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Uchino A, Tokushige K. Triplicated middle cerebral arteries (duplicated and ipsilateral accessory) associated with triplicated anterior cerebral arteries (accessory) diagnosed by magnetic resonance angiography. Surg Radiol Anat 2024; 46:959-962. [PMID: 38743145 DOI: 10.1007/s00276-024-03380-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 05/02/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE To describe a case of duplicated middle cerebral artery (MCA) combined with ipsilateral accessory MCA, forming a triplicated MCA, associated with the accessory anterior cerebral artery (ACA), forming a triplicated A2 segment of the ACA detected incidentally on magnetic resonance (MR) angiography. METHODS A 70-year-old woman with internal carotid artery (ICA) stenosis at the origin, which was detected by ultrasound, underwent cranial MR imaging and MR angiography of the intracranial region for an evaluation of brain and cerebral arterial lesions. The MR machine was a 3-Tesla scanner. MR angiography was performed using a standard 3-dimensional time-of-flight technique. RESULTS Multiple ischemic white matter lesions are observed. No significant stenotic lesions were observed in intracranial arteries. The right duplicated MCA was originated from right distal ICA. And main MCA was originated from right ICA bifurcation. Right accessory MCA was arisen from the A2 segment of the right ACA. Thus, the right MCA was triplicated. There was also an accessory ACA forming a triplicated ACA at its A2 segment. These findings were clearly identified on partial volume-rendering (VR) images. CONCLUSION We herein report a case of triplicated MCA associated with triplicated ACA. MCA variations are relatively rare, and this is the third case of triplicated MCA reported in relevant English-language literature. To identify multiple cerebral arterial variations, creating partial VR images using MR angiographic source images is useful.
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Affiliation(s)
- Akira Uchino
- Department of Radiology, Saitama Sekishinkai Hospital, 2-37-20 Irumagawa, Sayama, Saitama, 350-1305, Japan.
| | - Kazuo Tokushige
- Department of Neurosurgery, Saitama Sekishinkai Hospital, 2-37-20 Irumagawa, Sayama, Saitama, 350-1305, Japan
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Kashtiara A, Beldé S, Schollaert J, Menovsky T. Anatomical Variations and Anomalies of the Middle Cerebral Artery. World Neurosurg 2024; 183:e187-e200. [PMID: 38101539 DOI: 10.1016/j.wneu.2023.12.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/09/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE Intracranial arteries have a high rate of variation, but a clear schematic overview is lacking. In this pictorial review we classify and depict all the variations and anomalies within the middle cerebral artery (MCA). METHODS PubMed was searched with the MeSH-term "Middle Cerebral Artery." Articles were selected based on their description of variants within the MCA. Cross-referencing was used to broaden the range of articles. The anatomical variants were then schematically drawn using the anteroposterior and lateral view during angiography of the internal carotid artery. RESULTS A total of 29 unique medical illustrations were made, depicting variation in number of vessels; variation in vessel origin; and variation in morphology. CONCLUSIONS The MCA provides vital blood supply to the frontal, parietal, temporal, and central brain structures. An overview of these variations is important to diagnose and treat patients with MCA-related pathology correctly and safely. They can aid in distinguishing pathology from normal anatomical variance; aid neurosurgeons during aneurysmal clipping or arteriovenous malformation resections; and aid interventional radiologists during thrombectomy or coiling. This article provides a summary regarding current knowledge of anatomical variations within the MCA, their prevalence and clinical relevance. A total of 29 unique illustrations were made, depicting currently known variants. We encourage all who diagnose, treat, and study the MCA to use this overview for a uniform and better understanding of its anatomy.
