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Yu J. Current state and confusion of twig-like middle cerebral artery. Interv Neuroradiol 2024; 30:361-371. [PMID: 35979607 PMCID: PMC11310732 DOI: 10.1177/15910199221121380] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 08/03/2022] [Indexed: 11/17/2022] Open
Abstract
A twig-like middle cerebral artery (MCA) is an uncommon lesion in which a plexiform network of small vessels replaces the M1 segment of the MCA. Currently, we have insufficient information for twig-like MCAs. Therefore, a review of the literature using PubMed was conducted. In this review of twig-like MCAs, the following were discussed: the definition, pathogenesis, hemodynamics, associated aneurysm, clinical manifestations, imaging examinations, therapeutic strategies, therapeutic complications and prognosis. In addition, we proposed a reasonable grading system for twig-like MCAs, which is significant. For a twig-like MCA, the pathogenesis is unclear, and congenital and acquired factors can be involved. A twig-like MCA disturbed cerebral hemodynamics. An associated aneurysm can occur in patients with twig-like MCAs. Twig-like MCAs can present subclinically and without clinical symptoms, hemorrhage, or ischemic strokes. Of all the available imaging examinations, digital subtracted angiography is the gold standard. When treating a twig-like MCA, it is feasible to target the associated aneurysm, and extracranial-intracranial bypass can be effective in reducing the risk of strokes, but more evidence is needed. Now, the decision to perform surgery for twig-like MCAs should be made on a case-by-case basis.
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Affiliation(s)
- Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
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2
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Zhou Z, Yu J. Coiling an aneurysm in the twig-like MCA via a Marathon microcatheter: A case report. Int J Surg Case Rep 2024; 119:109661. [PMID: 38692120 PMCID: PMC11070228 DOI: 10.1016/j.ijscr.2024.109661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/10/2024] [Accepted: 04/19/2024] [Indexed: 05/03/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE The twig-like middle cerebral artery (MCA) is rare and has a plexiform network of small vessels that replaces the MCA trunk, with a prevalence ranging from 0.11 %-1.17 %. It can be associated with an aneurysm. A Marathon microcatheter may be an alternative for coiling procedures. However, this technique has rarely been reported. PRESENTATION OF CASE A 63-year-old man suffered from headaches. The neurological examination results were unremarkable. Angiography revealed a twig-like MCA with an unruptured aneurysm. Due to stenosis of the aneurysm neck, a Marathon microcatheter was used to successfully reach the aneurysm, and coiling was completed with Chinese Visee coils. Postoperatively, the patient recovered uneventfully. Due to the lack of ischemic changes in the right hemisphere, the patient was kept under follow-up observation. At the 8-month follow-up by telephone, the patient was healthy. CLINICAL DISCUSSION Aneurysms in the twig-like MCA may have stenosis of the aneurysm neck, and routine microcatheters used to deliver coils are often too thick to catheterize the aneurysm neck. The Marathon microcatheter has a distal inner diameter (ID) of 0.013, and as an alternative for coiling procedures, it may be soft enough to thin enough to go into the aneurysm. However, it can be used in the delivery of certain coils. CONCLUSION Aneurysms in the twig-like MCA are difficult to catheterize with the routine microcatheters used to deliver coils. A Marathon microcatheter may be used to perform the coiling procedure. However, only certain coils that match the Marathon microcatheter can be chosen.
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Affiliation(s)
- Zibo Zhou
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, China.
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3
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Kawakami M, Murai S, Kusaka N, Baba F, Inoue Y, Miyake H, Shinji Y, Itami H, Otsuka S, Nishiura T, Ogihara K. Non-aneurysmal subarachnoid hemorrhage in aplastic or twig-like middle cerebral artery: A case report and literature review. J Stroke Cerebrovasc Dis 2024; 33:107582. [PMID: 38237811 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Aplastic or twig-like middle cerebral artery (Ap/T-MCA) is a rare vascular anomaly that can cause hemorrhagic and ischemic stroke. Ap/T-MCA can induce aneurysms due to the fragility of the vessel wall, consequently leading to subarachnoid hemorrhage. Herein, we report a case of Ap/T-MCA with subarachnoid hemorrhage without an aneurysm. CASE PRESENTATION A 67-year-old man presented to our hospital with a sudden onset of headache. Computed tomography of the head revealed subarachnoid hemorrhage (SAH) in the left Sylvian fissure; however, no aneurysm was observed on digital subtraction angiography. Following conservative treatment, follow-up imaging showed no aneurysm or no recurrent stroke. CONCLUSION Non-aneurysmal SAH is a possible indication of vessel wall fragility in Ap/T-MCA; however, a standardized treatment strategy for this condition remains to be established.
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Affiliation(s)
- Masato Kawakami
- Department of Neurological Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences.
| | | | - Noboru Kusaka
- Department of Neurological Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Fukiko Baba
- Department of Neurosurgery, Iwakuni Clinical Center.
| | - Yohei Inoue
- Department of Neurological Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Hayato Miyake
- Department of Neurological Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences.
| | - Yukei Shinji
- Department of Neurosurgery, Japanese Red Cross Society Himeji Hospital
| | | | - Shinji Otsuka
- Department of Neurosurgery, Iwakuni Clinical Center.
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Kajita M, Yanaka K, Hanai S, Aiyama H, Takahashi N, Saiki S, Ishikawa E. De novo formation of twig-like middle cerebral artery: An illustrative case. Surg Neurol Int 2023; 14:192. [PMID: 37404498 PMCID: PMC10316151 DOI: 10.25259/sni_274_2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/17/2023] [Indexed: 07/06/2023] Open
Abstract
Background Twig-like middle cerebral artery (T-MCA) is a rare vascular abnormality characterized by the replacement of the M1 segment of the middle cerebral artery (MCA) with a plexiform arterial network of small vessels. T-MCA is generally regarded as an embryological persistence. Conversely, T-MCA may also be a secondary sequela but no reports of cases of de novo formation exist. Here, we report the first case describing possible de novo T-MCA formation. Case Description A 41-year-old woman was referred to our hospital from a nearby clinic because of transient left hemiparesis. Magnetic resonance (MR) imaging revealed mild stenosis of the bilateral MCAs. The patient then underwent MR imaging follow-ups once a year. MR imaging at the age of 53 showed a right M1 occlusion. Cerebral angiography revealed a right M1 occlusion and formation of a plexiform network consistent with the occlusion site, leading to the diagnosis of de novo T-MCA. Conclusion This is the first case report describing possible de novo T-MCA formation. Although a detailed laboratory examination did not confirm the etiology, autoimmune disease was suspected to have precipitated this vascular lesion.
