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An aneurysm at the site of the fenestration of the middle cerebral artery in a patient with multiple aneurysms: A case report.

Sharifi G, Bakhtevari MH, Sabouri S, Rezaei O - Surg Neurol Int (2015)

Bottom Line: Postoperatively, the patient awoke without a deficit.After treatment of postoperative bacterial meningitis, he was discharged on the 26(th) postoperative day in good condition without any neurologic deficit.Six months after the first surgery, he was operated for the distal azygos ACA aneurysm.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Loghman e Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

ABSTRACT

Background: Middle cerebral artery (MCA) fenestration is a very rare anatomical variant of the MCA, incidentally found during magnetic resonance or computed tomography angiography. It has an incidence of 0.6%. Unlike fenestration of the posterior cerebral arterial circulation, fenestration of the anterior cerebral arterial circulation has not been well described.

Methods: We present the rare case of a patient who was admitted for a ruptured aneurysm of the MCA arising at the site of the fenestration of the MCA and also an unruptured fusiform aneurysm of the right posterior communicating artery and a distal anterior cerebral artery (ACA) aneurysm.

Results: The patient underwent craniotomy with microsurgical aneurysm clipping and the previously undiagnosed ruptured aneurysm, at the site of the fenestration of the MCA, arose immediately. Postoperatively, the patient awoke without a deficit. After treatment of postoperative bacterial meningitis, he was discharged on the 26(th) postoperative day in good condition without any neurologic deficit. Six months after the first surgery, he was operated for the distal azygos ACA aneurysm.

Conclusion: Anomalies of the intracranial vasculature are common, and we describe a rare case of left MCA fenestration with an associated ruptured aneurysm at the site of the fenestration. In the literature, cases of fenestration of the MCA are sporadically reported and are only incidental findings.

No MeSH data available.


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Postoperative computed tomography angiography revealed an aneurysm at the site of the fenestration of the middle cerebral artery
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Figure 3: Postoperative computed tomography angiography revealed an aneurysm at the site of the fenestration of the middle cerebral artery

Mentions: The patient underwent surgery, with the left pterional approach. A left frontotemporal craniotomy was performed, and an aneurysm was exposed through the sylvian fissure. The saccular aneurysm, with superior projection in the bifurcation of the left MCA, was clipped with a 7 mm straight clip. After dissection of the aneurysm, fenestration of the MCA was exposed immediately at the aneurysm's site [Figure 3]. The postoperative course was complicated with bacterial meningitis that was treated with antibiotic therapy. After 26 days, the patient was discharged without neurologic deficit.


An aneurysm at the site of the fenestration of the middle cerebral artery in a patient with multiple aneurysms: A case report.

Sharifi G, Bakhtevari MH, Sabouri S, Rezaei O - Surg Neurol Int (2015)

Postoperative computed tomography angiography revealed an aneurysm at the site of the fenestration of the middle cerebral artery
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4597291&req=5

Figure 3: Postoperative computed tomography angiography revealed an aneurysm at the site of the fenestration of the middle cerebral artery
Mentions: The patient underwent surgery, with the left pterional approach. A left frontotemporal craniotomy was performed, and an aneurysm was exposed through the sylvian fissure. The saccular aneurysm, with superior projection in the bifurcation of the left MCA, was clipped with a 7 mm straight clip. After dissection of the aneurysm, fenestration of the MCA was exposed immediately at the aneurysm's site [Figure 3]. The postoperative course was complicated with bacterial meningitis that was treated with antibiotic therapy. After 26 days, the patient was discharged without neurologic deficit.

Bottom Line: Postoperatively, the patient awoke without a deficit.After treatment of postoperative bacterial meningitis, he was discharged on the 26(th) postoperative day in good condition without any neurologic deficit.Six months after the first surgery, he was operated for the distal azygos ACA aneurysm.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Loghman e Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

ABSTRACT

Background: Middle cerebral artery (MCA) fenestration is a very rare anatomical variant of the MCA, incidentally found during magnetic resonance or computed tomography angiography. It has an incidence of 0.6%. Unlike fenestration of the posterior cerebral arterial circulation, fenestration of the anterior cerebral arterial circulation has not been well described.

Methods: We present the rare case of a patient who was admitted for a ruptured aneurysm of the MCA arising at the site of the fenestration of the MCA and also an unruptured fusiform aneurysm of the right posterior communicating artery and a distal anterior cerebral artery (ACA) aneurysm.

Results: The patient underwent craniotomy with microsurgical aneurysm clipping and the previously undiagnosed ruptured aneurysm, at the site of the fenestration of the MCA, arose immediately. Postoperatively, the patient awoke without a deficit. After treatment of postoperative bacterial meningitis, he was discharged on the 26(th) postoperative day in good condition without any neurologic deficit. Six months after the first surgery, he was operated for the distal azygos ACA aneurysm.

Conclusion: Anomalies of the intracranial vasculature are common, and we describe a rare case of left MCA fenestration with an associated ruptured aneurysm at the site of the fenestration. In the literature, cases of fenestration of the MCA are sporadically reported and are only incidental findings.

No MeSH data available.


Related in: MedlinePlus