J Cerebrovasc Endovasc Neurosurg.  2015 Sep;17(3):223-226. 10.7461/jcen.2015.17.3.223.

An Unruptured Cerebral Aneurysm at the Origin of the Duplicated Middle Cerebral Artery

Affiliations
  • 1Department of Neurosurgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea. chl68@gnu.ac.kr

Abstract

A variety of cerebral vascular anomalies are widely applied, however anomalies of the middle cerebral artery (MCA) are relatively infrequent. The duplicated MCA (DMCA) is a MCA anomaly. Aneurysm arising from the origin of the DMCA is rare. Cerebral angiography in a 61-year-old female demonstrated a small (about 3 mm) saccular aneurysm located at the origin of the DMCA in the anterior direction. Considering the unusual location, the lesion was treated, regardless of the size. Aneurysmal characteristics of a broad neck and small size limited the endovascular approach, necessitating open surgery. Her postoperative course was uneventful and postoperative angiography showed complete obliteration of the aneurysm. The patient was discharged without neurologic deficit.

Keyword

Middle cerebral artery; Duplicated; Aneurysm

MeSH Terms

Aneurysm
Angiography
Cerebral Angiography
Female
Humans
Intracranial Aneurysm*
Middle Aged
Middle Cerebral Artery*
Neck
Neurologic Manifestations

Figure

  • Fig. 1 Preoperative CT angiography (CTA) showing an unusual vessel originating from the right distal ICA (arrowhead) and an associated small saccular aneurysm. ICA = internal carotid artery.

  • Fig. 2 Preoperative oblique three-dimensional rotational cerebral angiography showing a vessel from the right distal ICA coursing parallel with other MCA branches to the Sylvian fissure and a small aneurysm. ICA = internal carotid artery; MCA = middle cerebral artery.

  • Fig. 3 Intraoperative microscopic view showing detailed anatomy around the DMCA and aneurysm. DMCA = duplicate MCA.

  • Fig. 4 Microscopic view showing after aneurysmal clipping.

  • Fig. 5 Postoperative cerebral angiography showing complete occlusion of the aneurysm and patent DMCA. DMCA = duplicate MCA.


Cited by  1 articles

A case of an unruptured duplicated middle cerebral artery aneurysm–An unusual presentation of the distal internal carotid artery aneurysm
Bu Kwang Oh, Young Ha Kim, Chang Hyeun Kim, Sang Weon Lee, Soon Ki Sung, Geun Sung Song
J Cerebrovasc Endovasc Neurosurg. 2021;23(3):240-244.    doi: 10.7461/jcen.2021.E2020.10.004.


Reference

1. Alpers BJ, Berry RG, Paddison RM. Anatomical studies of the circle of Willis in normal brain. AMA Arch Neurol Psychiatry. 1959; 4. 81(4):409–418. PMID: 13636509.
Article
2. Chang HY, Kim MS. Middle cerebral artery duplication: classification and clinical implications. J Korean Neurosurg Soc. 2011; 2. 49(2):102–106. PMID: 21519498.
3. Crompton MR. The pathology of ruptured middle-cerebral aneurysms with special reference to the differences between the sexes. Lancet. 1962; 9. 2(7253):421–425. PMID: 13882322.
Article
4. Elsharkawy A, Ishii K, Niemela M, Kivisaari R, Lehto H, Hernesniemi J. Management of aneurysms at the origin of duplicated middle cerebral artery: series of four patients with review of the literature. World Neurosurg. 2013; 12. 80(6):e313–e318. PMID: 23043997.
Article
5. Gibo H, Carver CC, Rhoton AL Jr, Lenkey C, Mitchell RJ. Microsurgical anatomy of the middle cerebral artery. J Neurosurg. 1981; 2. 54(2):151–169. PMID: 7452329.
Article
6. Kai Y, Hamada J, Morioka M, Yano S, Kudo M, Kuratsu J. Treatment of unruptured duplicated middle cerebral artery aneurysm: case report. Surg Neurol. 2006; 2. 65(2):190–193. discussion 193PMID: 16427423.
Article
7. Komiyama M, Nakajima H, Nishikawa M, Yasui T. Middle cerebral artery variations: duplicated and accessory arteries. AJNR Am J Neuroradiol. 1998; 1. 19(1):45–49. PMID: 9432156.
8. Kwak R, Kuwahara K, Niizuma H, Suzuki J. Anomalies of the cerebral artery with intracranial saccular aneurysms-duplication and fenestration. No Shinkei Geka. 1979; 7. 7(7):691–696. PMID: 471180.
9. Miyahara K, Fujitsu K, Ichikawa T, Mukaihara S, Okada T, Kaku S. Unruptured saccular aneurysm at the origin of the duplicated middle cerebral artery: Reports of two cases and review of the literature. No Shinkei Geka. 2009; 12. 37(12):1241–1245. PMID: 19999558.
10. Takahashi S, Hoshino F, Uemura K, Takahashi A, Sakamoto K. Accessory middle cerebral artery: is it a variant form of the recurrent artery of Heubner? AJNR Am J Neuroradiol. 1989; May-Jun. 10(3):563–568. PMID: 2501988.
11. Teal JS, Rumbaugh CL, Bergeron RT, Segall HD. Anomalies of the middle cerebral artery: accessory artery, duplication, and early bifurcation. Am J Roentgenol Radium Ther Nucl Med. 1973; 7. 118(3):567–575.
Article
12. Uchino M, Kitajima S, Sakata Y, Honda M, Shibata I. Ruptured aneurysm at a duplicated middle cerebral artery with accessory middle cerebral artery. Acta Neurochir (Wien). 2004; 12. 146(12):1373–1374. discussion 1375PMID: 15340873.
Article
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