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Affiliation(s)
- Michihide Kajita
- Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan
| | - Kiyoyuki Yanaka
- Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan
| | - Sho Hanai
- Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan
| | - Hitoshi Aiyama
- Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan
| | - Nobuyuki Takahashi
- Department of Radiology, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan
| | - Shinji Saiki
- Department of Neurology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Terakado T, Matsumaru Y, Ishikawa E. Anterior cerebral artery dissection for a patient with ipsilateral aplastic or twig-like middle cerebral artery: An illustrative case report. Surg Neurol Int 2023; 14:154. [PMID: 37151429 PMCID: PMC10159307 DOI: 10.25259/sni_170_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/12/2023] [Indexed: 05/09/2023] Open
Abstract
Background An aplastic or twig-like middle cerebral artery (Ap/T-MCA) is a rare anomaly, which sometimes causes ischemic infarction. Collateral flow from the ipsilateral anterior cerebral artery (ACA) is important for patients with Ap/T-MCA. If ipsilateral ACA stenosis or occlusion occurs, a large infarction with a wider field than the ACA territory could happen. First, mechanical thrombectomy was performed for the right ACA near occlusion caused by arterial dissection with ipsilateral Ap/T-MCA in this case. Second, Wingspan stenting was performed for the right ACA restenosis. Case Description A 77-year-old female presented to the hospital with the left hemiparesis. We diagnosed a right ACA infarction caused by right ACA occlusion. Digital subtraction angiography showed right Ap/T-MCA and ipsilateral ACA near occlusion. Thrombectomy was performed, and recanalization was achieved with mild ACA stenosis. The lesion was the dissection due to angiographical finding. Two months after treatment, transient left hemiparesis occurred and right ACA stenosis progressed. Computed tomography perfusion showed hypoperfusion of the right hemisphere. Wingspan stenting was performed from the left internal carotid artery through the anterior communicating artery with an intermediate catheter. The patient was discharged without any neurological deficit. Conclusion We reported the first case of a patient who underwent Wingspan stenting for the right ACA dissection with Ap/T-MCA. Short-term follow-up and aggressive intervention should be considered for collateral pathway dissection with Ap/T-MCA because the symptoms can become serious. The patients with Ap/T-MCA should be cautious about the collateral pathway arterial changes in particular ipsilateral ACA due to the increasing hemodynamic stress.
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Affiliation(s)
- Toshitsugu Terakado
- Department of Neurosurgery, Koyama Memorial Hospital, Kashima, Japan
- Corresponding author: Toshitsugu Terakado, Department of Neurosurgery, Koyama Memorial Hospital, Kashima, Japan.
| | - Yuji Matsumaru
- Department of Stroke Prevention and Treatment, Tsukuba, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, University of Tsukuba, Tsukuba, Japan
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Zhang L, Su H, Yu J. Case report: Endovascular coil embolization of an aneurysm at the origin of the accessory middle cerebral artery from the A1 segment as the collateral artery to twigs. Front Neurol 2023; 14:1078173. [PMID: 37153660 PMCID: PMC10157198 DOI: 10.3389/fneur.2023.1078173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/27/2023] [Indexed: 05/10/2023] Open
Abstract
An aneurysm at the origin of the accessory middle cerebral artery (AccMCA) from the A1 segment of the anterior cerebral artery (ACA) as the supplying artery of a twig-like MCA is exceptional. In this study, we reported on such a case and presented a review of the relevant literature. A 56-year-old male suffered a subarachnoid hemorrhage. Digital subtraction angiography confirmed a twig-like MCA and a ruptured aneurysm at the origin of the AccMCA. Endovascular coil embolization of the aneurysm was performed. After the microcatheter was positioned in the aneurysm, soft coils were delivered to complete the embolization. Postoperatively, the patient recovered uneventfully. One month later, the patient returned to his job without any neurological deficits. Postoperative computed tomography at the 3-month follow-up showed that the brain tissue was normal. By reporting our case and reviewing the relevant literature, we found that endovascular coil embolization for such aneurysms at the AccMCA origin is feasible in certain cases.
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Affiliation(s)
- Lei Zhang
- Department of Neurosurgery, Daqing Oilfield General Hospital, Daqing, China
| | - Han Su
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
- *Correspondence: Jinlu Yu ;
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Goto Y, Nanto M, Oka H, Murakami N, Nakagawa T, Kimura S, Iwamoto Y, Inoue Y, Matsumoto K, Miyamoto J, Hashimoto N. Radiological and clinical features of twig-like middle cerebral artery in comparison with moyamoya angiopathy: a multicenter retrospective study. J Neurosurg 2022; 137:1718-1726. [PMID: 35426829 DOI: 10.3171/2022.2.jns212338] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/24/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Twig-like middle cerebral artery (T-MCA) is a rare congenital anomaly that is difficult to distinguish from moyamoya angiopathy (MMA), given the similarity of the angioarchitectures. The aim of this study was to gain insights into the radiological and clinical features of T-MCA and to distinguish this condition from MMA. METHODS A multicenter retrospective study was conducted in 29 patients with T-MCA and 57 patients with MMA. Demographic, radiological, and clinical data were compared between the patients with T-MCA and those with MMA. RESULTS The T-MCA group tended to be older than the MMA group (mean age 47 ± 18 vs 39 ± 22 years). Twenty patients with T-MCA (69%) were initially diagnosed with MMA. All T-MCA cases had twig-like networks and steno-occlusive changes involving the MCA. The T-MCA group had a higher incidence of intracranial aneurysms (35% vs 11%) and coexisting arterial anomalies (48% vs 12%). T-MCA and MMA cases had significant differences in involvement of the internal carotid artery terminus (0% vs 100%) and posterior cerebral artery (0% vs 23%), and in transdural anastomosis (0% vs 51%). T-MCA cases were less likely to present with stroke (59% vs 86%) and more likely to be asymptomatic (28% vs 12%). Of the patients with stroke, those with T-MCA had more hemorrhagic strokes (41% vs 29%) and fewer ischemic strokes (59% vs 71%) compared to those with MMA. CONCLUSIONS This study suggests that T-MCA is a different disease entity from MMA based on significant differences in the radiological and clinical features. Neurosurgeons should recognize this anomaly and understand the key features that differentiate T-MCA from MMA.
