‘Mickey mouse head aneurysms’ – Kissing aneurysms of the distal anterior cerebral artery: A case report and review of literature

Abstract

When two or more adjacent intracranial aneurysms, arise from the same or different arteries, with separate origins and partially adherent walls, they are referred to as 'kissing aneurysms'. These are rare aneurysms. Among different locations of kissing aneurysms reported in the literature, kissing aneurysms of bilateral distal anterior cerebral arteries (DACAs), two different aneurysms situated symmetrically on opposite DACA are very rare. A 69-year-old woman with multiple comorbidities was admitted with anterior interhemispheric bleed. Magnetic resonance angiography and digital subtraction angiography (DSA) showed ruptured bilateral DACA aneurysms in mirror position to each other forming a Mickey mouse head appearance. The patient was managed surgically by craniotomy and clipping of both aneurysms. Kissing aneurysms of bilateral DACA aneurysms are very rare. DSA is essential to be useful for pre-operative diagnosis and planning. The basic principle of securing the parent artery proximally and clipping the neck after meticulous dissection should be followed.