Management of aneurysms at the origin of duplicated middle cerebral artery: series of four patients with review of the literature

Abstract

Objective: To review the management of aneurysms arising at the origin of a duplicated middle cerebral artery (DMCA), which is an extremely rare entity.

Methods: Four patients with internal carotid artery-DMCA aneurysms are presented, and 24 previously published cases are reviewed.

Results: Of the 28 internal carotid artery-DMCA aneurysms, 17 were ruptured, and 11 were unruptured. The aneurysms were equally distributed on the right and left sides and were small in size (≤6 mm) except for two that were of medium size. All aneurysms were treated surgically except for two very small aneurysms, which have been managed conservatively and followed for 9 years.

Conclusions: Although all previously published clinical cases of internal carotid artery-DMCA aneurysms were treated surgically, conservative management with follow-up is a viable option in very small unruptured aneurysms.

Keywords: CT; Cerebral aneurysm; Clipping; Computed tomography; Computed tomography angiography; Conservative management; DMCA; Duplicated middle cerebral artery; Duplication of middle cerebral artery; ICA; Internal carotid artery; Lateral supraorbital approach; MCA; Middle cerebral artery; STA; Subarachnoid hemorrhage; Superficial temporal artery; Variation of cerebral artery.