anatomy of the AComA and its relationship with pathologic conditions, mainly aneurysms. A total of 20 studies, including anatomic, imaging, surgical, and case reports, were analyzed. Key anatomic variants, such as hypoplasia or aplasia of the A1 segment, fenestration anomalies of the AComA, and the presence of a median artery of the corpus callosum, are often linked to aneurysm formation and rupture risk. Hemodynamic factors, including asymmetry of the A1 segments and a decreased A1-A2 junction angle, significantly increase the odds of aneurysm development. Surgically, features such as the configuration of the A2 segment (eg, closed or open A2 plane) and aneurysm projection direction influence clipping outcomes and complication rates. Preoperative digital subtraction angiography (DSA) has proven superior in identifying complex malformations that may be missed on computed tomography angiography (CTA) or magnetic resonance angiography (MRA). Classification systems provide a structured interpretation of AComA variants with clinical relevance. This review highlights the crucial role of anatomic knowledge in surgical planning and individualized risk assessment for patients with AComA aneurysms.
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