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Affiliation(s)
- Ardavan Kashtiara
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium; Faculty of Medicine and Health sciences, University of Antwerp, Antwerp, Belgium.
| | - Sarah Beldé
- Faculty of Medicine and Health sciences, University of Antwerp, Antwerp, Belgium
| | - Joris Schollaert
- Faculty of Medicine and Health sciences, University of Antwerp, Antwerp, Belgium
| | - Tomas Menovsky
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium; Faculty of Medicine and Health sciences, University of Antwerp, Antwerp, Belgium; Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Kashtiara A, Beldé S, Menovsky T. Anatomical Variations and Anomalies of the Anterior Communicating Artery Complex. World Neurosurg 2024; 183:e218-e227. [PMID: 38104930 DOI: 10.1016/j.wneu.2023.12.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 12/10/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Intracranial arteries have a high rate of variation, but a clear schematic overview is lacking. In this pictorial review we classify and depict all variations and anomalies within the anterior communicating artery complex. METHODS PubMed was searched with the terms "Anterior Communicating Artery" AND "Variations" OR "Anomalies." Articles were selected based on their description of variants. Cross-referencing was used to broaden the range of variations. Surgical view during pterional craniotomy and transsylvian approach was used as a baseline for schematic drawings of the variations. RESULTS A total of 42 variants were identified, schematically drawn and classified into A1-A2 segment, anterior communicating artery, and the recurrent artery of Heubner. CONCLUSIONS The anterior communicating artery complex consists of the anterior cerebral artery, anterior communicating artery and the recurrent artery of Heubner. An overview of these variations may be helpful in distinguishing pathology from anatomical variations, assist neurosurgeons during clipping of cerebral aneurysms, and support interventional radiologists during endovascular treatments. This article summarizes the current knowledge of anatomical variations within the anterior communicating artery complex, their prevalence and clinical relevance. A total of 42 variants were identified and schematically depicted. We encourage all who diagnose, treat, and study the anterior communicating artery complex to use this overview for a uniform and better understanding of its anatomy.
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Affiliation(s)
- Ardavan Kashtiara
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium; Faculty of Medicine and Health sciences, University of Antwerp, Antwerp, Belgium.
| | - Sarah Beldé
- Faculty of Medicine and Health sciences, University of Antwerp, Antwerp, Belgium
| | - Tomas Menovsky
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium; Faculty of Medicine and Health sciences, University of Antwerp, Antwerp, Belgium; Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Otsuka N, Yajima H, Miyawaki S, Koizumi S, Kiyofuji S, Hongo H, Teranishi Y, Kin T, Saito N. Case Report: “Clipping” an Internal Carotid Artery Aneurysm With a Duplicated Middle Cerebral Artery and the Anterior Choroidal Artery Arising From the Dome. Front Neurol 2022; 13:845296. [PMID: 35309560 PMCID: PMC8927671 DOI: 10.3389/fneur.2022.845296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundA duplicated middle cerebral artery (DMCA) is an anatomical variant that includes duplication of the middle cerebral artery (MCA) and an anomalous vessel originating between the anterior choroidal artery (AChA) and the distal end of the internal carotid artery (ICA). Here, we present a case report of an ICA aneurysm with a DMCA and the AChA originating from the dome, which was successfully treated with clipping.Case DescriptionIn a 64-year-old man, preoperative angiography revealed an unruptured right ICA aneurysm with a maximum diameter of 4.3 mm, and fusion three-dimensional computer graphics revealed that a DMCA and the AChA originated from the dome. The aneurysm enlarged; therefore, clipping was performed. The closure of the aneurysm while preserving the patency of the DMCA and AChA was identified using intraoperative microvascular Doppler ultrasonography and indocyanine green video angiography. The postoperative course was uneventful, and no ischemic lesions were confirmed on MR imaging.ConclusionTo the best of our knowledge, this is the first report of an ICA aneurysm with a DMCA and the AChA arising from the dome. In such cases, the anatomy of the DMCA and AChA should be well-characterized before treatment.
