Distal Middle Cerebral Artery Aneurysm: Case Report

Choi, Woo Jin; Yee, Gi Taek; Sohn, Moon Jun; Choi, Chan Young; Yoon, Sang Won; Whang, Choong Jin

Abstract

OBJECTIVE
Middle cerebral artery (MCA) aneurysm, which takes up about 25% of all intracranial aneurysms, usually occurs in MCA bifurcation, and 10% occurs in proximal MCA, and about 1% occurs in distal MCA. For that reason, it is rare to find an understanding and report on distal MCA aneurysm in its clinical aspect and radiological characteristics. In this class, four people experienced distal MCA aneurysm with subarachnoid hemorrhage (SAH), and it was reported along with document research.
METHODS
Among the 214 intracranial aneurysm operations carried out in this class from May 2001 to May 2004, We report four ruptured distal MCA aneurysms.
RESULTS
Distal MCA aneurysm was equal male to female ratio, and manifested in M2 segment mainly. In the case of ruptured distal MCA aneurysm, intracerebral hematoma (ICH) is usually accompanied, showing poor pre-operation grade, and no intracranial aneurysm was found on other regions. Except one case of mycotic aneurysm, all were saccular types. Aneurysm clipping was carried out in trans-sylvian approach, and except one case of Glasgow Coma Scale (GCS) of 3 points before operation, all showed good recovery.
CONCLUSION
Distal MCA aneurysm is usually accompanied by ICH and shows poor preoperative grade, but early surgery draws favorable outcome. Distal aneurysm is not anatomically well known and has problems in dissection, therefore intraoperative angiography can be helpful to the surgery, and in case distal MCA aneurysm should be discovered, it is wise to carry out an evaluation on the possibility of mycotic aneurysm.