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Fujimoto K, Hashimoto H, Uchiyama Y, Maekawa H, Shida Y, Nakagawa I. Duplicated Middle Cerebral Artery Aneurysms Treated by Coil Embolization; A Report of Two Cases and Literature Review. J Stroke Cerebrovasc Dis 2021; 30:105773. [PMID: 33865230 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/11/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Duplication of the middle cerebral artery (DMCA) is an anomalous vessel arising from the internal carotid artery (ICA). Aneurysms at the origin of a DMCA have been reported; however, most have been treated with clipping surgery. Here, we describe two cases of aneurysms at the origin of a DMCA treated with coil embolization. CASE PRESENTATION Case 1: A seventy-three year-old man presented with severe headache and was diagnosed with subarachnoid hemorrhage (SAH). Digital subtraction angiography (DSA) and 3-dimensional (3-D) DSA showed an aneurysm arising from a DMCA. Coil embolization was performed with DMCA patency. The patient had an uneventful postoperative course. CASE 1: A 44-year-old woman presented with a history of clipping for an IC-anterior choroidal artery (AchA) aneurysm 8 years prior. Magnetic resonance imaging (MRI) showed regrowth of the aneurysm. 3-D DSA showed an IC-DMCA aneurysm located laterally and distal to the AchA. The DMCA arose from the bottom of the aneurysm. Coil embolization was performed without DMCA occlusion and showed no postoperative ischemic changes. CONCLUSION An IC-DMCA aneurysm is rare and may be misdiagnosed as an AchA aneurysm. Clinicians should perform a 3D-DSA evaluation if the aneurysm arises from the lateral wall of the IC to obtain a precise diagnosis and to preserve the DMCA during coil embolization.
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Affiliation(s)
- Kenta Fujimoto
- Department of Neurosurgery, Nara Prefectural General Medical Center, 2-897-5, Shichijo-nishi, Nara 630-8581, Japan.
| | - Hiroyuki Hashimoto
- Department of Neurosurgery, Nara Prefectural General Medical Center, 2-897-5, Shichijo-nishi, Nara 630-8581, Japan.
| | - Yoshitomo Uchiyama
- Department of Neurosurgery, Nara Prefectural General Medical Center, 2-897-5, Shichijo-nishi, Nara 630-8581, Japan.
| | - Hidetsugu Maekawa
- Department of Neurosurgery, Nara Prefectural General Medical Center, 2-897-5, Shichijo-nishi, Nara 630-8581, Japan.
| | - Yoichi Shida
- Department of Neurosurgery, Nara Prefectural General Medical Center, 2-897-5, Shichijo-nishi, Nara 630-8581, Japan.
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan.
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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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Imahori T, Mizobe T, Fujinaka T, Miura S, Sugihara M, Aihara H, Kohmura E. An Aneurysm at the Origin of a Duplicated Middle Cerebral Artery Treated by Stent-Assisted Coiling Using the "Wrapped-Candy" Low-Profile Visualized Intraluminal Support (LVIS) Technique: A Technical Case Report and Review of the Literature. World Neurosurg 2020; 143:353-359. [PMID: 32791218 DOI: 10.1016/j.wneu.2020.08.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Aneurysms at the origin of a duplicated middle cerebral artery (DMCA) are quite rare. Here, we report a patient with such an aneurysm successfully treated endovascularly using our novel "wrapped-candy" low-profile visualized intraluminal support (LVIS) technique. CASE DESCRIPTION A 44-year-old woman underwent endovascular treatment for an unruptured wide-necked aneurysm at the origin of a DMCA that incorporated the origin of the DMCA into its neck. Stent-assisted coiling was performed using our newly developed "wrapped-candy" LVIS technique. To protect the origin of the DMCA and increase the stent metal density at the neck, an LVIS blue 3.5-mm × 22-mm stent was deployed by pushing the delivery wire aggressively to transform the visible wire components of the LVIS into a shape like "wrapped candy," maximizing the strut compaction at the neck of the aneurysm. Subsequently, the aneurysm component was coiled using a jailed microcatheter. The final procedural angiography demonstrated almost complete aneurysm occlusion with DMCA preservation. CONCLUSIONS Stent-assisted coiling can be a feasible treatment for an unruptured, usually wide-necked, aneurysm at the origin of a DMCA. The wrapped-candy LVIS technique may be useful in more challenging morphologies such as wide-necked aneurysms that incorporate the branch origin into the aneurysm neck.