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Affiliation(s)
- Nozomi Otsuka
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hirohisa Yajima
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoru Miyawaki
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
- *Correspondence: Satoru Miyawaki
| | - Satoshi Koizumi
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoshi Kiyofuji
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Hongo
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yu Teranishi
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taichi Kin
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Medical Information Engineering, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Sharma VK, Wong LK. Middle Cerebral Artery Disease. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00024-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Alliez JR, Manera L. Aneurysm Arising at the Origin of a Duplicated Middle Cerebral Artery. Case Rep Neurol 2021; 13:446-450. [PMID: 34326754 PMCID: PMC8299405 DOI: 10.1159/000517366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/23/2021] [Indexed: 11/27/2022] Open
Abstract
A duplicated middle cerebral artery (DMCA) is a common anomaly. However, aneurysms arising from the origin of a DMCA are extremely rare. A 22-year-old female was admitted to our hospital with a World Federation of Neurosurgical Societies grade 2 subarachnoid haemorrhage. Four-vessel angiography revealed a DMCA and an aneurysm arising from the origin of this artery. The aneurysm was successfully treated by embolization, and the patient was discharged 2 weeks later. Ruptured aneurysms arising from the origin of a DMCA can be successfully treated by embolization. These aneurysms are small and 3D-computed tomography reconstruction is mandatory to detect them. It is important to preserve the DMCA during the treatment procedure.
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Affiliation(s)
| | - Luis Manera
- Department of Neuroradiology, CHU E. Herriot, Lyon, France
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Hou K, Xu K, Liu H, Li G, Yu J. The Clinical Characteristics and Treatment Considerations for Intracranial Aneurysms Associated With Middle Cerebral Artery Anomalies: A Systematic Review. Front Neurol 2020; 11:564797. [PMID: 33193002 PMCID: PMC7654337 DOI: 10.3389/fneur.2020.564797] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/10/2020] [Indexed: 11/17/2022] Open
Abstract
Background: As a result of their low incidence, most of the studies on intracranial aneurysms associated with middle cerebral artery (MCA) anomalies were presented as case reports or small case series. No systematic review on this specific entity has been conducted. Methods: A PubMed search of the published studies was performed on April 6th, 2019 for patients who had intracranial aneurysms associated with MCA anomalies. The languages included in this study were English, Chinese, and Japanese. Results: Finally, 58 articles reporting of 67 patients including 1 case in our center were included. The identified patients (37 females, 55.2%) aged from 4 to 81 (49.85 ± 15.22) years old. 50 (50/67, 74.6%) patients presented with hemorrhagic stroke either from the MCA anomalies associated aneurysms or other sources. 63 aneurysms (63/67, 94.0%) were saccular, 3 (4.5%) were dissecting or fusiform, and 1 (1.5%) was pseudoaneurysm. 32 (32/65, 49.2%) patients had other concurrent cerebrovascular anomalies. 56 (83.6%) patients underwent open surgeries, 8 (11.9%) patients underwent endovascular treatment, and 3 (4.5%) patients were conservatively managed. 56 (56/61, 91.8%) patients achieved a good recovery. Conclusions: The pathophysiological genesis of intracranial aneurysms associated with MCA anomalies is still obscure. The inflicted patients tend to have other concurrent cerebrovascular anomalies, which denotes that congenital defect in cerebrovascular development might play a role in this process. Most of the affected patients could experience a good recovery after treatment.
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Affiliation(s)
- Kun Hou
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Kan Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Hongping Liu
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Guichen Li
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
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Mori K, Tamase A, Seki S, Iida Y, Kawabata Y, Nakano T, Nomura M. Duplicated middle cerebral artery associated with aneurysm at M1/M2 bifurcation: a case report. J Med Case Rep 2018; 12:283. [PMID: 30269684 PMCID: PMC6166289 DOI: 10.1186/s13256-018-1824-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 08/28/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND A duplicated middle cerebral artery arises from the internal carotid artery and supplies blood to the middle cerebral artery territory. A duplicated middle cerebral artery is sometimes associated with an intracranial aneurysm. Most aneurysms associated with duplicated middle cerebral artery are located at the origin of the duplicated middle cerebral artery. An aneurysm located at the distal middle cerebral artery is not common. CASE PRESENTATION We encountered a 62-year-old Asian man with duplicated middle cerebral artery associated with aneurysms at the M1/M2 junction of the duplicated middle cerebral artery and top of the internal carotid artery. CONCLUSIONS In cases of duplicated middle cerebral artery, association with a distal aneurysm on the duplicated middle cerebral artery is rare. However, the aneurysm may be formed on the thicker middle cerebral artery due to hemodynamic stress.
