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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.

Otani N, Nawashiro H, Tsuzuki N, Osada H, Suzuki T, Shima K, Nakai K - Surg Neurol Int (2010)

Bottom Line: Intracranial vascular anomalies involving the middle cerebral artery (MCA) are relatively rare, as such knowledge will be helpful for planning the optimal surgical procedures.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.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, National Defense Medical College, Saitama, Japan.

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.

No MeSH data available.


Related in: MedlinePlus

(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
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Figure 0001: (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

Mentions: 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 [Figure 1a]. A three-dimensional CT angiograph (3D-CTA) showed an ICA aneurysm located at the origin of the hypoplastic duplicated middle cerebral artery (dup-MCA) associated with an accessory middle cerebral artery (acc-MCA) arising from the anterior cerebral artery to share in supplying the right MCA territory [Figure 1b and d]. The aneurysm measured 6mm in size and was directed laterally. A right frontotemporal craniotomy was performed on the day of admission. 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 [Figure 1c]. The dup-MCA projected toward the Sylvian fissure. With further retraction of the frontal lobe, aplasia of the main MCA was confirmed. The neck of the aneurysm was dissected and clipped successfully [Figure 1d]. The postoperative course was uneventful with no spasms or cerebral infarction.Figure 1


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.

Otani N, Nawashiro H, Tsuzuki N, Osada H, Suzuki T, Shima K, Nakai K - Surg Neurol Int (2010)

(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
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2958321&req=5

Figure 0001: (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
Mentions: 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 [Figure 1a]. A three-dimensional CT angiograph (3D-CTA) showed an ICA aneurysm located at the origin of the hypoplastic duplicated middle cerebral artery (dup-MCA) associated with an accessory middle cerebral artery (acc-MCA) arising from the anterior cerebral artery to share in supplying the right MCA territory [Figure 1b and d]. The aneurysm measured 6mm in size and was directed laterally. A right frontotemporal craniotomy was performed on the day of admission. 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 [Figure 1c]. The dup-MCA projected toward the Sylvian fissure. With further retraction of the frontal lobe, aplasia of the main MCA was confirmed. The neck of the aneurysm was dissected and clipped successfully [Figure 1d]. The postoperative course was uneventful with no spasms or cerebral infarction.Figure 1

Bottom Line: Intracranial vascular anomalies involving the middle cerebral artery (MCA) are relatively rare, as such knowledge will be helpful for planning the optimal surgical procedures.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.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, National Defense Medical College, Saitama, Japan.

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.

No MeSH data available.


Related in: MedlinePlus