{"id":"be82a622-0854-4e99-b21c-0fb940b4f59c","slug":"unruptured-cerebral-aneurysms-with-the-segmental-duplicated-middle-cerebral-artery-formed-a-fenestrated-structure-at-origin","title":"Unruptured cerebral aneurysms with the segmental duplicated middle cerebral artery formed a fenestrated structure at origin","authors":["Eri Shiozaki","Ichiro Kawahara","Daiki Uchida","Yoichi Morofuji","Tomonori Ono","Wataru Haraguchi","Kazuya Honda","Tomoya Moritsuka","Keisuke Tsutsumi"],"abstract":"Background: Middle cerebral artery (MCA) has a significantly lower incidence of anatomical variations than other intracranial arteries. We present an extremely rare case of unruptured aneurysms with the segmental duplicated MCA (d-MCA) formed a fenestrated structure at origin. Case Description: A 55-year-old female underwent direct surgery for the unruptured aneurysms at the top of the right internal cerebral artery with d-MCA. The d-MCA branches separated at the right internal cerebral artery top and had comparable with that of the main MCA trunk. Moreover, there was an anastomosis between the d-MCA branches. We diagnosed this anastomosis as segmental d-MCA. Two aneurysmal domes were identified during surgery at the origin of the d-MCA, which the main dome protruding backward was wide necked and another small one was collapsed or thrombosed protruding forward. We used a fenestrated clip for the posterior projecting dome, and the aneurysms were successfully obliterated. Conclusion: Although cerebral aneurysms associated with d-MCA are rare, there are technical difficulties in the surgical management. A fenestrated clip might be most reasonable to obtain patency of the parent arteries for the posterior projecting aneurysms if the perforators can be avoided.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/be82a622-0854-4e99-b21c-0fb940b4f59c/featured/hero-1781561668222.png","publishDate":"2022-01-29T00:00:00.000Z","doi":"10.25259/SNI_1108_2021","categories":["Neurovascular","Case Report"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2022/01/11363/SNI-13-33.pdf"}