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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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Zedde M, Moratti C, Pavone C, Napoli M, Valzania F, Nguyen TN, Abdalkader M, Pascarella R. Twig-like Middle Cerebral Artery: Case Series in a European Population. World Neurosurg 2024; 183:e11-e21. [PMID: 37806521 DOI: 10.1016/j.wneu.2023.09.121] [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: 09/06/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVES Twig-like middle cerebral artery (MCA) is a rare anomaly where the M1 MCA is partially or completely replaced by a plexiform network. It has been described in angiographic series from Asian and South-American cohorts, but has not yet been reported in a European population. METHODS The digital subtraction angiograms (DSAs) of adult patients referred to a single neurovascular center for a diagnostic hypothesis of moyamoya arteriopathy (MMA) from 2018 to 2023 were prospectively and retrospectively checked by experienced neuroradiologists for identifying patients with twig-like MCA. The angioarchitecture of twig-like MCA was systematically evaluated and described. RESULTS Five of 30 (16.7%) male patients (mean age 55.8 + 14.7 years) of European ancestry were identified as having twig-like MCA. The clinical presentations were ischemic stroke (2 of 5), hemorrhagic stroke (1 of 5), and headache (2 of 5). All patients showed a unilateral involvement on DSA and in 1 of 5 (20%) an intracranial aneurysm was found. DSA was used to confirm the diagnosis of twig-like MCA and define the angioarchitecture and associated anomalies. An accessory MCA and recurrent artery of Heubner were found in 3 of 5 (60%) cases, feeding the network together with the anterior choroidal artery (4 of 5, 80%). CONCLUSIONS Twig-like MCA is a rare vascular anomaly, but it seems to be less rare than expected among adult European patients with suspected MMA on noninvasive neuroimaging studies. DSA is fundamental for a reliable differential diagnosis and should not be omitted in these patients.
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Affiliation(s)
- Marialuisa Zedde
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Reggio Calabria, Italy.
| | - Claudio Moratti
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, Reggio Calabria, Italy
| | - Claudio Pavone
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, Reggio Calabria, Italy
| | - Manuela Napoli
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, Reggio Calabria, Italy
| | - Franco Valzania
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Reggio Calabria, Italy
| | - Thanh N Nguyen
- Departments of Neurology, Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Rosario Pascarella
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, Reggio Calabria, Italy
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Kashtiara A, Beldé S, Schollaert J, Menovsky T. Anatomical Variations and Anomalies of the Middle Cerebral Artery. World Neurosurg 2024; 183:e187-e200. [PMID: 38101539 DOI: 10.1016/j.wneu.2023.12.052] [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: 11/23/2023] [Accepted: 12/09/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE Intracranial arteries have a high rate of variation, but a clear schematic overview is lacking. In this pictorial review we classify and depict all the variations and anomalies within the middle cerebral artery (MCA). METHODS PubMed was searched with the MeSH-term "Middle Cerebral Artery." Articles were selected based on their description of variants within the MCA. Cross-referencing was used to broaden the range of articles. The anatomical variants were then schematically drawn using the anteroposterior and lateral view during angiography of the internal carotid artery. RESULTS A total of 29 unique medical illustrations were made, depicting variation in number of vessels; variation in vessel origin; and variation in morphology. CONCLUSIONS The MCA provides vital blood supply to the frontal, parietal, temporal, and central brain structures. An overview of these variations is important to diagnose and treat patients with MCA-related pathology correctly and safely. They can aid in distinguishing pathology from normal anatomical variance; aid neurosurgeons during aneurysmal clipping or arteriovenous malformation resections; and aid interventional radiologists during thrombectomy or coiling. This article provides a summary regarding current knowledge of anatomical variations within the MCA, their prevalence and clinical relevance. A total of 29 unique illustrations were made, depicting currently known variants. We encourage all who diagnose, treat, and study the MCA to use this overview for a uniform and better understanding of its anatomy.
