Unruptured Aneurysm at the Origin of the Duplicated Middle Cerebral Artery Treated by Coil Embolization: A Case Report

Abstract

Aneurysm at the origin of a duplication of the middle cerebral artery (DMCA) is very rare, and only 29 treated cases have been reported. All of the cases were treated by direct surgery except a ruptured case treated by intentional partial coil embolization. We report the first unruptured case treated by coil embolization and review the previously published cases. Coil embolization can be alternative treatment for an unruptured aneurysm at the origin of the DMCA. Stable framing to spare the origin of it and prevention of thromboembolic complications are keys for safe treatment.

Correlation between multiple cerebral aneurysms and a rare type of segmental duplication of the middle cerebral artery

“…The DMCA, as we know, is classified into two types. Type A is diagnosed when branches are separated from the very tip of the ICA together with the ACA, and Type B is diagnosed when one branch occurs between the top of the ICA and the onset of AchA [5,6]. The frequency of type B is twice as common as type A.…”

“…In 1962, Crompton was among the first to report the existence of MCA anomaly, such as duplication of the MCA, accessory MCA and fenestration of the MCA [5]. In 1973, Teal gave a classification of anomalous changes on the MCA [6]. He defined the term DMCA and the concept of accessory MCA.…”

“…1). The incidence of accessory MCA ranges in autopsy and angiographic studies from 0.3 to 4% [2,5,6]. The presence of MCA fenestration, i.e., a bridged opening in the blood vessel itself is also very rare and occurs in angiographic studies as 0.17-0.43% [7] and in autopsy studies from 0.02 to 1% [2,5].…”

Aneurysm at origin of duplicated middle cerebral artery associated with another aneurysm

“…[ 2 ] To date, 30 cases of DMCA aneurysms have been reported in the literature. [ 9 ] Therefore, our cases are the 31 st and 32 nd cases of DMCA aneurysms. Among them, 17 cases including ours were associated with aneurysms at other sites.…”

“…To our knowledge, only 30 cases of DMCA aneurysms have been reported in the literature. [ 3 9 ] We encountered 2 patients with DMCA aneurysms, ruptured, and unruptured ones. Each ruptured and unruptured DMCA aneurysm was accompanied by an unruptured ICA aneurysm at the bifurcation of the posterior communicating artery (PCoA) and a ruptured MCA aneurysm, respectively.…”