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Affiliation(s)
- Kentaro Mori
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Akira Tamase
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Syunsuke Seki
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Yu Iida
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Yuichi Kawabata
- Department of Neurology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Tatsu Nakano
- Department of Neurology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Motohiro Nomura
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
- Department of Neurosurgery, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, 211-8510 Japan
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Duplication of the middle cerebral artery in a neonate: case report. Surg Radiol Anat 2018; 40:1173-1175. [PMID: 30069575 DOI: 10.1007/s00276-018-2074-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 07/28/2018] [Indexed: 10/28/2022]
Abstract
The middle cerebral artery, a terminal branch of the internal carotid artery, participates greatly in the blood supply of the cerebral cortex and basal nuclei. The aim of this paper is to present a case of middle cerebral artery duplication in a 3-day-old neonate. A brief literature overview in this paper serves to summarize the research on the middle cerebral artery duplication. Also, possible etiology of this anatomical variation will be discussed, together with the embryology of the middle cerebral artery. The arteries of the circle of Willis are affected by numerous neurovascular diseases and the knowledge of these anatomical variations is important in the diagnostic and therapeutic interventions in this field.
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Abstract
RATIONALE Middle cerebral artery (MCA) anomalies are relatively rare and often related to aneurysms. Familiarity with these anomalies is important in resolving problems that arise in the complex angioarchitecture. Reports often describe that aneurysms that are related to accessory or duplicated MCA are often located at its origin. PATIENT CONCERNS A 59-year-old man presented with a headache for 10 days, without nausea and vomiting. The physical examination was negative. DIAGNOSIS A computed tomography (CT) scan revealed an intracerebral hematoma in the deep right frontal lobe, near the caudate nucleus. Digital subtraction angiography (DSA) revealed an anomalous duplicated origin of the right MCA, with occlusion of the main MCA trunk as well as twisting and dilation of the accessory MCA trunk. A wide-necked aneurysm was located at a sharp curve of the tortuous accessory MCA trunk. A ruptured aneurysm related to a duplicated MCA origin was diagnosed. INTERVENTIONS Open surgery was rejected by the patient; hence, palliative endovascular coil embolization of the larger daughter sac was performed. OUTCOMES The postoperative course was uneventful. There was no rebleeding at 8-months follow-up. LESSONS MCA anomalies are relatively rare and often related to aneurysms. It is important to be familiar with these anomalies as related lesions often manifest within a complex angioarchitecture. Aneurysms at the trunk of an anomalous MCA are a rare entity and open surgery may be recommended.
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Kim JS, Lee CH, Park H, Han JW. An Unruptured Cerebral Aneurysm at the Origin of the Duplicated Middle Cerebral Artery. J Cerebrovasc Endovasc Neurosurg 2015; 17:223-6. [PMID: 26523256 PMCID: PMC4626346 DOI: 10.7461/jcen.2015.17.3.223] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 08/10/2015] [Accepted: 09/03/2015] [Indexed: 11/23/2022] Open
Abstract
A variety of cerebral vascular anomalies are widely applied, however anomalies of the middle cerebral artery (MCA) are relatively infrequent. The duplicated MCA (DMCA) is a MCA anomaly. Aneurysm arising from the origin of the DMCA is rare. Cerebral angiography in a 61-year-old female demonstrated a small (about 3 mm) saccular aneurysm located at the origin of the DMCA in the anterior direction. Considering the unusual location, the lesion was treated, regardless of the size. Aneurysmal characteristics of a broad neck and small size limited the endovascular approach, necessitating open surgery. Her postoperative course was uneventful and postoperative angiography showed complete obliteration of the aneurysm. The patient was discharged without neurologic deficit.