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Affiliation(s)
- Yudai Goto
- 1Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto
- 2Department of Neurosurgery, Kyoto Daiichi Red Cross Hospital, Kyoto
| | - Masataka Nanto
- 1Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto
| | - Hideki Oka
- 3Department of Neurosurgery, Saiseikai Shigaken Hospital, Ritto
| | | | - Toru Nakagawa
- 5Department of Neurosurgery, Saiseikai Suita Hospital, Suita
| | - Satoshi Kimura
- 2Department of Neurosurgery, Kyoto Daiichi Red Cross Hospital, Kyoto
| | - Yoshihiro Iwamoto
- 6Department of Neurosurgery, Kyoto Yamashiro General Medical Center, Kizugawa
| | - Yasuo Inoue
- 7Department of Neurosurgery, Maizuru Medical Center, Maizuru
| | - Keigo Matsumoto
- 8Department of Neurosurgery, JCHO Kobe Central Hospital, Kobe; and
| | - Junichi Miyamoto
- 9Department of Neurosurgery, Saiseikai Kyoto Hospital, Nagaokakyo, Japan
| | - Naoya Hashimoto
- 1Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto
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Serrano-Rubio A, Ferrufino-Mejia BR, Balcázar-Padrón JC, Rodríguez-Rubio HA, Nathal E. Ruptured aneurysm associated with a twig-like middle cerebral artery: An illustrative case report. Surg Neurol Int 2022; 13:456. [PMID: 36324980 PMCID: PMC9610211 DOI: 10.25259/sni_678_2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/01/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Anomalies of the middle cerebral artery (MCA) are rare; among the different types of anomalies, the aplastic or twig-like (Ap/T) MCA is extremely rare and has been reported under various names, including aplastic, unfused, or rete type anomaly. The occurrence of a brain aneurysm associated with this anatomic variant is an even rare event, and probably their development and rupture are related to hemodynamic stress of the tinny wall of vessels forming the network. Case Description: We present a 43-year-old male patient with an explosive and persistent right orbitofrontal headache. A computed tomography showed a right frontobasal hematoma with intraventricular disruption. Magnetic resonance angiography showed a right MCA aneurysm and what seems to be a MCA trunk stenosis. Cerebral digital subtraction angiography demonstrated a plexiform arterial network and one aneurysm arising from the network. The patient was successfully treated by surgical clipping to evacuate the hematoma and to prevent further intracranial hemorrhages. Conclusion: The Ap/T-MCA may be associated with hemodynamic stress with a significant effect through the tinny wall of the vessels causing hemorrhage or leading to the formation and rupture of cerebral aneurysms. Based on a correct diagnosis of the anomaly, treatment can be completed successfully through different standard methods.
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9
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Luh HT, Yang ST, Lu YH, Lu YC, Chan JY, Tu YK, Su IC. Three-Dimensional Angioarchitecture of Rete Middle Cerebral Artery Anomalies and the Clinical Significance. Clin Neuroradiol 2022; 33:319-325. [PMID: 36056108 DOI: 10.1007/s00062-022-01211-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/08/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Rete middle cerebral artery (MCA) anomaly is characterized by a web-like network of arteries involving the first MCA segment (M1) and a normal downstream MCA. The detailed composition of this anomaly and the hemodynamic impacts on cerebral perfusion are rarely addressed. The purpose of this study was to elucidate the anatomical and hemodynamic perspectives of the rete MCA anomaly. METHODS From August 2020 to December 2021, 4 rete MCA anomalies were identified at Shuang Ho hospital. Clinical information, perfusion magnetic resonance (MR) imaging, and angiographic images were collected. Detailed angioarchitecture, including types of arterial feeders and extent of rete involvement, were analyzed based on three-dimensional volume-rendering reconstruction images obtained from the catheter-based angiographies. RESULTS Despite their variable clinical presentations (two hemorrhage, one ischemia, and one asymptomatic), all cases shared common angiographic findings as follows: (1) the internal carotid artery did not connect directly to the rete, (2) the anterior choroidal artery (AChA) was the artery constantly supplying the rete and (3) there was a watershed zone shift toward MCA territory. The perfusion MR cerebral blood flow map was symmetric in all studied cases. CONCLUSION The AChA is an artery constantly supplying the rete, which suggests that the angioarchitectural features associated with this anomaly may be the result of both congenital and acquired compensatory processes. Cerebral perfusion remains preserved at the lesion side, despite angiographic evidence of watershed zone shift. These findings will be important for making better clinical judgments about this condition.
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Affiliation(s)
- Hui-Tzung Luh
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, Province of China.,Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan, Province of China.,Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan, Province of China
| | - Shung-Tai Yang
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, Province of China.,Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan, Province of China.,Department of Neurosurgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, Province of China
| | - Yueh-Hsun Lu
- Department of Radiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, Province of China.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, Province of China
| | - Yu-Chun Lu
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, Province of China.,Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan, Province of China
| | - Jun-Yeen Chan
- Department of Neurosurgery, Hospital Lam Wah Ee, Georgetown, Penang, Malaysia
| | - Yong-Kwang Tu
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, Province of China.,Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan, Province of China
| | - I-Chang Su
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, Province of China. .,Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan, Province of China. .,Department of Neurosurgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, Province of China.
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Takeda H, Yanaka K, Onuma K, Nakamura K, Ishii K, Ishikawa E. Aplastic or twiglike middle cerebral artery with contralateral middle cerebral artery stenosis showing transient ischemic attack: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 3:CASE22121. [PMID: 35734606 PMCID: PMC9204927 DOI: 10.3171/case22121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 03/28/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Aplastic or twiglike middle cerebral artery (Ap/T-MCA) is a rare anomaly characterized by a unilateral MCA occlusion with plexiform vessels that causes hemorrhagic and (less commonly) ischemic strokes. The reasons for this are rarely discussed, and thus optimal treatment for ischemic Ap/T-MCA remains controversial. Here, the authors report a case of Ap/T-MCA with transient ischemic attacks treated by bypass surgery and discuss the mechanism of ischemic development and treatment methods. OBSERVATIONS A 62-year-old hypertensive man with transient, recurrent left hemiparesis visited the authors’ hospital. Magnetic resonance angiography showed proximal occlusion of the right MCA and stenosis in the left MCA. Digital subtraction angiography revealed occlusion of the right MCA and abnormal vascular networks, leading to a diagnosis of Ap/T-MCA with contralateral MCA stenosis. Antiplatelet therapy with aspirin was insufficient, and a superficial temporal artery–MCA bypass was performed. There were no ischemic or hemorrhagic events postoperatively. LESSONS Atherosclerosis seems to have a significant impact on the development of ischemic stroke in patients with Ap/T-MCA, and the presence of coexisting atherosclerotic stenotic vascular lesions outside the Ap/T-MCA site is substantial in its development. Bypass surgery is a promising treatment option for ischemic Ap/T-MCA.
