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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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Hou K, Xu K, Liu H, Li G, Yu J. The Clinical Characteristics and Treatment Considerations for Intracranial Aneurysms Associated With Middle Cerebral Artery Anomalies: A Systematic Review. Front Neurol 2020; 11:564797. [PMID: 33193002 PMCID: PMC7654337 DOI: 10.3389/fneur.2020.564797] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/10/2020] [Indexed: 11/17/2022] Open
Abstract
Background: As a result of their low incidence, most of the studies on intracranial aneurysms associated with middle cerebral artery (MCA) anomalies were presented as case reports or small case series. No systematic review on this specific entity has been conducted. Methods: A PubMed search of the published studies was performed on April 6th, 2019 for patients who had intracranial aneurysms associated with MCA anomalies. The languages included in this study were English, Chinese, and Japanese. Results: Finally, 58 articles reporting of 67 patients including 1 case in our center were included. The identified patients (37 females, 55.2%) aged from 4 to 81 (49.85 ± 15.22) years old. 50 (50/67, 74.6%) patients presented with hemorrhagic stroke either from the MCA anomalies associated aneurysms or other sources. 63 aneurysms (63/67, 94.0%) were saccular, 3 (4.5%) were dissecting or fusiform, and 1 (1.5%) was pseudoaneurysm. 32 (32/65, 49.2%) patients had other concurrent cerebrovascular anomalies. 56 (83.6%) patients underwent open surgeries, 8 (11.9%) patients underwent endovascular treatment, and 3 (4.5%) patients were conservatively managed. 56 (56/61, 91.8%) patients achieved a good recovery. Conclusions: The pathophysiological genesis of intracranial aneurysms associated with MCA anomalies is still obscure. The inflicted patients tend to have other concurrent cerebrovascular anomalies, which denotes that congenital defect in cerebrovascular development might play a role in this process. Most of the affected patients could experience a good recovery after treatment.
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Affiliation(s)
- Kun Hou
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Kan Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Hongping Liu
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Guichen Li
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
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Sharifi G, Bakhtevari MH, Sabouri S, Rezaei O. An aneurysm at the site of the fenestration of the middle cerebral artery in a patient with multiple aneurysms: A case report. Surg Neurol Int 2015; 6:S414-7. [PMID: 26539312 PMCID: PMC4597291 DOI: 10.4103/2152-7806.166177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 06/28/2015] [Indexed: 11/29/2022] Open
Abstract
Background: Middle cerebral artery (MCA) fenestration is a very rare anatomical variant of the MCA, incidentally found during magnetic resonance or computed tomography angiography. It has an incidence of 0.6%. Unlike fenestration of the posterior cerebral arterial circulation, fenestration of the anterior cerebral arterial circulation has not been well described. Methods: We present the rare case of a patient who was admitted for a ruptured aneurysm of the MCA arising at the site of the fenestration of the MCA and also an unruptured fusiform aneurysm of the right posterior communicating artery and a distal anterior cerebral artery (ACA) aneurysm. Results: The patient underwent craniotomy with microsurgical aneurysm clipping and the previously undiagnosed ruptured aneurysm, at the site of the fenestration of the MCA, arose immediately. Postoperatively, the patient awoke without a deficit. After treatment of postoperative bacterial meningitis, he was discharged on the 26th postoperative day in good condition without any neurologic deficit. Six months after the first surgery, he was operated for the distal azygos ACA aneurysm. Conclusion: Anomalies of the intracranial vasculature are common, and we describe a rare case of left MCA fenestration with an associated ruptured aneurysm at the site of the fenestration. In the literature, cases of fenestration of the MCA are sporadically reported and are only incidental findings.