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Affiliation(s)
- Jin Seong Kim
- Department of Neurosurgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Chul-Hee Lee
- Department of Neurosurgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Hyun Park
- Department of Neurosurgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Jong-Woo Han
- Department of Neurosurgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
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Toyota S, Kumagai T, Sugano H, Yamamoto S, Mori K, Taki T. Unruptured Aneurysm at the Origin of the Duplicated Middle Cerebral Artery Treated by Coil Embolization: A Case Report. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ojmn.2015.51005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Patel MA, Caplan JM, Yang W, Colby GP, Coon AL, Tamargo RJ, Huang J. Arterial fenestrations and their association with cerebral aneurysms. J Clin Neurosci 2014; 21:2184-8. [DOI: 10.1016/j.jocn.2014.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 07/05/2014] [Indexed: 11/25/2022]
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Noguchi K, Aoki T, Komaki S, Takeuchi Y, Hirohata M, Morioka M. Unusual hemodynamic stroke related to an accessory middle cerebral artery: The usefulness of fusion images from three-dimensional angiography. Surg Neurol Int 2014; 5:26. [PMID: 24778914 PMCID: PMC3994683 DOI: 10.4103/2152-7806.127890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 01/24/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Ischemic stroke associated with an anomaly of the middle cerebral artery (MCA) is a rare occurrence. The diagnosis is very difficult when there are steno-occlusive lesions associated with an accessory middle cerebral artery (AMCA). CASE DESCRIPTION A 77-year-old female with hypertension and hyperlipidemia experienced repeated transient ischemic attacks (TIAs) of motor aphasia and dysarthria. Although angiography showed only left intracranial occlusion, the fusion images of three-dimensional digital subtraction angiography (3-D DSA) showed complex steno-occlusive lesions and an AMCA related with the TIA. The cerebral blood flow (CBF) to the left frontal lobe was supplied by the AMCA, via the anterior communicating artery from the right internal carotid artery. The left temporal and parietal lobes were supplied by the stenotic MCA, via the left posterior communicating artery from the left posterior cerebral artery. Single-photon emission computed tomography showed a marked decrease in CBF to both the left frontal and temporal lobes. A left superficial temporal artery (STA)-to-left MCA double anastomosis was performed, in which each branch of the STA supplied branches of the AMCA and MCA. CONCLUSION This is the first reported case of ischemic stroke in a patient with an AMCA. The exact diagnosis could be made only by using fusion images of 3-D DSA, which were useful for understanding the complicated CBF pattern and for the choice of recipient artery in bypass surgery.
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Affiliation(s)
- Kei Noguchi
- Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Takachika Aoki
- Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Satoru Komaki
- Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Yasuharu Takeuchi
- Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Masaru Hirohata
- Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Motohiro Morioka
- Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan
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Elsharkawy A, Ishii K, Niemelä M, Kivisaari R, Lehto H, Hernesniemi J. Management of Aneurysms at the Origin of Duplicated Middle Cerebral Artery: Series of Four Patients with Review of the Literature. World Neurosurg 2013; 80:e313-8. [DOI: 10.1016/j.wneu.2012.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 10/02/2012] [Indexed: 10/27/2022]
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17
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OTANI N, WADA K, SAKAKIBARA F, TAKEUCHI S, NAGATANI K, KOBAYASHI H, OSADA H, SUZUKI T, MORI K. A ruptured aneurysm located at a collateral artery that extended from the proximal A2 segment to the M1 segment, associated with an anomalous branch of the anterior choroidal artery and middle cerebral artery hypoplasia: case report. Neurol Med Chir (Tokyo) 2013; 54:201-4. [PMID: 24140763 PMCID: PMC4533421 DOI: 10.2176/nmc.cr2012-0219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Accepted: 11/28/2012] [Indexed: 11/20/2022] Open
Abstract
We here describe the first case of a ruptured aneurysm located at a collateral artery that extended from the proximal A2 segment to the M1 segment, which was associated with an anomalous branch of the anterior choroidal artery and middle cerebral artery (MCA) hypoplasia. The aneurysm was revealed by angiograms and intraoperative findings. No previous accounts have been published of such an extremely rare vessel anomaly. In practice, this case highlights the urgent need to preoperatively recognize such vascular anomalies, as well as to better understand the collateral blood supply in cerebral ischemia associated with these MCA anomalies. Such knowledge will be helpful for planning optimal surgical procedures.