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Affiliation(s)
- Hayato Takeda
- Department of Neurosurgery, Tsukuba Memorial Hospital, Ibaraki, Japan; and
| | - Kiyoyuki Yanaka
- Department of Neurosurgery, Tsukuba Memorial Hospital, Ibaraki, Japan; and
| | - Kuniyuki Onuma
- Department of Neurosurgery, Tsukuba Memorial Hospital, Ibaraki, Japan; and
| | - Kazuhiro Nakamura
- Department of Neurosurgery, Tsukuba Memorial Hospital, Ibaraki, Japan; and
| | | | - Eiichi Ishikawa
- Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Velo M, Grasso G, Fujimura M, Torregrossa F, Longo M, Granata F, Pitrone A, Vinci SL, Ferraù L, La Spina P. Moyamoya Vasculopathy: Cause, Clinical Manifestations, Neuroradiologic Features, and Surgical Management. World Neurosurg 2022; 159:409-425. [PMID: 35255640 DOI: 10.1016/j.wneu.2021.11.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 11/17/2022]
Abstract
In moyamoya disease, the progressive occlusion of the distal portion of the internal carotid artery and its major branches is typically responsible for the formation of an extensive network of collateral vessels at the base of the brain. When moyamoya collateral network develops in association with various systemic or acquired diseases, the term moyamoya syndrome is used to denote this phenomenon. Sudden changes in the supraclinoid internal carotid artery and middle cerebral artery can be recognized with noninvasive neurovascular imaging techniques, which also allow a differential diagnosis with similar diseases such as degenerative steno-occlusive disease, cerebral vasculitis, and twig-like middle cerebral artery. Once the diagnosis is established, the definitive treatment for moyamoya disease is surgical revascularization, with the goal of increasing cerebral blood flow and preventing recurrent stroke. We provide a comprehensive review of the clinical and radiologic features in moyamoya vasculopathy along with its surgical management.
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Affiliation(s)
- Mariano Velo
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Giovanni Grasso
- Neurosurgical Unit, Department of Biomedicine, Neurosciences and Advance Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Miki Fujimura
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Fabio Torregrossa
- Neurosurgical Unit, Department of Biomedicine, Neurosciences and Advance Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Marcello Longo
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Francesca Granata
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy.
| | - Antonio Pitrone
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Sergio Lucio Vinci
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Ludovica Ferraù
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Paolino La Spina
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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12
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Oi Y, Inoue Y, Taniyama I, Shirato M, Houri T. A Case of Aneurysmal Subarachnoid Hemorrhage with Middle Cerebral Artery Aplasia at 30 Weeks of Pregnancy. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 16:376-380. [PMID: 37502343 PMCID: PMC10370917 DOI: 10.5797/jnet.cr.2021-0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/22/2021] [Indexed: 07/29/2023]
Abstract
Objective We report a case of subarachnoid hemorrhage (SAH) that occurred at 30 weeks of pregnancy and was treated by coil embolization in a woman with middle cerebral artery (MCA) aplasia. Case Presentation A 40-year-old woman who was 30 weeks pregnant presented to the emergency department with a half-day history of headache and nausea. She had sudden onset headache and her symptom did not improve. There was no neurological deficit. Head CT at the referring hospital revealed SAH. The fetal state was stable. There was no sign of threatened premature delivery. Head MRA revealed aplasia of the left MCA and aneurysm with a daughter sac at the A1 segment of the anterior cerebral artery (ACA). Head DSA revealed that the A1 aneurysm with a daughter sac arose from the anomalous collateral artery leading to a plexiform network. The diagnosis was SAH due to rupture of an A1 aneurysm. Performance of less invasive coil embolization seemed to be possible and was carried out under general anesthesia. The operation was completed after placing one coil and confirming that most of the aneurysmal dome was embolized, including the daughter sac. There was no cerebral vasospasm and no obvious neurological deficit. Antiplatelet drugs were only required for 10 days after the operation. Pregnancy was stable and the patient delivered a baby by cesarean section at 38 weeks of pregnancy. Conclusion A rare case of aneurysmal SAH in a pregnant woman with MCA aplasia was successfully treated by endovascular surgery.
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Affiliation(s)
- Yuta Oi
- Department of Neurosurgery, Maizuru Medical Center, Maizuru, Kyoto, Japan
| | - Yasuo Inoue
- Department of Neurosurgery, Maizuru Medical Center, Maizuru, Kyoto, Japan
| | - Ichita Taniyama
- Department of Neurosurgery, Maizuru Medical Center, Maizuru, Kyoto, Japan
| | - Mitsuru Shirato
- Department of Neurosurgery, Maizuru Medical Center, Maizuru, Kyoto, Japan
| | - Takashi Houri
- Department of Neurosurgery, Maizuru Medical Center, Maizuru, Kyoto, Japan
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Takarada A, Yanaka K, Onuma K, Nakamura K, Takahashi N, Ishikawa E. Aplastic or twig-like middle cerebral artery harboring unruptured cerebral aneurysms treated by clipping and bypass surgery: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2021; 2:CASE21360. [PMID: 35854945 PMCID: PMC9265206 DOI: 10.3171/case21360] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/24/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Aplastic or twig-like middle cerebral artery (Ap/T-MCA) is a congenital MCA anomaly. It may present with symptoms of both hemorrhage and ischemia, similar to moyamoya disease, and hemodynamic stress may play an essential role in the development of symptoms in both clinical entities. The optimal treatment remains controversial in symptomatic patients with Ap/T-MCA. This report discussed the treatment method for a patient with Ap/T-MCA with unruptured aneurysms who presented with intraventricular hemorrhage (IVH) treated by aneurysm clipping and bypass surgery. OBSERVATIONS In a 46-year-old woman with a sudden headache, computed tomography showed left IVH. Magnetic resonance angiography showed a left MCA aneurysm and MCA trunk stenosis. Three-dimensional angiography demonstrated a plexiform arterial network and multiple aneurysms arising from the MCA and in the plexiform network, leading to the diagnosis of Ap/T-MCA harboring unruptured aneurysms. The patient was successfully treated by craniotomy with aneurysm clipping and bypass surgery to prevent further intracranial hemorrhages and/or aneurysm rupture. LESSONS Especially in cases such as Ap/T-MCA, in which hemodynamic stress has a significant effect, the optimal treatment method should be based on vascular morphology and the impact of hemodynamic stress.
