Bilateral infraoptic A1 arteries in association with a craniopharyngioma: Case report and review of the literature

BACKGROUND: While variation within the anterior cerebrovascular circulation is common, an infraoptic course of the proximal anterior cerebral artery (ACA), or infraoptic A1, is a relatively rare cerebrovascular anomaly. Associations with suprasellar neoplasms may occur, and accurate identification of this aberrant vessel during dissection is crucial to preventing vascular injury or stroke. CASE DESCRIPTION: We present the first reported case of surgically confirmed bilateral infraoptic A1 arteries associated with a craniopharyngioma. We review the relevant magnetic resonance imaging (MRI), angiographic, and intraoperative anatomic features of the infraoptic A1 to emphasize the importance of these variables when planning and performing surgery in the region of the anterior communicating artery (AComm) complex. CONCLUSIONS: Awareness of the existence and clinical significance of this unusual anomaly can facilitate its recognition on preoperative studies and during dissection in the suprasellar space, allowing neurosurgeons to adjust operative plans accordingly.