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Affiliation(s)
- Taichiro Imahori
- Department of Neurosurgery, Hyogo Brain and Heart Center, Hyogo, Japan.
| | - Takashi Mizobe
- Department of Neurosurgery, Hyogo Brain and Heart Center, Hyogo, Japan
| | - Toshiyuki Fujinaka
- Department of Neurosurgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Shinichi Miura
- Department of Neurosurgery, Hyogo Brain and Heart Center, Hyogo, Japan
| | - Masahiro Sugihara
- Department of Neurosurgery, Hyogo Brain and Heart Center, Hyogo, Japan
| | - Hideo Aihara
- Department of Neurosurgery, Hyogo Brain and Heart Center, Hyogo, Japan
| | - Eiji Kohmura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Hyogo, Japan
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Hakim A, Gralla J, Rozeik C, Mordasini P, Leidolt L, Piechowiak E, Ozdoba C, El-Koussy M. Anomalies and Normal Variants of the Cerebral Arterial Supply: A Comprehensive Pictorial Review with a Proposed Workflow for Classification and Significance. J Neuroimaging 2017; 28:14-35. [PMID: 28945289 DOI: 10.1111/jon.12475] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 12/13/2022] Open
Abstract
Cerebral arteries may exhibit a wide range of variation from normal anatomy, which can be incidentally discovered during imaging. Knowledge of such variants is crucial to differentiate them from pathologies, to understand the etiology of certain pathologies directly related to a vascular variant, and to depict the changes in collateral circulation in patients with certain variants. Detection of particular variants may lead to the discovery of other nonvascular or vascular anomalies, especially aneurysms, and may also affect planning of endovascular or neurosurgical interventions. In this review, we summarize the variants and anomalies of cerebral arteries seen on cross-sectional imaging classified by a morphological approach and categorize their significance from a clinical perspective. This structured review is intended to serve as a guide for daily use in clinical practice.
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Affiliation(s)
- Arsany Hakim
- University Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Jan Gralla
- University Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Christoph Rozeik
- Radiology Department, Lörrach District Hospital, Lörrach, Germany
| | - Pasquale Mordasini
- University Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Lars Leidolt
- University Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Eike Piechowiak
- University Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Christoph Ozdoba
- University Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Marwan El-Koussy
- University Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
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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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Toyota S, Kumagai T, Sugano H, Yamamoto S, Mori K, Taki T. Unruptured Aneurysm at the Origin of the Duplicated Middle Cerebral Artery Treated by Coil Embolization: A Case Report. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ojmn.2015.51005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Elsharkawy A, Ishii K, Niemelä M, Kivisaari R, Lehto H, Hernesniemi J. Management of Aneurysms at the Origin of Duplicated Middle Cerebral Artery: Series of Four Patients with Review of the Literature. World Neurosurg 2013; 80:e313-8. [DOI: 10.1016/j.wneu.2012.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 10/02/2012] [Indexed: 10/27/2022]
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A rare case of supraclinoid internal carotid artery (ICA) fenestration in combination with duplication of the middle cerebral artery (MCA) originating from the ICA fenestration and an associated aneurysm. Clin Neuroradiol 2012; 23:133-6. [PMID: 22231576 DOI: 10.1007/s00062-011-0120-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 11/24/2011] [Indexed: 10/14/2022]
Abstract
Fenestrations and duplications of the cervical and intracranial arteries are rare anatomic variants, reported to be associated with aneurysms or other vascular anomalies. We here present a patient with a supraclinoid ICA fenestration in combination with a duplication of the MCA originating from the ICA fenestration and an associated aneurysm.