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Affiliation(s)
| | | | | | | | | | - Eiichi Ishikawa
- Department of Neurosurgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Ota T, Komiyama M. Twig-like middle cerebral artery: Embryological persistence or secondary consequences? Interv Neuroradiol 2021; 27:584-587. [PMID: 34096364 DOI: 10.1177/15910199211024077] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Takahiro Ota
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Masaki Komiyama
- Department of Neurointervention, Osaka City General Hospital, Osaka, Japan
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Wang Z, Wang C, Jiang BH, Shi L, Lin S, Wang L, Liu LZ, Qiu JG, Qin Y, Jia Y. Predictive significance of STK17A in patients with gastric cancer and association with gastric cancer cell proliferation and migration. Oncol Rep 2021; 45:119. [PMID: 33955523 PMCID: PMC8107654 DOI: 10.3892/or.2021.8070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/12/2021] [Indexed: 12/14/2022] Open
Abstract
Gastric cancer (GC) is one of the most frequently diagnosed types of cancer worldwide, and exploring its potential therapeutic targets is particularly important for improving the prognosis of patients with GC. The aim of the present study was to investigate the association between serine/threonine kinase 17a (STK17A) expression and GC prognosis. STK17A expression was measured by quantitative real-time PCR, western blotting and immunohistochemical staining. Standard stable transfection technology was also used to construct overexpression and knockdown cell lines. Wound healing, Transwell, Cell Counting Kit-8 and colony formation assays, as well as other methods, were used to explore the function and underlying molecular mechanism of STK17A in GC. The results indicated that STK17A overexpression significantly promoted the proliferation and migration of GC cells. The clinical significance of STK17A in a cohort of 102 cases of GC was assessed by clinical correlation and Kaplan-Meier analyses. Overexpression of STK17A was demonstrated to be associated with tumor invasion depth (P<0.001), lymph node metastasis (P<0.001) and poor prognosis in terms of 5-year survival (P<0.001). In addition, Cox multivariate analysis revealed that STK17A expression was an independent risk factor for overall and progress-free survival (P<0.001). Therefore, STK17A may be a valuable biomarker for the prognosis of patients with GC.
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Affiliation(s)
- Zehua Wang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Chenyi Wang
- Department of General Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Bing-Hua Jiang
- Academy of Medical Science, Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Litong Shi
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Shan Lin
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Lei Wang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Ling-Zhi Liu
- Academy of Medical Science, Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Jian-Ge Qiu
- Academy of Medical Science, Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Yanru Qin
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Yongxu Jia
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
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Wang H, Liu H. An "over-fused middle cerebral artery" anomaly: a case report. BMC Neurol 2021; 21:123. [PMID: 33731030 PMCID: PMC7972202 DOI: 10.1186/s12883-021-02147-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 03/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND MCA has several anomalies, such as accessory MCA, duplicated MCA and twig-like MCA, up to now all these reported anomalies were hypothesized to due to the failure in fusion of the primitive arterial network. No anomaly of over fused MCA has been reported. CASE PRESENTATION A 59- year- old male was hospitalized with a history of paroxysmal slurred speech and left side headache for a week, his blood pressure was 160/80 mmHg and he manifested mild incomplete motor aphasia at the time of admission. The head and neck CTA and DSA all presented a huge and tortuous left MCA, we diagnosed it an anomaly and termed it over-fused MCA. The patient's speech impairment and headache were relieved by controlling his blood pressure. CONCLUSIONS Such an anomaly of over-fused MCA is reported for the first time, it's not needed to put special intervention on the anomaly of the patient temporarily, but more observation are needed.
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Affiliation(s)
- Huifang Wang
- Department of Neurology, Peking University Shougang Hospital, jinyuanzhuang No.9, Shijingshan, Beijing, China.
| | - Hui Liu
- Department of Radiology, Peking University Shougang Hospital, Jinyuanzhuang No.9, Shijingshan, Beijing, China
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Hosur B, Bhatia V, Kumar A, Karthigeyan M. Rete middle cerebral artery: a rare association with anterior cerebral artery aneurysm rupture. BMJ Case Rep 2021; 14:14/2/e240219. [PMID: 33526539 PMCID: PMC7852965 DOI: 10.1136/bcr-2020-240219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Haemodynamic flow-related stress at the vessel curvatures is an important risk factor for intracranial aneurysmal growth and rupture. The rete middle cerebral artery (MCA) is a rare entity causing hyperdynamic blood flow into the ipsilateral anterior cerebral artery (ACA), especially when the contralateral A1-segment is non-dominant. Ruling out the clinicoradiological mimics like vasculitis, moyamoya and chronic occlusive disease with vessel wall imaging and detailed investigations helps manage the clinical entity effectively. We present a successfully managed case of ruptured ACA aneurysm at the acute curvature of the A1-A2 junction associated with ipsilateral rete MCA. Pre-emptive diagnosis of the rete MCA can aid preventive strategies to manage rupture and regrowth of the aneurysm at the points of flow-related stress.