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Affiliation(s)
- Ardavan Kashtiara
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium; Faculty of Medicine and Health sciences, University of Antwerp, Antwerp, Belgium.
| | - Sarah Beldé
- Faculty of Medicine and Health sciences, University of Antwerp, Antwerp, Belgium
| | - Joris Schollaert
- Faculty of Medicine and Health sciences, University of Antwerp, Antwerp, Belgium
| | - Tomas Menovsky
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium; Faculty of Medicine and Health sciences, University of Antwerp, Antwerp, Belgium; Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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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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Requejo F, Teplisky D, Dutra MLG, Mouratian DM, Kikano R, Nguyen TN, Abdalkader M. Pediatric Interventional Neuroradiology. Semin Neurol 2023; 43:408-418. [PMID: 37536373 DOI: 10.1055/s-0043-1771511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Pediatric neurovascular disorders can lead to substantial mortality and morbidity if not diagnosed early and adequately managed. Children with neurovascular diseases cannot be treated as small adults as the vascular and central nervous system anatomy, physiology, and pathologies in children differ greatly from those of adults. In addition, some neurovascular pathologies are seen exclusively in children such as aneurysmal malformation of the vein of Galen, pial fistulas, and dural fistulas in the context of dural sinus disease. In this review, we aim to present an overview of the common pediatric neurovascular diseases along with their endovascular management.
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Affiliation(s)
- Flavio Requejo
- Department of Pediatric Interventional Neuroradiology, Hospital de Pediatría Prof. Dr. Juan P Garrahan, Buenos Aires, Argentina
| | - Dario Teplisky
- Department of Pediatric Interventional Radiology, Vascular Anomalies Interdisciplinary Group, Hospital de Pediatría Prof. Dr. Juan P Garrahan, Buenos Aires, Argentina
| | - María Laura González Dutra
- Department of Pediatric Interventional Neuroradiology, Hospital de Pediatría Prof. Dr. Juan P Garrahan, Buenos Aires, Argentina
| | | | - Raghid Kikano
- Department of Radiology, Lebanese American University-Gilbert and Rose Mary Chagoury School of Medicine, Beirut, Lebanon
- Department of Radiology, CISS de l'Abitibi-Temiscamingues, Québec, Canada
| | - Thanh N Nguyen
- Department of Neurology, Neurosurgery and Radiology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Mohamad Abdalkader
- Department of Radiology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
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Inoue H, Oomura M, Nishikawa Y, Mase M, Matsukawa N. Aplastic or twig-like middle cerebral artery and cardiogenic cerebral embolism mimicking moyamoya disease with RNF213 polymorphism: A case report. Interv Neuroradiol 2022; 28:634-638. [PMID: 34913393 PMCID: PMC9706272 DOI: 10.1177/15910199211062016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/14/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022] Open
Abstract
Progressive stenosis and occlusion of the bilateral internal carotid artery terminals and circle of Willis are typical features of Moyamoya disease. However, aplastic or twig-like middle cerebral artery (Ap/T-MCA)-wherein the unilateral main trunk of the middle cerebral artery (MCA) is not depicted, and a plexiform arterial network is formed-is similar to the findings of Moyamoya disease. Here, we describe a 78-year-old man who presented with mild right paralysis and aphasia. Magnetic resonance angiography (MRA) at admission did not show the bilateral MCAs. The findings were similar to those of Moyamoya disease, and his symptoms worsened after hospitalization. Endovascular treatment was performed, and the left MCA was completely recanalized. Later, paroxysmal atrial fibrillation was detected, and we finally determined that left MCA occlusion had occurred due to embolism. The right MCA was completely occluded at its origin, indicating an Ap/T-MCA. Embolic occlusion of the unilateral MCA and contralateral Ap/T-MCA made this case resemble Moyamoya disease in the acute stage. Even when chronic occlusion is suspected on MRA in acute cerebral infarction, endovascular treatment should be considered. Additionally, a heterotypic R4810K polymorphism was later found in the RNF213 gene. To our knowledge, this is the second report of Ap/T-MCA with the RNF213 gene polymorphism; however, their association remains unclear and requires further analyses.
