J Cerebrovasc Endovasc Neurosurg.  2015 Sep;17(3):223-226. 10.7461/jcen.2015.17.3.223.

An Unruptured Cerebral Aneurysm at the Origin of the Duplicated Middle Cerebral Artery

• Kim JS
• Lee CH
• Park H
• Han JW

• KMID: 2069247
• DOI: http://doi.org/10.7461/jcen.2015.17.3.223

Abstract

A variety of cerebral vascular anomalies are widely applied, however anomalies of the middle cerebral artery (MCA) are relatively infrequent. The duplicated MCA (DMCA) is a MCA anomaly. Aneurysm arising from the origin of the DMCA is rare. Cerebral angiography in a 61-year-old female demonstrated a small (about 3 mm) saccular aneurysm located at the origin of the DMCA in the anterior direction. Considering the unusual location, the lesion was treated, regardless of the size. Aneurysmal characteristics of a broad neck and small size limited the endovascular approach, necessitating open surgery. Her postoperative course was uneventful and postoperative angiography showed complete obliteration of the aneurysm. The patient was discharged without neurologic deficit.

Keyword

Middle cerebral artery; Duplicated; Aneurysm

MeSH Terms

Aneurysm
Angiography
Cerebral Angiography
Female
Humans
Intracranial Aneurysm*
Middle Aged
Middle Cerebral Artery*
Neck
Neurologic Manifestations

Figure

• 

  Fig. 1 Preoperative CT angiography (CTA) showing an unusual vessel originating from the right distal ICA (arrowhead) and an associated small saccular aneurysm. ICA = internal carotid artery.

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  Fig. 2 Preoperative oblique three-dimensional rotational cerebral angiography showing a vessel from the right distal ICA coursing parallel with other MCA branches to the Sylvian fissure and a small aneurysm. ICA = internal carotid artery; MCA = middle cerebral artery.

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  Fig. 3 Intraoperative microscopic view showing detailed anatomy around the DMCA and aneurysm. DMCA = duplicate MCA.

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  Fig. 4 Microscopic view showing after aneurysmal clipping.

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  Fig. 5 Postoperative cerebral angiography showing complete occlusion of the aneurysm and patent DMCA. DMCA = duplicate MCA.

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