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.
Dimitriou et al. (Mon,) studied this question.
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