Small symptomatic anterior communicating artery aneurysms: report of three cases and literature review

PurposeGiven the anatomical relationship between the ACom complex and the optic nerve, small aneurysms of the ACom can present with visual symptoms.Case reportsWe summarize and illustrate the clinical course of three patients with symptomatic small ACom aneurysms and collect similar other cases reported.ResultsTen patients with small unruptured visually symptomatic anterior communicating artery aneurysms were found in the literature. Including three patients herein reported, the mean age at presentation was 56. The most common visual symptoms were bitemporal vision loss and/or a decrease in visual acuity.ConclusionUnruptured aneurysms of the anterior communicating artery can present with visual symptoms due to compression of optic pathways, even at a small size. Prompt recognition and treatment of such a condition are paramount as new onset of visual symptoms can signify impending rupture akin to small PCom aneurysms compressing the third nerve. We discuss a few pitfalls of clipping small ACom aneurysms compressing the optic nerve.