Mirror Aneurysms of the Pericallosal Artery Clipped During a Single Surgical Procedure: Case Report and Literature Review

Pericallosal artery aneurysms are rare, accounting for 2-9% of all intracranial aneurysms, and mirror aneurysms in this location are exceptionally uncommon, presenting unique surgical challenges due to their deep location and proximity to critical neurovascular structures. The aim of this case report is to describe the surgical management and successful outcome of a patient with mirror pericallosal artery aneurysms and to contribute insights into the clinical and surgical considerations for this rare condition. We report the case of a 71-year-old female with multiple cardiovascular and metabolic conditions, including hypertension and smoking-well-established risk factors for intracranial aneurysm formation and rupture. She presented with a Hunt and Hess grade II subarachnoid hemorrhage resulting in communicating internal hydrocephalus. Preoperative angiography revealed mirror aneurysms of the pericallosal artery. The patient underwent a left basal paramedian frontal craniotomy, during which a ruptured aneurysm on the right A2 segment and an unruptured aneurysm on the left A2 segment were identified. Both aneurysms were successfully clipped using curved Yasargil clips. Postoperative recovery was favorable, with no neurological deficits and stable imaging findings at a three-month follow-up. This case underscores the necessity for precise microsurgical intervention and a thorough understanding of pericallosal artery anatomy to manage such rare and challenging conditions effectively. The role of hyperlipidemia and statin use in intracranial aneurysm development remains debated and warrants further investigation. Our successful management of mirror pericallosal artery aneurysms contributes to the limited literature on this rare condition and highlights the importance of meticulous surgical techniques for favorable outcomes.