Cerebral aneurysms are occasionally associated with anomalies of cerebral arteries, that should be
recognized pre- and intra-operatively. Most of the previous reports on the anomalies of the anterior
cerebral artery have been concerned with hypoplasia, fenestration, and infra-optic course of the A1,
variant A1 perforators or Heubner´s artery, multi-channeled anterior communicating artery, and azygos
anterior cerebral artery. The author experienced a patient with a ruptured proximal anterior cerebral
artery (A1) aneurysm located at an anomalous origin of the fronto-orbital artery from the A1. The
fronto-orbital artery normally branches off the anterior cerebral artery just distal to the anterior
communicating artery (proximal A2). An anomalous branching of the fronto-orbital artery off the A1 seems
very rare. This anomalous artery could be mistaken for an unusually large medial lenticulostriate artery,
aberrant frontopolar artery, or the third A2. The author reviewed the literature on anomalies of the A1
and the fronto-orbital artery.
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