A complication of recurrent artery of Heubner infarction after resection of a giant thrombotic aneurysm in the anterior cerebral artery A2 segment: case report

Giant thrombotic aneurysms of the anterior cerebral artery (ACA) are rare and pose significant challenges due to their variable clinical presentations. While complications following surgical interventions for these aneurysms are known, they have not been fully characterized. We present a novel case of postoperative infarction in the recurrent artery of Heubner (RAH) following resection of a thrombotic giant aneurysm in the ACA. A 53-year-old man with no prior systemic illnesses presented with progressive weakness in his left hand and foot, along with slurred speech. Imaging studies revealed a giant thrombotic aneurysm in the proximal A2 segment of the right ACA, which was completely occluded. Additionally, a chronic infarction was identified in the territory of the right ACA. The patient underwent successful surgical resection of the aneurysm. However, he subsequently developed an infarction in the RAH territory, a complication rarely reported in the literature. This case highlights the importance of comprehensive preoperative evaluation and underscores the need to anticipate and manage potential complications following surgery.