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Affiliation(s)
- Bharat Hosur
- Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Bhatia
- Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Kumar
- Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhivanan Karthigeyan
- Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Twig-like middle cerebral arteries: Clinical and radiological findings. Clin Imaging 2020; 73:31-37. [PMID: 33296771 DOI: 10.1016/j.clinimag.2020.11.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 10/26/2020] [Accepted: 11/24/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE Aplastic or twig-like middle cerebral artery (MCA) is a rare vascular anomaly characterized by replacement of the M1 segment by a plexiform network of small vessels. Though rare, familiarity with this entity and ability to differentiate it from radiological mimics such as moyamoya changes and steno-occlusive diseases are important. We review the clinical and radiological manifestations of patients diagnosed with twig-like MCA on cerebral angiograms over a five-year period. MATERIALS AND METHODS Retrospective review of all patients diagnosed with twig-like MCA on cerebral angiograms was performed from January 2015 to January 2020. This was the inclusion criterion for this retrospective study. For each patient, demographic data, clinical presentation, imaging findings and management strategies were reviewed. RESULTS AND CONCLUSIONS Between January 2015 and January 2020, three patients with twig-like MCA were identified from 657 patients who underwent four-vessel diagnostic cerebral angiograms (0.45%). In all three cases, the involvement was unilateral (two left-sided and one right- sided). Two patients were male, and one was female. Patients ages were 25, 26 and 46 years. Two of the three patients presented with headache and the third patient with pulsatile tinnitus. There were otherwise no ischemic or hemorrhagic changes. No other vascular anomaly was identified. Twig-like MCA is a rare anatomical variant in which a plexiform network of small vessels replaces the M1 segment of the MCA. Accurate diagnosis and distinguishing this entity from radiological mimics such as moyamoya and steno-occlusive diseases are important for appropriate management and to prevent unnecessary investigations.
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Viso R, Lylyk I, Albiña P, Lundquist J, Scrivano E, Lylyk P. Hemorrhagic events associated with unfused or twig-like configuration of the Middle cerebral artery: A rare vascular anomaly with clinical relevance. Interv Neuroradiol 2020; 27:285-290. [PMID: 33121291 DOI: 10.1177/1591019920970430] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Twig-like middle cerebral artery configuration (Tw-MCA) is a rare and commonly misdiagnosed vascular anomaly characterized by a plexiform arterial network that replaces the normal M1 segment. The prevalence and clinical relevance of this anomaly is not fully established. MATERIAL AND METHODS We sought to explore the prevalence of Tw-MCA in patients clinically referred to digital angiography in a single academic comprehensive endovascular center and evaluated the radiological and clinical findings among patients with hemorrhagic events. RESULTS From 2011 to 2020, a total of 10,234 patients underwent a cerebral angiography at our institution. During this period, 9 (0.088%) Tw-MCAs were identified. Out of these, 5 patients (62.5%) were admitted due to an intracranial hemorrhage. Two patients had a ruptured intracranial aneurysm on the anterior communicating artery, one with multiple brain aneurysms; two patients presented an intraparenchymal hematoma (IPH) due to the presence of a periventricular anastomosis and one patient an intraventricular hemorrhage with unclear origin. CONCLUSION Tw-MCA is a very rare vascular anomaly associated with hemorrhagic events. Adequate identification of this anomaly is essential in order to avoid misdiagnosis as steno-occlusive disorders.
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Affiliation(s)
- Rene Viso
- Departamento de Neuroradiología Intervencionista, Instituto Medico Eneri-Clinica La Sagrada Familia, Buenos Aires, Argentina
| | - Ivan Lylyk
- Departamento de Neuroradiología Intervencionista, Instituto Medico Eneri-Clinica La Sagrada Familia, Buenos Aires, Argentina
| | - Pablo Albiña
- Departamento de Neurocirugía, Hospital Barros Luco Trudeau, Santiago, Chile.,Departamento de Anatomía, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javier Lundquist
- Departamento de Neuroradiología Intervencionista, Instituto Medico Eneri-Clinica La Sagrada Familia, Buenos Aires, Argentina
| | - Esteban Scrivano
- Departamento de Neuroradiología Intervencionista, Instituto Medico Eneri-Clinica La Sagrada Familia, Buenos Aires, Argentina
| | - Pedro Lylyk
- Departamento de Neuroradiología Intervencionista, Instituto Medico Eneri-Clinica La Sagrada Familia, Buenos Aires, Argentina
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Wei W, Liu C. Prognostic and predictive roles of microRNA‑411 and its target STK17A in evaluating radiotherapy efficacy and their effects on cell migration and invasion via the p53 signaling pathway in cervical cancer. Mol Med Rep 2019; 21:267-281. [PMID: 31746360 PMCID: PMC6896360 DOI: 10.3892/mmr.2019.10826] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 10/10/2018] [Indexed: 02/06/2023] Open
Abstract
Cervical cancer is one of the most common gynecological malignancies worldwide. However, the pathogenesis of cervical cancer remains to be fully elucidated. Increasing evidence shows that microRNAs (miRNAs) may be involved in the pathogenesis of cervical cancer. The present study tested the hypothesis that the overexpression of miRNA (miR)-411 may delay, whereas the overexpression of serine/threonine kinase 17a (STK17A) may contribute to, cervical cancer development and progression through the p53 pathway. Cervical cancer tissues and adjacent normal tissues were obtained from 141 patients with cervical cancer following radiotherapy, with efficacy evaluated. The receiver operating characteristic curve was plotted to show the value of miR-411 and STK17A in predicting the efficacy of radiotherapy. Cox's proportional hazards regression model was utilized for multivariate analysis. A series of inhibitors, mimics or small interfering RNAs against STK17A were introduced to validate the regulatory mechanism of miR-411 in governing STK17A, determined with a luciferase reporter gene assay. The expression of miR-411 and STK17A, and the status of the p53 signaling pathway were evaluated. The colony forming ability, proliferation, migration, invasion and apoptosis of CaSki cells were assessed using a colony formation assay, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, Transwell assay and flow cytometry, respectively. miR-411 was upregulated but STK17A was reciprocal in cervical tissues. The overexpression of miR-411 and low expression of STK17A were correlated with high efficacy of radiotherapy. miR-411 and STK17A had predictive value for the efficacy of radiotherapy; miR-411 was the protective factor and STK17A was a risk factor for prognosis of cervical cancer. Increasing miR-411 activated the p53 signaling pathway and promoted cell apoptosis, but inhibited cell proliferation, invasion and migration. STK17A, an miR-411 target, increased following miR-411 over-expression, whereas the p53 signaling pathway was activated following STK17A inhibition. It was observed that the effect of miR-411 inhibition was lost following STK17A silencing. These findings indicate that the miR-411-mediated direct suppression of STK17A induces apoptosis and suppresses the proliferation, migration and invasion of human cervical cancer cells via the p53 signaling pathway. Additionally, miR-411 and STK17A have predictive value for the efficacy of radiotherapy.
