Ruptured Fusiform Callosomarginal Artery Aneurysm Treated by Excision and End-to-end Reconstruction - Case Report, Technical Considerations and Review of Literature

Sep 29, 2026

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Aneurysms of the callosomarginal artery (CMA) are rare, usually saccular, and commonly located at the CMA-pericallosal bifurcation. Fusiform aneurysms at this distal location are exceptionally uncommon and challenging because of their morphology and accessibility. This case report presents a 60-year-old patient with a ruptured fusiform CMA aneurysm treated with open excision and tension-free end-to-end microsurgical reconstruction. Histology and microbiology showed no mycotic origin, and cardiology ruled out infective endocarditis. After uneventful recovery, follow-up angiography confirmed complete resection and vessel patency, with lifelong antiplatelet therapy and full functional recovery at one and two years.

LanguageEnglish

CategoryHealthcare

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Pages8

Reading Time20 min

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Introduction

Case report

Discussion

Brain and Spine 6 (2026) 105908 Contents lists available at ScienceDirect Brain and Spine journal [homepage:](homepage: www.journals.elsevier.com/brain-and-spine)[ www.journals.elsevier.com/brain-and-spine](homepage: www.journals.elsevier.com/brain-and-spine) | Ruptured fusiform callosomarginal artery aneurysm treated by excision and end-to-end reconstruction – Case report, technical considerations and review of literature
Jiri Dostal a , Vladimir Pribana,* , Filip Heidenreich b , Petr Kasik a , Radek Tupyb , Jan Mraceka
a Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University and University Hospital Pilsen, Czech Republic b Department of Imaging Methods, Faculty of Medicine in Pilsen, Charles University and University Hospital Pilsen, Czech Republic | | | | --- | --- | --- | | A R T I C L E I N F O | | A B S T R A C T | | Keywords:
Callosomarginal artery Fusiform aneurysm
Distal anterior cerebral artery Microsurgical reconstruction End-to-end anastomosis Aneurysm excision | | Background: Aneurysms of the callosomarginal artery (CMA), a major branch of the pericallosal artery, are rare and typically located at the CMA-pericallosal bifurcation. These distal anterior cerebral artery (DACA) aneurysms comprise 1.5 %–9 % of all intracranial aneurysms and are usually saccular. Fusiform aneurysms in this location are exceedingly uncommon and present unique management challenges due to their morphology and location. This report describes the management of a ruptured fusiform CMA aneurysm and discusses key technical aspects of microsurgical planning and reconstruction.
Case description: A 60-year-old smoker presented with a one-week history of severe headache, nausea, and vomiting. Imaging revealed a ruptured fusiform aneurysm of the distal callosomarginal artery. Given the aneurysm’s location and morphology, open surgical treatment was chosen. The aneurysm was excised, and after careful mobilization, the affected vessel was reconstructed with a tension-free end-to-end anastomosis. Histological and microbiological analysis of the aneurysm and abnormal arachnoid showed no signs of mycotic origin. A cardiological evaluation ruled out infective endocarditis. Postoperative recovery was uneventful, and followup angiography confirmed complete aneurysm resection with vessel patency. The patient was started on lifelong antiplatelet therapy and remained asymptomatic with full functional recovery at the one and two year follow-up. Conclusion: While endovascular options are expanding, distal aneurysms in small-caliber vessels remain inaccessible in most cases. Direct microsurgical vessel reconstruction offers a durable and definitive treatment option in carefully selected cases. Microsurgical training and expertise in vascular reconstruction are essential for managing complex vascular lesions that fall beyond the reach of endovascular therapy. | 1. Introduction The callosomarginal artery (CMA) is the largest branch of the pericallosal artery, running parallel to it within the cingulate gyrus and supplying cortical regions of the frontal and parietal lobes, including the supplementary motor area. Aneurysms of the CMA are rare and most often arise at its bifurcation from the pericallosal artery. They form part of the broader group of distal anterior cerebral artery (DACA) aneurysms, which account for approximately 1.5 %–9 % of all intracranial aneurysms (Zhai et al., 2021). Because of their rarity, CMA aneurysms are less frequently addressed in the literature compared with aneurysms at other locations. This report describes a ruptured fusiform CMA aneurysm treated by surgical excision and direct end-to-end vessel reconstruction, with complete recovery. Current literature, key technical considerations and available strategies for dissection and microvascular reconstruction are also discussed. 2. Case report A 60-year-old patient presented to the emergency department of our hospital with a o

FAQs

Why are fusiform callosomarginal artery aneurysms difficult to manage?

They are rare and occur in a distal, small-caliber location with distinctive morphology, making endovascular access limited in most cases. This increases reliance on carefully planned microsurgical reconstruction.

How was the ruptured aneurysm treated in the case report?

The aneurysm was surgically excised, and the affected vessel was reconstructed using a tension-free end-to-end anastomosis. The approach was selected after consultation and evaluation of the lesion’s location and features.

What postoperative and follow-up results were reported?

Recovery was uneventful, and follow-up angiography confirmed complete aneurysm resection with preserved vessel patency. The patient remained asymptomatic with full functional recovery at one- and two-year follow-up while on lifelong antiplatelet therapy.

Sep 29, 2026

Uploaded by Miles