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Affiliation(s)
- Naoki OTANI
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama
| | - Kojiro WADA
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama
| | - Fumihiro SAKAKIBARA
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama
| | - Satoru TAKEUCHI
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama
| | - Kimihiro NAGATANI
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama
| | - Hiroaki KOBAYASHI
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama
| | - Hideo OSADA
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama
| | - Takamoto SUZUKI
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama
| | - Kentaro MORI
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama
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A rare case of supraclinoid internal carotid artery (ICA) fenestration in combination with duplication of the middle cerebral artery (MCA) originating from the ICA fenestration and an associated aneurysm. Clin Neuroradiol 2012; 23:133-6. [PMID: 22231576 DOI: 10.1007/s00062-011-0120-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 11/24/2011] [Indexed: 10/14/2022]
Abstract
Fenestrations and duplications of the cervical and intracranial arteries are rare anatomic variants, reported to be associated with aneurysms or other vascular anomalies. We here present a patient with a supraclinoid ICA fenestration in combination with a duplication of the MCA originating from the ICA fenestration and an associated aneurysm.
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19
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Chang HY, Kim MS. Middle cerebral artery duplication : classification and clinical implications. J Korean Neurosurg Soc 2011; 49:102-6. [PMID: 21519498 DOI: 10.3340/jkns.2011.49.2.102] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Revised: 02/05/2011] [Accepted: 02/27/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Although there are several explanations for a duplicated middle cerebral artery (DMCA), its embryological origin is still an open question. We reviewed these anomalous vessels to postulate a theory of their different origins, sizes, and courses. METHODS A retrospective review of 1,250 cerebral angiographies, 1,452 computed tomography (CT)-angiographies, and 2,527 magnetic resonance (MR)-angiographies was performed to identify patients with DMCA. RESULTS Twenty-five patients had 25 DMCAs. Conventional angiography detected nine patients with DMCA (9/1250, 0.72%), MR-angiography detected seven patients with DMCA (7/2527, 0.28%), and CT-angiography detected nine patients with DMCA (9/1452, 0.62%). The DMCAs originated near the internal carotid artery terminal in eight patients (type A), and between the origin of the anterior choroidal artery and the terminal internal carotid artery in 17 patients (type B). The diameters of the eight type A DMCAs were the same or slightly smaller than those of the other branch of the DMCA. All type A DMCAs showed a course parallel to that of the other branch of the DMCA. The diameters of the 17 type B DMCAs were the same, slightly smaller, or very much smaller than that of the other branch of the DMCA. Nine type B DMCAs showed parallel courses, and the other eight curved toward the temporal lobe. CONCLUSION The two branches of the type A DMCAs can be regarded as early bifurcations of the MCA. The branches of the type B DMCAs had parallel courses or a course that curved toward the temporal lobe. The type B DMCA can be regarded as direct bifurcations of the MCA trunk or the early ramification of the temporal branch of the MCA.
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Affiliation(s)
- Hoe Young Chang
- Department of Neurosurgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Miyamoto J, Mineura K. Unruptured Middle Cerebral Artery Aneurysm Associated With a Duplicated Middle Cerebral Artery and a Dolichoectasic Anterior Cerebral Artery. J Stroke Cerebrovasc Dis 2010; 19:503-6. [DOI: 10.1016/j.jstrokecerebrovasdis.2009.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Revised: 07/31/2009] [Accepted: 08/28/2009] [Indexed: 10/19/2022] Open
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Otani N, Nawashiro H, Tsuzuki N, Osada H, Suzuki T, Shima K, Nakai K. 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. Surg Neurol Int 2010; 1:51. [PMID: 20975967 PMCID: PMC2958321 DOI: 10.4103/2152-7806.69378] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 08/20/2010] [Indexed: 12/04/2022] Open
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.