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TAKAHASHI C, KUBO M, OKAMOTO S, MATSUMURA N, HORIE Y, HAYASHI N, KUWAYAMA N, ENDO S. "Kissing" Aneurysms of the Internal Carotid Artery Treated by Coil Embolization -Case Report-. Neurol Med Chir (Tokyo) 2011; 51:653-6. [DOI: 10.2176/nmc.51.653] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Michiya KUBO
- Department of Neurosurgery, Saiseikai Toyama Hospital
| | | | | | - Yukio HORIE
- Department of Neurosurgery, Saiseikai Toyama Hospital
| | - Nakamasa HAYASHI
- Department of Neurosurgery, Faculty of Medicine, University of Toyama
| | - Naoya KUWAYAMA
- Department of Neurosurgery, Faculty of Medicine, University of Toyama
| | - Shunro ENDO
- Department of Neurosurgery, Faculty of Medicine, University of Toyama
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10
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Miyamoto J, Mineura K. Unruptured Middle Cerebral Artery Aneurysm Associated With a Duplicated Middle Cerebral Artery and a Dolichoectasic Anterior Cerebral Artery. J Stroke Cerebrovasc Dis 2010; 19:503-6. [DOI: 10.1016/j.jstrokecerebrovasdis.2009.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Revised: 07/31/2009] [Accepted: 08/28/2009] [Indexed: 10/19/2022] Open
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KIMURA T, MORITA A. Treatment of Unruptured Aneurysm of Duplication of the Middle Cerebral Artery -Case Report-. Neurol Med Chir (Tokyo) 2010; 50:124-6. [DOI: 10.2176/nmc.50.124] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Toshikazu KIMURA
- Department of Neurosurgery and Stroke Unit, Kanto Medical Center, NTT East Corporation
| | - Akio MORITA
- Department of Neurosurgery and Stroke Unit, Kanto Medical Center, NTT East Corporation
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12
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Perez J, Machado C, Scherle C, Hierro D. Duplicated middle cerebral artery. BMJ Case Rep 2009; 2009:bcr06.2009.2035. [PMID: 22140405 DOI: 10.1136/bcr.06.2009.2035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Duplicated middle cerebral artery (DMCA) is an anomalous vessel arising from the internal carotid artery. The incidence DMCA is relatively law, and an association between this anomaly and cerebral aneurysms has been documented. There is a controversy whether DMCA may have perforating arteries. This is an important fact to consider in aneurysm surgery. We report the case of a 34-year-old black woman who suffered a subarachnoid hemorrhage and the angiography a left DMCA, and an aneurysm in an inferior branch of the main MCA. The DMCA and the MCA had perforating arteries. The aneurysm was clipped without complications. The observation of perforating arteries in our patient confirms that the DMCA may have perforating arteries. This is very important to be considered in cerebral aneurysms surgery. Moreover, the DMCA may potentially serve as a collateral blood supply to the MCA territory in cases of MCA occlusion.
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Affiliation(s)
- Jesus Perez
- Hermanos Ameijeiras Hospital, Neurology, San Lazaro 701, Havana, Havana, 10300, Cuba
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Dimmick SJ, Faulder KC. Normal Variants of the Cerebral Circulation at Multidetector CT Angiography. Radiographics 2009; 29:1027-43. [DOI: 10.1148/rg.294085730] [Citation(s) in RCA: 175] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kai Y, Hamada JI, Morioka M, Yano S, Kudo M, Kuratsu JI. Treatment of unruptured duplicated middle cerebral artery aneurysm: case report. ACTA ACUST UNITED AC 2006; 65:190-3; discussion 193. [PMID: 16427423 DOI: 10.1016/j.surneu.2005.05.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2005] [Accepted: 05/23/2005] [Indexed: 11/28/2022]
Abstract
BACKGROUND Duplication of the middle cerebral artery (DMCA) is an anomalous vessel arising from the internal carotid artery (ICA). The origin of the DMCA lies between the anterior choroidal artery and the distal end of the ICA. The association of cerebral aneurysm and DMCA is rare. CASE DESCRIPTION In this 63-year-old woman, preoperative angiography and 3-dimensional computed tomography angiography revealed an aneurysm at the origin of the DMCA. The aneurysm was clipped and superficial temporal artery-DMCA anastomosis was performed. She was discharged with no neurologic deficits. Duplication of the middle cerebral artery can be divided into 2 types based on whether the site of separation from the ICA is at the top of the ICA (type A) or between the ICA top and the anterior choroidal artery (type B). The diameter of type A DMCA is comparable with that of the main middle cerebral artery trunk; in type B, it is smaller. In all 18 previously reported cases, the aneurysm was associated with type B DMCA. CONCLUSION For appropriate treatment planning, it is necessary to determine the DMCA type and the anatomic relationship between the aneurysm and the DMCA. In patients with type B DMCA, the possibility of aneurysm formation should be considered.
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Affiliation(s)
- Yutaka Kai
- Department of Neurosurgery, Graduate School of Medical Science, Kumamoto University, Kumamoto 860-8556, Japan.
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Hori E, Kurosaki K, Matsumura N, Yamatani K, Kusunose M, Kuwayama N, Endo S. Multiple aneurysms arising from the origin of a duplication of the middle cerebral artery. J Clin Neurosci 2005; 12:812-5. [PMID: 16169231 DOI: 10.1016/j.jocn.2004.08.033] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2004] [Accepted: 08/15/2004] [Indexed: 11/27/2022]
Abstract
Duplication of the middle cerebral artery is an anomalous vessel arising from the internal carotid artery. There have only been 14 reports of aneurysms arising from the origin of a duplication of the middle cerebral artery and 5 of these patients had multiple aneurysms. Aneurysms at this site have a high rupture rate compared to aneurysms in other locations and aggressive management is indicated.
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Affiliation(s)
- Emiko Hori
- Department of Neurosurgery, Toyama Red Cross Hospital, University Toyama, Japan.
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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: 45] [Impact Index Per Article: 2.4] [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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