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

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.

Review on the anatomy of the middle cerebral artery; cortical branches, branching pattern and anomalies

“…Selected authors noted an association between duplicated MCAs and aneurysms (50,61,62), although very few studies have reported aneurysms at the origin or near the anomalous branch (12,24,29,42,49,57,70). Several authors observed an association between accessory MCAs and aneurysms (30,80,91).…”

“…Few studies have, however, reported aneurysms at the origin or near the anomalous branch (14,16,22,41,45,46,51,67,88). Fenestration might predispose patients to aneurysm formation (62) and selected authors have observed an association between fenestration and aneurysms (proximal or distal to the fenestration) (13,44,52,54,62,65,81). trunks included the PfA and precentral artery in 42.1%, the temporopolar artery and ATA in 31.6%, and the PcA and central artery in 31.6% of cases.…”

Unruptured Aneurysm at the Origin of the Duplicated Middle Cerebral Artery Treated by Coil Embolization: A Case Report

“…This anomalous vessel is associated with various other intracranial anomalies such accessory MCA, azygos ACA, and moyamoya disease [5] [15]. However, the association of a cerebral aneurysm with this anomaly is very rare, and only 29 treated cases have been reported [1]- [24]. Komiyama et al reported that the DMCAs supplied the cortical territory of the temporopolar and the anterior temporal and/or middle temporal arteries, and they had perforating arteries in three of four cases [27].…”

“…In most of them, the DMCAs originate at the base of the aneurysms. In some cases, the aneurysm arises solely from the DMCA rather than the junction of the internal carotid artery and the DMCA [4] [23] [24].…”

“…Aneurysm at the origin of a duplication of the middle cerebral artery (DMCA) from the internal carotid artery (ICA) is very rare, and only 29 treated cases (18 ruptured cases, 11 unruptured cases) have been reported [1]- [24]. All of the cases were treated by direct surgery except a ruptured case treated by intentional partial coil embolization.…”