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Affiliation(s)
- Guive Sharifi
- Department of Neurosurgery, Loghman e Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Sofia Sabouri
- Department of Neuroradiology, Tooska Medical Imaging Center, Tehran, Iran
| | - Omidvar Rezaei
- Department of Neurosurgery, Loghman e Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Wakabayashi Y, Hori Y, Kondoh Y, Asano T, Yamada A, Kenai H, Yamashita M, Nagatomi H. Ruptured anterior cerebral artery aneurysm at the origin of the accessory middle cerebral artery. Neurol Med Chir (Tokyo) 2011; 51:645-8. [PMID: 21946729 DOI: 10.2176/nmc.51.645] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 36-year-old female patient was admitted to our hospital with a rare case of aneurysm at the origin of the accessory middle cerebral artery (MCA) manifesting as severe headache and vomiting. Neurological examination did not detect any abnormalities or consciousness disturbance. Computed tomography demonstrated diffuse subarachnoid hemorrhage. Magnetic resonance angiography showed an aneurysm in the horizontal portion of the left anterior cerebral artery (A(1)). Digital subtraction angiography and three-dimensional digital subtraction angiography demonstrated a saccular aneurysm originating at the junction of the left A(1) and accessory MCA. Another accessory MCA originated at the proximal portion of the left A(2) without an aneurysm. Two accessory MCAs were found on the left. Neck clipping was performed via a left pterional approach. One month after admission, she was discharged without neurological deficits.
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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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Kang DH, Park J, Park SH, Hamm IS. Saccular aneurysm at the anterior communicating artery complex associated with an accessory middle cerebral artery : report of two cases and review of the literature. J Korean Neurosurg Soc 2010; 46:568-71. [PMID: 20062574 DOI: 10.3340/jkns.2009.46.6.568] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 03/05/2009] [Accepted: 10/26/2009] [Indexed: 11/27/2022] Open
Abstract
Accessory middle cerebral artery (MCA) is an infrequent vascular anomaly of the brain. Cerebral aneurysms associated with this anomalous artery are also very rare. To our knowledge, there have only been ten previous reports of an aneurysm associated with accessory MCA. The authors present two patients with accessory MCA-related aneurysms. A 38-year-old male and a 59-year-old female both presented with sudden-onset severe headache. In both patients, computed tomography (CT) scan revealed subarachnoid hemorrhage. A subsequent angiogram demonstrated an accessory MCA arising from the anterior cerebral artery (ACA) and a saccular aneurysm at the anterior communicating artery (ACoA) complex associated with an accessory MCA. Surgical clipping allowed for complete exclusion of the aneurysm from the arterial circulation. Based on our review of the ten cases of aneurysms associated with accessory MCA documented in the literature, we suggest that accessory MCA-related aneurysms can be classified according to whether the accessory MCA originates from the proximal A1 segment or from the ACoA complex. We also emphasize the importance of precise interpretation of preoperative angiograms and intraoperative precaution in determining the presence of this anomalous artery prior to temporary clip placement.
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Affiliation(s)
- Dong-Hun Kang
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
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Kim MS, Lee HK. The angiographic feature and clinical implication of accessory middle cerebral artery. J Korean Neurosurg Soc 2009; 45:289-92. [PMID: 19516946 DOI: 10.3340/jkns.2009.45.5.289] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Accepted: 04/26/2009] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Although there are several descriptions of this vessel, there is no detailed angiographic study of the accessory middle cerebral artery (AMCA) in Korea. We describe the angiographic characteristics of the cortical territory and origin of AMCA and discuss the clinical significance of this anomaly. METHODS We searched for patients with AMCAs from a retrospective review of 1,250 conventional cerebral angiograms. We determined the origins, diameters and cortical territories of these AMCAs. RESULTS Fifteen patients (15 of 1250 = 1.2%) had 16 AMCAs (one patient had bilateral AMCAs). AMCAs originated from the distal A1 in eleven cases, middle A1 in two, proximal A1 in two, and proximal A2 in one case. All AMCAs followed a course parallel to the main middle cerebral artery (MCA). All but three of these arteries were smaller than the main MCA. Thirteen of the smaller diameter AMCAs had cortical distribution to the orbito-frontal and prefrontal, and precentral areas. Three AMCAs had diameter as large as the main MCA. These three supplied the orbitofrontal, prefrontal, precentral, central and anterior-parietal arteries. CONCLUSION The AMCAs originated from A1 or A2. Most had smaller diameter than the main MCA. The AMCAs coursed along the horizontal portion of the MCA, but supplied the orbital surface, the anterior frontal lobe and sometimes wider cortical territory, including the precentral, central, anterior-parietal areas.