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Affiliation(s)
- Naoki Otani
- Department of Neurosurgery, National Defense Medical College, Saitama, Japan
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22
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Lame A, Kaloshi G, Petrela M. Anatomic variants of accessory medial cerebral artery. Neurosurgery 2010; 66:E1217; author reply E1217. [PMID: 20495402 DOI: 10.1227/01.neu.0000371079.84563.f5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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KIMURA T, MORITA A. Treatment of Unruptured Aneurysm of Duplication of the Middle Cerebral Artery -Case Report-. Neurol Med Chir (Tokyo) 2010; 50:124-6. [DOI: 10.2176/nmc.50.124] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Toshikazu KIMURA
- Department of Neurosurgery and Stroke Unit, Kanto Medical Center, NTT East Corporation
| | - Akio MORITA
- Department of Neurosurgery and Stroke Unit, Kanto Medical Center, NTT East Corporation
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Perez J, Machado C, Scherle C, Hierro D. Duplicated middle cerebral artery. BMJ Case Rep 2009; 2009:bcr06.2009.2035. [PMID: 22140405 DOI: 10.1136/bcr.06.2009.2035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Duplicated middle cerebral artery (DMCA) is an anomalous vessel arising from the internal carotid artery. The incidence DMCA is relatively law, and an association between this anomaly and cerebral aneurysms has been documented. There is a controversy whether DMCA may have perforating arteries. This is an important fact to consider in aneurysm surgery. We report the case of a 34-year-old black woman who suffered a subarachnoid hemorrhage and the angiography a left DMCA, and an aneurysm in an inferior branch of the main MCA. The DMCA and the MCA had perforating arteries. The aneurysm was clipped without complications. The observation of perforating arteries in our patient confirms that the DMCA may have perforating arteries. This is very important to be considered in cerebral aneurysms surgery. Moreover, the DMCA may potentially serve as a collateral blood supply to the MCA territory in cases of MCA occlusion.
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Affiliation(s)
- Jesus Perez
- Hermanos Ameijeiras Hospital, Neurology, San Lazaro 701, Havana, Havana, 10300, Cuba
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Kim MS, Lee HK. The angiographic feature and clinical implication of accessory middle cerebral artery. J Korean Neurosurg Soc 2009; 45:289-92. [PMID: 19516946 DOI: 10.3340/jkns.2009.45.5.289] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Accepted: 04/26/2009] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Although there are several descriptions of this vessel, there is no detailed angiographic study of the accessory middle cerebral artery (AMCA) in Korea. We describe the angiographic characteristics of the cortical territory and origin of AMCA and discuss the clinical significance of this anomaly. METHODS We searched for patients with AMCAs from a retrospective review of 1,250 conventional cerebral angiograms. We determined the origins, diameters and cortical territories of these AMCAs. RESULTS Fifteen patients (15 of 1250 = 1.2%) had 16 AMCAs (one patient had bilateral AMCAs). AMCAs originated from the distal A1 in eleven cases, middle A1 in two, proximal A1 in two, and proximal A2 in one case. All AMCAs followed a course parallel to the main middle cerebral artery (MCA). All but three of these arteries were smaller than the main MCA. Thirteen of the smaller diameter AMCAs had cortical distribution to the orbito-frontal and prefrontal, and precentral areas. Three AMCAs had diameter as large as the main MCA. These three supplied the orbitofrontal, prefrontal, precentral, central and anterior-parietal arteries. CONCLUSION The AMCAs originated from A1 or A2. Most had smaller diameter than the main MCA. The AMCAs coursed along the horizontal portion of the MCA, but supplied the orbital surface, the anterior frontal lobe and sometimes wider cortical territory, including the precentral, central, anterior-parietal areas.
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Affiliation(s)
- Myoung Soo Kim
- Department of Neurosurgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Gao F, Jiang WJ. Transient ischemic attack associated with stenosis of accessory middle cerebral artery: a case report. Clin Neurol Neurosurg 2009; 111:588-90. [PMID: 19233548 DOI: 10.1016/j.clineuro.2009.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2008] [Revised: 12/21/2008] [Accepted: 01/12/2009] [Indexed: 11/28/2022]
Abstract
Accessory middle cerebral artery (MCA) is a rare anatomical variation of middle cerebral artery branching. An association of the accessory middle cerebral artery and cerebral aneurysms had been well documented. We report a patient who presented with transient ischemic attack (TIA) associated with stenosis of the accessory MCA ostium.
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Affiliation(s)
- Feng Gao
- Department of Neurology and Interventional Neuroradiology, Beijing Tiantan Hospital, The Capital University of Medical Sciences, Beijing 100050, China
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Reis CV, Zabramski JM, Safavi-Abbasi S, Hanel RA, Deshmukh P, Preul MC. The Accessory Middle Cerebral Artery: Anatomic Report. Oper Neurosurg (Hagerstown) 2008. [DOI: 10.1227/01.neu.0000315284.44157.4a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Objective:
An accessory middle cerebral artery (MCA) usually originates between the A1 and proximal A2 segment of the anterior cerebral artery, reaches the sylvian fissure, and supplies the territory of the MCA. This anomaly has been associated with cerebral aneurysms and Moyamoya disease. We report an accessory MCA arising from the A2 segment.
