Kenta Fujimoto1, Hiroyuki Hashimoto2, Yoshitomo Uchiyama3, Hidetsugu Maekawa4, Yoichi Shida5, Ichiro Nakagawa6. 1. Department of Neurosurgery, Nara Prefectural General Medical Center, 2-897-5, Shichijo-nishi, Nara 630-8581, Japan. Electronic address: kentaf@nara-hp.jp. 2. Department of Neurosurgery, Nara Prefectural General Medical Center, 2-897-5, Shichijo-nishi, Nara 630-8581, Japan. Electronic address: hhashimoto@nara-hp.jp. 3. Department of Neurosurgery, Nara Prefectural General Medical Center, 2-897-5, Shichijo-nishi, Nara 630-8581, Japan. Electronic address: y-uchiyama@ishinkai.or.jp. 4. Department of Neurosurgery, Nara Prefectural General Medical Center, 2-897-5, Shichijo-nishi, Nara 630-8581, Japan. Electronic address: hidetsugumaekawa@yahoo.co.jp. 5. Department of Neurosurgery, Nara Prefectural General Medical Center, 2-897-5, Shichijo-nishi, Nara 630-8581, Japan. Electronic address: yoichi_0723@yahoo.co.jp. 6. Department of Neurosurgery, Nara Medical University, Kashihara, Japan. Electronic address: nakagawa@naramed-u.ac.jp.
Abstract
BACKGROUND: Duplication of the middle cerebral artery (DMCA) is an anomalous vessel arising from the internal carotid artery (ICA). Aneurysms at the origin of a DMCA have been reported; however, most have been treated with clipping surgery. Here, we describe two cases of aneurysms at the origin of a DMCA treated with coil embolization. CASE PRESENTATION: Case 1: A seventy-three year-old man presented with severe headache and was diagnosed with subarachnoid hemorrhage (SAH). Digital subtraction angiography (DSA) and 3-dimensional (3-D) DSA showed an aneurysm arising from a DMCA. Coil embolization was performed with DMCA patency. The patient had an uneventful postoperative course. CASE 1: A 44-year-old woman presented with a history of clipping for an IC-anterior choroidal artery (AchA) aneurysm 8 years prior. Magnetic resonance imaging (MRI) showed regrowth of the aneurysm. 3-D DSA showed an IC-DMCA aneurysm located laterally and distal to the AchA. The DMCA arose from the bottom of the aneurysm. Coil embolization was performed without DMCA occlusion and showed no postoperative ischemic changes. CONCLUSION: An IC-DMCA aneurysm is rare and may be misdiagnosed as an AchA aneurysm. Clinicians should perform a 3D-DSA evaluation if the aneurysm arises from the lateral wall of the IC to obtain a precise diagnosis and to preserve the DMCA during coil embolization.
BACKGROUND: Duplication of the middle cerebral artery (DMCA) is an anomalous vessel arising from the internal carotid artery (ICA). Aneurysms at the origin of a DMCA have been reported; however, most have been treated with clipping surgery. Here, we describe two cases of aneurysms at the origin of a DMCA treated with coil embolization. CASE PRESENTATION: Case 1: A seventy-three year-old man presented with severe headache and was diagnosed with subarachnoid hemorrhage (SAH). Digital subtraction angiography (DSA) and 3-dimensional (3-D) DSA showed an aneurysm arising from a DMCA. Coil embolization was performed with DMCA patency. The patient had an uneventful postoperative course. CASE 1: A 44-year-old woman presented with a history of clipping for an IC-anterior choroidal artery (AchA) aneurysm 8 years prior. Magnetic resonance imaging (MRI) showed regrowth of the aneurysm. 3-D DSA showed an IC-DMCA aneurysm located laterally and distal to the AchA. The DMCA arose from the bottom of the aneurysm. Coil embolization was performed without DMCA occlusion and showed no postoperative ischemic changes. CONCLUSION: An IC-DMCA aneurysm is rare and may be misdiagnosed as an AchA aneurysm. Clinicians should perform a 3D-DSA evaluation if the aneurysm arises from the lateral wall of the IC to obtain a precise diagnosis and to preserve the DMCA during coil embolization.