Aneurysm of a Duplicate Middle Cerebral Artery

Background Anatomic middle cerebral artery (MCA) anomalies are rare, but each of the described variants (eg, duplicate, fenestrated, accessory) can be of clinical significance. Case Description A 34-year-old man with a history of left hemispheric stroke was found to have an aberrant, early-arising d...

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Bibliographic Details
Published in:World neurosurgery 2012, Vol.77 (1), p.201.e1-201.e4
Main Authors: LaBorde, David V, Mason, Alexander M, Riley, Jonathan, Dion, Jacques E, Barrow, Daniel L
Format: Article
Language:English
Subjects:
Aberrant middle cerebral artery
Adult
Aneurysm, Ruptured - surgery
Anti-Bacterial Agents - therapeutic use
Cerebral Angiography
Cerebral vascular anomaly
Duplicate middle cerebral artery aneurysm
Humans
Intracranial Aneurysm - complications
Intracranial Aneurysm - pathology
Intracranial Aneurysm - surgery
Male
Middle Cerebral Artery - abnormalities
Middle Cerebral Artery - pathology
Neurosurgery
Neurosurgical Procedures - methods
Stroke - etiology
Surgical Flaps
Surgical Wound Infection - etiology
Surgical Wound Infection - surgery
Surgical Wound Infection - therapy
Temporal Arteries - surgery
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Summary:Background Anatomic middle cerebral artery (MCA) anomalies are rare, but each of the described variants (eg, duplicate, fenestrated, accessory) can be of clinical significance. Case Description A 34-year-old man with a history of left hemispheric stroke was found to have an aberrant, early-arising duplicate left M1 segment of the MCA with an associated asymptomatic fusiform aneurysm. The patient was treated with a superficial temporal artery (STA) to distal MCA bypass followed by surgical trapping of the aneurysm. Results Intraoperative and follow-up angiography performed postoperatively at 3 months showed complete isolation of the aneurysm from the circulation and patency of the bypass graft. The postoperative course was uneventful with the exception of a craniotomy flap infection, which was effectively managed with intravenous antibiotics, flap removal, and subsequent use of a fabricated replacement. Conclusions This rare case is presented and used as a framework for a brief discussion of the literature regarding both variant MCA anatomy and treatment considerations for these anomalies when associated with an aneurysm.
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2011.03.038