Methods:
A cadaveric head, fixed in formalin solution and injected with red and blue silicone on its vascular tree to trace intracranial and extracranial vessels, was dissected.
Results:
An accessory MCA was found arising from the A2 segment of the anterior cerebral artery and feeding the basal and inferior surface of the inferior frontal gyrus. In our specimen, the vessel was associated with intracranial aneurysms at other locations.
Conclusion:
Although anomalies of the MCA are rare, neurosurgeons must be familiar with such anatomic variations. An accessory MCA can be associated with Moyamoya disease and aneurysms at its junction with the anterior cerebral artery. Patients with this anomaly may, therefore, have an increased risk for developing aneurysms and other neurovascular complications. By obstructing the surgical view, an accessory MCA may increase the difficulty of exposing lesions in the vicinity of the optic chiasm.
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Affiliation(s)
- Cassius V.C. Reis
- Division of Neurological Surgery and Neurosurgical Research, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Joseph M. Zabramski
- Division of Neurological Surgery and Neurosurgical Research, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Sam Safavi-Abbasi
- Division of Neurological Surgery and Neurosurgical Research, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Ricardo A. Hanel
- Division of Neurological Surgery and Neurosurgical Research, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Pushpa Deshmukh
- Division of Neurological Surgery and Neurosurgical Research, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Mark C. Preul
- Division of Neurological Surgery and Neurosurgical Research, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Tutar NU, Töre HG, Kirbaş I, Tarhan NC, Coşkun M. Various origins of the duplicated middle cerebral artery. J Neuroimaging 2008; 18:448-50. [PMID: 18494777 DOI: 10.1111/j.1552-6569.2008.00254.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We describe the features of a duplicated middle cerebral artery identified by computed tomographic angiography that originates from a previously undefined origin, ie, from the petrous portion of the internal carotid artery. Recognition of this anomaly is important in patients with a possible aneurysm, which was not present in our patient.
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Affiliation(s)
- Nihal Uslu Tutar
- Baskent University Faculty of Medicine, Department of Radiology, Ankara, Turkey.
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Kai Y, Hamada JI, Morioka M, Yano S, Kudo M, Kuratsu JI. Treatment of unruptured duplicated middle cerebral artery aneurysm: case report. ACTA ACUST UNITED AC 2006; 65:190-3; discussion 193. [PMID: 16427423 DOI: 10.1016/j.surneu.2005.05.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2005] [Accepted: 05/23/2005] [Indexed: 11/28/2022]
Abstract
BACKGROUND Duplication of the middle cerebral artery (DMCA) is an anomalous vessel arising from the internal carotid artery (ICA). The origin of the DMCA lies between the anterior choroidal artery and the distal end of the ICA. The association of cerebral aneurysm and DMCA is rare. CASE DESCRIPTION In this 63-year-old woman, preoperative angiography and 3-dimensional computed tomography angiography revealed an aneurysm at the origin of the DMCA. The aneurysm was clipped and superficial temporal artery-DMCA anastomosis was performed. She was discharged with no neurologic deficits. Duplication of the middle cerebral artery can be divided into 2 types based on whether the site of separation from the ICA is at the top of the ICA (type A) or between the ICA top and the anterior choroidal artery (type B). The diameter of type A DMCA is comparable with that of the main middle cerebral artery trunk; in type B, it is smaller. In all 18 previously reported cases, the aneurysm was associated with type B DMCA. CONCLUSION For appropriate treatment planning, it is necessary to determine the DMCA type and the anatomic relationship between the aneurysm and the DMCA. In patients with type B DMCA, the possibility of aneurysm formation should be considered.
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Affiliation(s)
- Yutaka Kai
- Department of Neurosurgery, Graduate School of Medical Science, Kumamoto University, Kumamoto 860-8556, Japan.
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