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Affiliation(s)
- Hiroyasu Inoue
- Department of Neurology, Nagoya City University Graduate School of Medical
Sciences, Aichi, Japan
| | - Masahiro Oomura
- Department of Neurology, Nagoya City University Graduate School of Medical
Sciences, Aichi, Japan
| | - Yusuke Nishikawa
- Department of Neurosurgery, Nagoya City University Graduate School of Medical
Sciences, Aichi, Japan
| | - Mitsuhito Mase
- Department of Neurosurgery, Nagoya City University Graduate School of Medical
Sciences, Aichi, Japan
| | - Noriyuki Matsukawa
- Department of Neurology, Nagoya City University Graduate School of Medical
Sciences, Aichi, Japan
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Hato T, Yamaguchi M, Sugiyama A, Aoki K, Fukuda H, Kohno M, Nakayama M. A case of cerebral infarction due to aplastic or twig-like middle cerebral artery after lung cancer surgery. J Surg Case Rep 2022; 2022:rjac430. [PMID: 36158252 PMCID: PMC9491863 DOI: 10.1093/jscr/rjac430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/27/2022] [Indexed: 11/14/2022] Open
Abstract
Aplastic/twig-like middle cerebral artery is a rare vascular abnormality. We report a case of postoperative cerebral infarction caused by this disease. The patient is a male in his 40s. A 9-cm tumour was revealed to have invaded the superior vena cava from his right lung. He underwent right upper and middle bilobectomy. Due to the vascular invasion, the intraoperative bleeding exceeded 2 litres. Mechanical ventilation was required for postoperative pneumonia. After extubation, he was unable to write and was found to have cerebral infiltration in the left middle cerebral artery region. The cause of the cerebral infarction was investigated, but no thrombus in the left atrium or arteriosclerosis was found. No atrial fibrillation was observed during or after the surgery. Magnetic resonance angiography of the brain revealed an aplastic/twig-like middle cerebral artery.
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Affiliation(s)
- Tai Hato
- Department of General Thoracic Surgery, Saitama Medical Centre, Saitama Medical University , 1981 Kawagoe City, Saitama 350-8550 , Japan
| | - Masatoshi Yamaguchi
- Department of General Thoracic Surgery, Saitama Medical Centre, Saitama Medical University , 1981 Kawagoe City, Saitama 350-8550 , Japan
| | - Ato Sugiyama
- Department of General Thoracic Surgery, Saitama Medical Centre, Saitama Medical University , 1981 Kawagoe City, Saitama 350-8550 , Japan
| | - Kohei Aoki
- Department of General Thoracic Surgery, Saitama Medical Centre, Saitama Medical University , 1981 Kawagoe City, Saitama 350-8550 , Japan
| | - Hiroki Fukuda
- Department of General Thoracic Surgery, Saitama Medical Centre, Saitama Medical University , 1981 Kawagoe City, Saitama 350-8550 , Japan
| | - Mitsutomo Kohno
- Department of General Thoracic Surgery, Saitama Medical Centre, Saitama Medical University , 1981 Kawagoe City, Saitama 350-8550 , Japan
| | - Mitsuo Nakayama
- Department of General Thoracic Surgery, Saitama Medical Centre, Saitama Medical University , 1981 Kawagoe City, Saitama 350-8550 , Japan
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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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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] [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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Pagiola I, Abaurre L, Pianca P, Pimentel D, Barbosa L. Twig-like middle cerebral artery: a rare condition not to be confused with Moyamoya disease. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:1043-1046. [PMID: 34816997 DOI: 10.1590/0004-282x-anp-2021-0142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/08/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Igor Pagiola
- Hospital Estadual Central, Departamento de Neurorradiologia Intervencionista, Vitória ES, Brazil.,Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória, Hospital da Santa Casa de Vitória, Departamento de Neurologia, Vitória ES, Brazil
| | - Leonardo Abaurre
- Hospital Estadual Central, Departamento de Neurorradiologia Intervencionista, Vitória ES, Brazil
| | - Pedro Pianca
- Hospital Estadual Central, Departamento de Neurorradiologia Intervencionista, Vitória ES, Brazil
| | - Derval Pimentel
- Hospital Estadual Central, Departamento de Neurorradiologia Intervencionista, Vitória ES, Brazil
| | - Leandro Barbosa
- Hospital Estadual Central, Departamento de Neurorradiologia Intervencionista, Vitória ES, Brazil
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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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