Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(03): 769-772
DOI: 10.4103/ajns.AJNS_264_19
Case Report

Unusually located proximal middle cerebral artery saccular aneurysm

Raghavendra Sharma
Department of Neurosurgery, AIIMS, Raipur, C.G.
,
Yashuhiro Yamada
1   Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya
,
Riki Tanaka
1   Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya
,
Saurabh Sharma
2   Department of Neurosurgery, Max Patparganj Hospital, New Delhi
,
Kyosuke Miyatani
1   Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya
,
Saeko Higashiguchi
1   Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya
,
Tsukasa Kawase
1   Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya
,
Srikanth Talluri
3   Department of Neurosurgery, SVIMS, Tirupati, Andhra Pradesh
,
Yoko Kato
1   Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Middle cerebral aneurysms constitute almost one-third of all anterior circulation aneurysms. Most of the saccular aneurysms originate from the arterial branching sites, but origins other than at the branching site are extremely rare. In this article, we are describing a unique M1 segment middle cerebral artery aneurysm which is not related with any branching site. Our literature search suggests that atherosclerotic changes in the arterial wall and local hemodynamic forces play an important role in the development of these types of aneurysm. Surgical management is not so unique in this type of aneurysm, but due to atherosclerotic parent arterial wall and thin-walled aneurysm sac, a neurosurgeon should be more cautious.

Key-words:

Atherosclerosis - hemodynamic stress - middle cerebral artery - saccular aneurysm

Financial support and sponsorship

Nil.




Publication History

Received: 28 August 2019

Accepted: 06 June 2020

Article published online:
16 August 2022

© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Brisman JL, Song JK, Newell DW. Cerebral aneurysms. N Engl J Med 2006;355:928-39.
  • 2 Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr., Piepgras DG, et al. Unruptured intracranial aneurysms: Natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 2003;362:103-10.
  • 3 International study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysm — Risk of rupture and risks of surgical intervention. N Engl J Med 1998;339:1725-33.
  • 4 UCAS Japan Investigators; Morita A, Kirino T, Hashi K, Aoki N, Fukuhara S, et al. The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med 2012;366:2474-82.
  • 5 Ulm AJ, Fautheree GL, Tanriover N, Russo A, Albanese E, Rhoton AL Jr., et al. Microsurgical and angiographic anatomy of middle cerebral artery aneurysms: Prevalence and significance of early branch aneurysms. Neurosurgery 2008;62:ONS344-52.
  • 6 Paulo MS, Edgardo S, Fernando M, Pablo P, Alejandro T, Verónica V. Aneurysms of the middle cerebral artery proximal segment (M1) anatomical and therapeutic considerations revision of a series. Analysis of a series of the pre bifurcation segment aneurysms. Asian J Neurosurg 2010;5:57-63.
  • 7 Ricci A, Di Vitantonio H, De Paulis D, Del Maestro M, Raysi SD, Murrone D, et al. Cortical aneurysms of the middle cerebral artery: A review of the literature. Surg Neurol Int 2017;8:117.
  • 8 Rhoton AL Jr. Aneurysms. Neurosurgery 2002;51:S121-58.
  • 9 Nutik S. Carotid paraclinoid aneurysms with intradural origin and intracavernous location. J Neurosurg 1978;48:526-33.
  • 10 Fox JL. Microsurgical treatment of ventral (paraclinoid) internal carotid artery aneurysms. Neurosurgery 1988;22:32-9.
  • 11 Yoshimoto Y, Ochiai C, Nagai M. Cerebral aneurysms unrelated to arterial bifurcations. Acta Neurochir (Wien) 1996;138:958-63.
  • 12 Redekop GJ, Woodhurst B. Unusual aneurysms of the distal internal carotid artery. Can J Neurol Sci 1998;25:202-8.
  • 13 Hosoda K, Fujita S, Kawaguchi T, Shose Y, Hamano S. Saccular aneurysms of the proximal (M1) segment of the middle cerebral artery. Neurosurgery 1995;36:441-6.
  • 14 Sekhar LN, Heros RC. Origin, growth, and rupture of saccular aneurysms: A review. Neurosurgery 1981;8:248-60.
  • 15 McCormick WF, Acosta-Rua GJ. The size of intracranial saccular aneurysms. An autopsy study. J Neurosurg 1970;33:422-7.
  • 16 Stehbens WE. The pathology of intracranial arterial aneurysms and their complications. In: Intracranial Aneurysms. New York, NY: Springer; 1983.
  • 17 Sano K. Internal carotid-posterior communicating anterior choroidal region aneurysms. Microsurgical treatment. In: Pia HW, Langmard C, Zierski J, eds. Berlin-Heidelberg-New York Springer 1979;252-9.
  • 18 Nixon AM, Gunel M, Sumpio BE. The critical role of hemodynamics in the development of cerebral vascular disease. J Neurosurg 2010;112:1240-53.
  • 19 Cebral JR, Castro MA, Burgess JE, Pergolizzi RS, Sheridan MJ, Putman CM. Characterization of cerebral aneurysms for assessing risk of rupture by using patient-specific computational hemodynamics models. AJNR Am J Neuroradiol 2005;26:2550-9.
  • 20 Hoi Y, Meng H, Woodward SH, Bendok BR, Hanel RA, Guterman LR, et al. Effects of arterial geometry on aneurysm growth: Three-dimensional computational fluid dynamics study. J Neurosurg 2004;101:676-81.
  • 21 Stehbens WE. Etiology and pathogenesis of intracranial berry aneurysms. In: Intracranial Aneurysms. New York, NY: Springer US; 1983. p. 358-95.
  • 22 Kondo S, Hashimoto N, Kikuchi H, Hazama F, Nagata I, Kataoka H. Cerebral aneurysms arising at nonbranching sites. An experimental Study. Stroke 1997;28:398-403.
  • 23 Sakarunchai I, Kato Y, Yamada Y, Inamasu J. Ischemic event and risk factors of embolic stroke in atherosclerotic cerebral aneurysm patients treated with a new clipping technique. J Stroke Cerebrovasc Dis 2015;24:2497-507.
  • 24 Barrow DL, Prats AR. Infectious intracranial aneurysms: Comparison of groups with and without endocarditis. Neurosurgery 1990;27:562-72.
  • 25 Rhee RY, Gloviczki P, Cherry KJ Jr., Edwards WD. Two unusual variants of internal carotid artery aneurysms due to fibromuscular dysplasia. Ann Vasc Surg 1996;10:481-5.
  • 26 Nakagawa F, Kobayashi S, Takemae T, Sugita K. Aneurysms protruding from the dorsal wall of the internal carotid artery. J Neurosurg 1986;65:303-8.