The Clinical Characteristics and Treatment Considerations for Intracranial Aneurysms Associated With Middle Cerebral Artery Anomalies: A Systematic Review

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.

Unruptured cerebral aneurysms with the segmental duplicated middle cerebral artery formed a fenestrated structure at origin

“…In 1973, Teal et al proposed the term ac-MCA as arterial branches arising from ACA or anterior communicating artery coursed with the MCA into the Sylvian fissure, and termed d-MCA as anomalous MCA arising from the ICA regardless of its size. [9] In the MCA fenestration at origin, M1 originates as a single trunk and be divided into two channels at a short segment, whereas in do-MCA, two M1 originate separately from the ICA terminal and conglutinate into a single trunk [3,10] . e d-MCA is a relatively rare anatomical branching variation from the ICA, with reported incidence of 0.2-2.9% in autopsy and 0.24-1.5% in angiography.…”

“…[3,4] On the other hand, hemodynamic stress in Type A d-MCA is not specific for the formation of aneurysms and this type might have congenital defect in cerebrovascular development and be prone to cerebrovascular anomalies rather than Type B. [3] Our case is extremely rare because of the aneurysms combined d-MCA applying to Type A. e d-MCA has perforating arteries to the anterior perforated substance and may contribute to the normal cerebral blood flow to the frontal lobe and the basal ganglia through the perforating arteries.…”

“…Anomalies of the middle cerebral artery (MCA) occur less frequently than those of other major intracranial arteries. [ 1 , 3 , 10 ] The duplicated MCA (d-MCA) arises from the internal carotid artery (ICA) and the incidence is relatively low. [ 2 , 3 , 8 ] The association of cerebral aneurysms with d-MCA is rare.…”

“…[ 1 , 3 , 10 ] The duplicated MCA (d-MCA) arises from the internal carotid artery (ICA) and the incidence is relatively low. [ 2 , 3 , 8 ] The association of cerebral aneurysms with d-MCA is rare. Due to rarity of aneurysms located at carotid trifurcation, the technical difficulties in the surgical management are dictated by the location, size, shape, and direction of aneurysmal projection.…”

A Rare Case of Ruptured Aneurysm at the Origin of Inferior Part of Duplicated Middle Cerebral Artery

“…Congenital factors which occur in cerebrovascular development such as congenital defects of the media, residual fetal arteries, and maldevelopment at the fetal stage. Acquired factors, such as degenerative process of the vessels, arteriosclerotic process and hemodynamic stress may also be involved 13,14 . Cerebral aneurysm with "heart-shaped" form is interesting and extremely rare and is usually associated with vessel-wall degeneration and hemodynamic stress.…”