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Affiliation(s)
- Wei Wei
- Department of Clinical Laboratory, Jining No. 1 People's Hospital, Jining, Shandong 272011, P.R. China
| | - Cun Liu
- Department of Clinical Laboratory, Jining No. 1 People's Hospital, Jining, Shandong 272011, P.R. China
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21
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Cho KC, Kim JJ, Jang CK, Hong CK, Joo JY, Kim YB. Rete middle cerebral artery anomalies: a unifying name, case series, and literature review. J Neurosurg 2019; 131:453-461. [PMID: 30074465 DOI: 10.3171/2018.2.jns1832] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 02/23/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Rete middle cerebral artery (MCA) is extremely rare and has not been frequently discussed. Rete MCA is a weblike anomaly of the MCA that does not coalesce and forms a prominent, large single branch from the plexiform vessels in the fetal stage. The purpose of this study was to further elucidate the clinical and radiological characteristics of patients with rete MCA. METHODS A total of 2262 cerebral digital subtraction angiography procedures were performed on 1937 patients at the authors' institution from February 2013 to May 2017. Data analysis included age, sex, clinical symptoms, underlying diseases, coexisting cerebral arterial anomalies, and operative methods and findings. RESULTS Rete MCAs were found in 13 patients, and the incidence of this anomaly was 0.67% (13 of 1937) in this study. Of the 13 patients, 3 had hemorrhagic strokes, 6 had ischemic strokes, and 4 had no symptoms. Eight patients underwent conservative treatment, and 5 patients underwent surgical treatment. Rete MCA is considered a congenital disease of the cerebral vasculature with the possibility of an acquired abnormality, such as an aneurysm, caused by hemodynamic stress. Although an epidemiological survey of rete MCA was not conducted, it is assumed that rete MCA has a high prevalence in Asia. Ischemic and hemorrhagic stroke events are fairly common in rete MCA. CONCLUSIONS Clinicians should understand the radiological and clinical features of patients with rete MCA to avoid misdiagnosis and unnecessary treatment. This anomaly should be differentiated from other vascular diseases and patients presenting incidentally should be carefully monitored because of their vulnerability to both hemorrhagic and ischemic strokes.
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Affiliation(s)
- Kwang-Chun Cho
- 1Department of Neurosurgery, College of Medicine, Catholic Kwandong University, International St. Mary's Hospital, Incheon; and
| | - Jung-Jae Kim
- 2Department of Neurosurgery, College of Medicine, Yonsei University, Gangnam Severance Hospital, Seoul, Korea
| | - Chang-Ki Jang
- 2Department of Neurosurgery, College of Medicine, Yonsei University, Gangnam Severance Hospital, Seoul, Korea
| | - Chang-Ki Hong
- 2Department of Neurosurgery, College of Medicine, Yonsei University, Gangnam Severance Hospital, Seoul, Korea
| | - Jin-Yang Joo
- 2Department of Neurosurgery, College of Medicine, Yonsei University, Gangnam Severance Hospital, Seoul, Korea
| | - Yong Bae Kim
- 2Department of Neurosurgery, College of Medicine, Yonsei University, Gangnam Severance Hospital, Seoul, Korea
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Gunnal SA, Farooqui MS, Wabale RN. Study of Middle Cerebral Artery in Human Cadaveric Brain. Ann Indian Acad Neurol 2019; 22:187-194. [PMID: 31007431 PMCID: PMC6472224 DOI: 10.4103/0972-2327.144289] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Middle cerebral artery (MCA) is the larger terminal branch of the internal carotid artery. It travels through the Sylvian fissure on the insula. Objective: MCA supplies a large area of distribution than the other two cerebral arteries. Though it is so, there are very few articles in the literature describing MCA. Aim of the present work is to study the MCA regarding its origin, course, termination, branching pattern, morphometry and symmetry. Materials and Methods: 340 MCAs from 170 formalin preserved brains were dissected. Morphology, morphometry and symmetry of MCAs, were studied in detail and well photographed. The data collected in the study was analyzed. Results: Accessory MCA was found in seven specimens (2.05%). Duplicated MCA was seen in three specimens (0.88%). Aneurysm was found in three specimens (0.88%). MCA with bifurcated, trifurcated, quadrifurcated and single trunk termination was seen in 220 (64.70%), 42 (12.35%), 8 (2.35%), and in 70 (20.58%) specimens respectively. Bifurcated pattern as upper prominent trunk (type A), lower prominent trunk (type B) and both equal prominent trunks (type C) were seen in 63 (28.63%), 129 (58.63%), and 28 (12.72%) specimens respectively. Asymmetry was seen in 102 specimens (60%). Mean length and diameter of the MCA was 25.5-27.8 mm and 3 mm respectively. Conclusion: Awareness of these anatomical variations in branching patterns is important in neurovascular procedures. As very few Anatomical studies on MCA are there in the literature, this type of research work should be done by a number of scientists from a different region of the world in large scale.
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Goto Y, Oka H, Hiraizumi S, Okamoto T, Nishii S, Yamamoto H, Yamanaka T, Nanto M, Shiomi N, Hino A, Hashimoto N. Aplastic or Twig-Like Middle Cerebral Artery Presenting with Intracerebral Hemorrhage During Pregnancy: Report of Two Cases. World Neurosurg X 2019; 2:100018. [PMID: 31218292 PMCID: PMC6580884 DOI: 10.1016/j.wnsx.2019.100018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/23/2019] [Indexed: 01/04/2023] Open
Abstract
Background An aplastic or twig-like middle cerebral artery (Ap/T-MCA) is a rare congenital anomaly that can present with both ischemic and hemorrhagic stroke. The etiology of this pathology has remained unclear. Here, we report 2 cases of intracerebral hemorrhage (ICH) owing to an Ap/T-MCA in pregnant patients. Case Description In both patients, cerebral angiography revealed a steno-occlusive lesion and an abnormal arterial network on the unilateral middle cerebral artery. One patient was treated conservatively for a putaminal hemorrhage, and a cesarean section was performed uneventfully 6 months after onset of the ICH. The other patient underwent a craniotomy for evacuation of the lobar hemorrhage. Subsequently, a cesarean section was performed uneventfully. Both patients gradually recovered without significant disabilities. Conclusions An Ap/T-MCA is a rare congenital anomaly and is a potential cause of ICH for pregnant patients. A cesarean section is a useful option for pregnant patients with this condition.
