- Department of Neurosurgery, National Defense Medical College, Saitama, Japan
Correspondence Address:
Naoki Otani
Department of Neurosurgery, National Defense Medical College, Saitama, Japan
DOI:10.4103/2152-7806.69378
© 2010 Otani N This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.How to cite this article: Otani N, Nawashiro H, Tsuzuki N, Osada H, Suzuki T, Shima K, Nakai K. A ruptured internal carotid artery aneurysm located at the origin of the duplicated middle cerebral artery associated with accessory middle cerebral artery and middle cerebral artery aplasia. Surg Neurol Int 16-Sep-2010;1:51
How to cite this URL: Otani N, Nawashiro H, Tsuzuki N, Osada H, Suzuki T, Shima K, Nakai K. A ruptured internal carotid artery aneurysm located at the origin of the duplicated middle cerebral artery associated with accessory middle cerebral artery and middle cerebral artery aplasia. Surg Neurol Int 16-Sep-2010;1:51. Available from: http://sni.wpengine.com/surgicalint_articles/a-ruptured-internal-carotid-artery-aneurysm-located-at-the-origin-of-the-duplicated-middle-cerebral-artery-associated-with-accessory-middle-cerebral-artery-and-middle-cerebral-artery-aplasia/
Abstract
Background:Intracranial vascular anomalies involving the middle cerebral artery (MCA) are relatively rare, as such knowledge will be helpful for planning the optimal surgical procedures.
Case Description:We herein present the first case of a ruptured internal carotid artery aneurysm arising at the origin of the hypoplastic duplicated MCA associated with accessory MCA and main MCA aplasia, which was revealed by angiograms and intraoperative findings.
Conclusion:In practice, this case highlights the urgent need to preoperatively recognize such vascular anomalies as well as understand the collateral blood supply in cerebral ischemia associated with these MCA anomalies.
Keywords: Subarachnoid hemorrhage, duplicated middle cerebral artery, accessory middle cerebral artery, cerebral aneurysm
INTRODUCTION
Intracranial vascular anomalies involving the middle cerebral artery (MCA) are relatively rare. Teal et al.[
CASE REPORT
A 66-year-old female suffered a sudden onset of headache and a loss of consciousness. On admission, a computed tomography (CT) scan revealed a diffuse subarachnoid hemorrhage (SAH) with laterality on the right Sylvian fissure [ (a) CT scan on admission revealed a diffuse SAH with laterality on the right Sylvian fissure. (b and d) A 3D-CTA showed an ICA aneurysm located at the origin of hypoplastic dup-MCA associated with an acc-MCA arising from the anterior cerebral artery to share in supplying the right MCA territory. (c) The aneurysm measured 6 mm in size and was directed laterally. An intraoperative photograph showing the dup-MCA, the acc-MCA, and the A1 segment of the anterior cerebral artery. After the dissection of the carotid cistern, we traced the right ICA, and observed that the dup-MCA arose from the proximal ICA with an aneurysm arising from the trunk of these vessels. (e) The dup-MCA projected toward the Sylvian fissure. With the further retraction of the frontal lobe, aplasia of the main MCA was confirmed. The neck of the aneurysm was thereafter dissected and clipped successfully
DISCUSSION
Intracranial vascular anomalies involving the MCA are relatively rare. Teal et al.[
Uchino et al.[
The embryologic explanation for anomalies and variations of the MCA remains unclear. The MCA develops after the ACA, and the ACA is considered a continuation of the primitive ICA. Thus, the MCA can be regarded as a branch of the ACA.[
The association between the dup-MCA, or the acc-MCA, and cerebral aneurysms has been well documented.[
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