A Ruptured Aneurysm in Aplastic or Twig-like Middle Cerebral Artery: A Case Report with Histological Investigation

Watanabe, Noriyuki; Marushima, Aiki; Hino, Tenyu; MINAMIMOTO, Shinya; Sato, Masayuki; Ito, Yoshiro; Hayakawa, Masayuki; Sakamoto, Noriaki; Ishikawa, Eiichi; Matsumura, Akira; Matsumaru, Yuji

doi:10.2176/jns-nmc.2021-0276

Cited by 6 publications

(11 citation statements)

References 25 publications

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“…In two of these cases, pathologic studies reported an internal elastic lamina disruption at the neck and wall disruption at the level of the dome of the aneurysm as the cause of rupture with a surrounding hematoma, similar as occurs in other brain aneurysms. [5,22,27,33] In this case, our patient had a Fisher Grade IV subarachnoid hemorrhage. During surgery, after evacuating the surrounding hematoma, we found many fragile vessels of the network around the aneurysm that bleed easily.…”

Section: Discussionmentioning

confidence: 73%

“…[20,11] e use of intraoperative ancillary methods such as Fluorescein videoangiography or intraoperative Doppler may increase the confidence of the surgical procedure to avoid postoperative ischemic complications. [33] CONCLUSION e Ap/T-MCA is a rare anomaly. ere is a lack of knowledge and information about it due to the scarcity of reports in the literature.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…[ 20 , 11 ] The use of intraoperative ancillary methods such as Fluorescein videoangiography or intraoperative Doppler may increase the confidence of the surgical procedure to avoid postoperative ischemic complications. [ 33 ]…”

Section: Discussionmentioning

confidence: 99%

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Ruptured aneurysm associated with a twig-like middle cerebral artery: An illustrative case report

Serrano-Rubio¹,

Ferrufino-Mejia²,

Balcázar-Padrón³

et al. 2022

Surgical Neurology International

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Background: Anomalies of the middle cerebral artery (MCA) are rare; among the different types of anomalies, the aplastic or twig-like (Ap/T) MCA is extremely rare and has been reported under various names, including aplastic, unfused, or rete type anomaly. The occurrence of a brain aneurysm associated with this anatomic variant is an even rare event, and probably their development and rupture are related to hemodynamic stress of the tinny wall of vessels forming the network. Case Description: We present a 43-year-old male patient with an explosive and persistent right orbitofrontal headache. A computed tomography showed a right frontobasal hematoma with intraventricular disruption. Magnetic resonance angiography showed a right MCA aneurysm and what seems to be a MCA trunk stenosis. Cerebral digital subtraction angiography demonstrated a plexiform arterial network and one aneurysm arising from the network. The patient was successfully treated by surgical clipping to evacuate the hematoma and to prevent further intracranial hemorrhages. Conclusion: The Ap/T-MCA may be associated with hemodynamic stress with a significant effect through the tinny wall of the vessels causing hemorrhage or leading to the formation and rupture of cerebral aneurysms. Based on a correct diagnosis of the anomaly, treatment can be completed successfully through different standard methods.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Ruptured aneurysm associated with a twig-like middle cerebral artery: An illustrative case report

Serrano-Rubio¹,

Ferrufino-Mejia²,

Balcázar-Padrón³

et al. 2022

Surgical Neurology International

View full text Add to dashboard Cite

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“…The embryological interruption of MCA trunk genesis may be the cause of these lesions ( 1 , 2 ). Twig-like MCAs can cause a hemorrhagic or ischemic event ( 3 , 4 ). A twig-like MCA has a complex angioarchitecture, and the accessory MCA (AccMCA) from the A1 segment of the anterior cerebral artery (ACA) can serve as an important collateral artery for MCA twigs ( 5 , 6 ).…”

Section: Introductionmentioning

confidence: 99%

Case report: Endovascular coil embolization of an aneurysm at the origin of the accessory middle cerebral artery from the A1 segment as the collateral artery to twigs

Zhang

2023

Front. Neurol.

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An aneurysm at the origin of the accessory middle cerebral artery (AccMCA) from the A1 segment of the anterior cerebral artery (ACA) as the supplying artery of a twig-like MCA is exceptional. In this study, we reported on such a case and presented a review of the relevant literature. A 56-year-old male suffered a subarachnoid hemorrhage. Digital subtraction angiography confirmed a twig-like MCA and a ruptured aneurysm at the origin of the AccMCA. Endovascular coil embolization of the aneurysm was performed. After the microcatheter was positioned in the aneurysm, soft coils were delivered to complete the embolization. Postoperatively, the patient recovered uneventfully. One month later, the patient returned to his job without any neurological deficits. Postoperative computed tomography at the 3-month follow-up showed that the brain tissue was normal. By reporting our case and reviewing the relevant literature, we found that endovascular coil embolization for such aneurysms at the AccMCA origin is feasible in certain cases.

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Rete Middle Cerebral Artery Aneurysm: A Case Report and Systematic Review

Cavalcante-Neto,

Monteiro,

Brandt

et al. 2023

Asian J Neurosurg

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Background Middle cerebral artery (MCA) anomalies are a rare finding and may be associated with vascular changes, such as intracranial aneurysms. Among them, the rete MCA aneurysm is very rare, with only 22 cases reported to date. Case Description A 50-year-old woman presented with subarachnoid, intraventricular, and intracerebral hemorrhage secondary to a ruptured aneurysm of rete MCA from an anomalous collateral artery of the anterior cerebral artery, treated successfully by microsurgical clipping. She presented a good recovery after a 2-year follow-up. Conclusion A systematic review of rete MCA aneurysms is presented, comparing aneurysms originating from twig-like MCA, with 16 reports, and twig-like networks of an anomalous collateral artery, with 6 reports including ours. Several factors influence the treatment decision-making, though microsurgical clipping is the main procedure. A wider use of coiling is requested for a better comparison of the treatment approaches.

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A Ruptured Aneurysm in Aplastic or Twig-like Middle Cerebral Artery: A Case Report with Histological Investigation

Cited by 6 publications

References 25 publications

Ruptured aneurysm associated with a twig-like middle cerebral artery: An illustrative case report

Ruptured aneurysm associated with a twig-like middle cerebral artery: An illustrative case report

Case report: Endovascular coil embolization of an aneurysm at the origin of the accessory middle cerebral artery from the A1 segment as the collateral artery to twigs

Rete Middle Cerebral Artery Aneurysm: A Case Report and Systematic Review

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