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Affiliation(s)
- Myoung Soo Kim
- Department of Neurosurgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Evans AL, Corkill RA, Wenderoth JD. Ruptured fusiform aneurysm of fenestrated A1 segment of the anterior cerebral artery. Neuroradiology 2006; 48:196-9. [PMID: 16453116 DOI: 10.1007/s00234-005-0031-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2004] [Accepted: 08/30/2005] [Indexed: 10/25/2022]
Abstract
We present a case report of a 56-year-old woman with a ruptured fusiform aneurysm of a fenestrated A(1) segment of the anterior cerebral artery (ACA). Fenestrated A(1) segments are rare and only a few case reports have been published of a saccular type aneurysm formation. To the best of our knowledge, there have been no documented cases of fusiform aneurysms in these segments.
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Affiliation(s)
- Amlyn L Evans
- Department of Neuroradiology, Radcliffe Infirmary, Oxford, UK
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Liu HM, Lai DM, Tu YK, Wang YH. Aneurysms in Twig-Like Middle Cerebral Artery. Cerebrovasc Dis 2005; 20:1-5. [PMID: 15925875 DOI: 10.1159/000086119] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2004] [Accepted: 02/23/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We report a vascular abnormality of the middle cerebral artery (MCA) that has not been described in the literature before. METHODS Two patients (1 male and 1 female; age 44 and 67 years, respectively) were found to have a vascular abnormality in which the main trunk of the MCA had a twig-like form. Both patients presented with intracranial hemorrhage. RESULTS In these 2 patients, the abnormality was seen before the genu of the MCA. They had an intracranial hemorrhage due to an associated aneurysm inside the twigs. The twig appeared to be a network between the bifurcation of internal carotid artery and insular segment of MCA, and it was different from the collateral circulation due to acquired occlusion or moyamoya disease. CONCLUSION This new type of vascular lesion of the MCA is not benign. It appears to be associated with the occurrence of an aneurysm, an important clinical aspect.
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Affiliation(s)
- Hon-Man Liu
- Department of Radiology, Division of Neurosurgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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Fujiwara K, Saito K, Ebina T. Saccular aneurysm of the accessory middle cerebral artery--case report. Neurol Med Chir (Tokyo) 2003; 43:31-4. [PMID: 12568319 DOI: 10.2176/nmc.43.31] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 30-year-old man presented with a rare ruptured saccular aneurysm located at the junction of the accessory middle cerebral artery and the horizontal portion (A1 segment) of the anterior cerebral artery. A right frontotemporal craniotomy was performed and the aneurysm was clipped through a transsylvian approach. The postoperative course was uneventful and he was discharged in good condition. The transsylvian approach is the method of choice for such aneurysm.
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Affiliation(s)
- Kazunori Fujiwara
- Department of Neurosurgery, Iwate Prefectural Iwai Hospital, Ichinoseki, Iwate, Japan.
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Wanibuchi M, Kurokawa Y, Ishiguro M, Fujishige M, Inaba K. Characteristics of aneurysms arising from the horizontal portion of the anterior cerebral artery. SURGICAL NEUROLOGY 2001; 55:148-54; discussion 154-5. [PMID: 11311909 DOI: 10.1016/s0090-3019(01)00396-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Aneurysms arising from the proximal portion of the anterior cerebral artery (A1: horizontal portion) are quite rare and are considered to be unique, because they are usually connected with other vascular anomalies and are sometimes part of a multiple aneurysm occurrence. A1 aneurysm cases experienced over the past seven and a half years are summarized in this paper. METHODS A total of 413 patients were surgically treated including 142 patients with subarachnoid hemorrhage (SAH); the remaining 271 patients had unruptured aneurysms. Among them, nine cases were categorized as constituent A1 aneurysms, three with SAH and six with unruptured aneurysms. RESULTS The shape of the aneurysm was saccular in all nine cases. Three of the nine cases had associated vascular malformations. The average aneurysm diameter in the three cases with SAH was 4.0 mm, which is smaller than other common aneurysms presenting with SAH. Eight aneurysms developed at the takeoff point of perforating arteries-the medial lenticulostriate artery in five cases and the recurrent artery of Heubner in three cases. In the remaining case, the aneurysm originated from the proximal end of the associated A1 fenestration. All nine patients had an excellent outcome after surgery. CONCLUSION A1 aneurysms require surgical elimination even if they are small. We emphasize the importance of preserving the blood flow of these perforating arteries by avoiding compression with either the clip blade or the clip body itself.
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Affiliation(s)
- M Wanibuchi
- Asahikawa Neurosurgical Hospital, Asahikawa, Japan
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