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Affiliation(s)
- Yudai Goto
- Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hideki Oka
- Department of Neurosurgery, Saiseikai Shigaken Hospital, Shiga, Japan
| | - Shiho Hiraizumi
- Department of Emergency and Critical Care Center, Saiseikai Shigaken Hospital, Shiga, Japan
| | - Takanari Okamoto
- Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Sho Nishii
- Department of Neurosurgery, Saiseikai Shigaken Hospital, Shiga, Japan
| | - Hiroyuki Yamamoto
- Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takumi Yamanaka
- Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masataka Nanto
- Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Naoto Shiomi
- Department of Emergency and Critical Care Center, Saiseikai Shigaken Hospital, Shiga, Japan
| | - Akihiko Hino
- Department of Neurosurgery, Saiseikai Shigaken Hospital, Shiga, Japan
| | - Naoya Hashimoto
- Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Abstract
There are several anomalies of the middle cerebral artery (MCA) in humans, such as accessory MCA, duplicated MCA, fenestration of MCA, and duplicated origin of MCA. Recently, unfused or twig-like MCA, which indicates MCA trunk occlusion with collateral plexiform arterial network, have been reported. During the embryonic stage, MCA is thought to generate from plexiform arterial twigs arising from the anterior cerebral artery, and these twigs form the definitive MCA by fusion and regression at the end of the development stage. Any interruption during the fusion of the arterial twigs may result in MCA anomalies, and the unfused or twig-like MCA, especially, is hypothesized to be the persistent primitive arterial twigs. Clinically, it is challenging to differentiate the unfused or twig-like MCA from unilateral moyamoya disease, in which stenotic change begins at the MCA. The knowledge of the anomalies of the MCA is important to perform a safe surgical or endovascular intervention.
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Tashiro R, Inoue T, Shibahara I, Ezura M, Uenohara H, Fujimura M, Tominaga T. Nonaneurysmal Subarachnoid Hemorrhage Due to Unfused or Twiglike Middle Cerebral Artery Rupture: Two Case Reports. J Stroke Cerebrovasc Dis 2016; 25:e77-8. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.03.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/23/2016] [Accepted: 03/15/2016] [Indexed: 11/15/2022] Open
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26
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Unfused or twig-like middle cerebral artery. Eur J Radiol 2015; 84:2013-8. [DOI: 10.1016/j.ejrad.2015.06.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 06/10/2015] [Accepted: 06/15/2015] [Indexed: 11/23/2022]
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Flow-related intracranial aneurysms associated with unfused arterial twigs relevant to different vascular anomalies: embryologic and hemodynamic considerations. Acta Neurochir (Wien) 2014; 156:1637-46. [PMID: 25030267 DOI: 10.1007/s00701-014-2165-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 06/19/2014] [Indexed: 10/25/2022]
Abstract
OBJECT Cerebrovascular anomalies resulting from the persistence of unfused embryonic twig-like vessels are associated with intracranial aneurysms. All records of patients with ruptured intracranial aneurysms who were treated at our institution were retrospectively reviewed for the presence of aneurysm-associated, unfused, twig-like vessels in the middle cerebral artery (MCA). Such vessels were recorded as twig-like MCA (T-MCA) or twig-like networks of an anomalous collateral artery (T-NACA). Additionally, we sought to characterize vulnerable intracranial aneurysms associated with those vascular anomalies. METHODS A total of 442 ruptured aneurysms were treated from June 2006 to November 2013; of these, 4 ruptured aneurysms exhibited the presence of ipsilateral, unfused, twig-like vessels. Computed tomography (CT) scans, three-dimensional CT angiography, and digital subtraction angiography (DSA) were performed immediately after the initial ictus. Data analysis included age, sex, Hunt and Hess grade (HHG), Fisher grade (FG), medical risk factors, angiographic architecture, operative methods and findings, radiologic outcomes, and Glasgow outcome scale (GOS). The average follow-up period was 26 months. RESULTS Patient ages ranged from 26 to 49 years with a mean age of 41; there were two females and two males. All four patients showed FG IV, and three patients had unfavorable HHG (IV in 2 and V in one) at admission. An M1 segmental occlusion and an adjacent small aneurysmal pouch were detected with three-dimensional CT angiography in three patients. Hypertension was recorded in all patients. The initial DSA revealed T-MCA in one patient and T-NACA in three patients. Six aneurysms in all, including two unruptured aneurysms, were found; three ruptured aneurysms existed inside of the twigs. All but one patient required diverse treatment modalities, and four of the five aneurysms were completely occluded after treatment. The remaining aneurysm, treated only with gluing, disappeared during follow-up. In two of the three patients with T-NACA, atresia of the M1 segment was confirmed intraoperatively. The GOS during follow-up was recorded as favorable (good recovery) in two patients and unfavorable (severe disability and permanent vegetative state) in two patients. CONCLUSIONS These unique vascular anomalies, T-MCA and T-NACA, which are caused by heterogeneous maldevelopment of the primitive cerebral vessels, are not benign because of their frequent association with flow-related aneurysms, which are vulnerable to rupture. Microsurgical or endovascular treatments for this type of flow-related aneurysm associated with twigs are mandatory to prevent fatal rebleeding, and more attention has to be given when physicians encounter steno-occlusive MCA lesions in patients with subarachnoid hemorrhage to detect any vulnerable aneurysms associated with twig-like vessels.
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Lee IH, Jeon P, Kim KH, Byun HS, Kim HJ, Kim ST, Kim JS. Endovascular treatment of a ruptured accessory middle cerebral artery aneurysm. J Clin Neurosci 2010; 17:383-4. [PMID: 20074969 DOI: 10.1016/j.jocn.2009.02.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Revised: 02/14/2009] [Accepted: 02/17/2009] [Indexed: 11/18/2022]
Abstract
A 51-year-old female presented with bilateral accessory middle cerebral arteries (MCA) with associated ruptured aneurysm manifesting as a subarachnoid hemorrhage. Angiography demonstrated the bilateral accessory MCA and associated ruptured aneurysm at the junction of the left anterior cerebral artery and left accessory MCA. This was successfully treated by coil embolization. Magnetic resonance angiography obtained 6 months later revealed no evidence of residual or recurring aneurysm.
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Affiliation(s)
- In Ho Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-dong, Gangnam-gu, Seoul 135-710, Korea
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