Sharifi Guive, Bakhtevari Mehrdad Hosseinzadeh, Sabouri Sofia, Rezaei Omidvar
Department of Neurosurgery, Loghman e Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Neuroradiology, Tooska Medical Imaging Center, Tehran, Iran.
Surg Neurol Int. 2015 Sep 28;6(Suppl 16):S414-7. doi: 10.4103/2152-7806.166177. eCollection 2015.
Middle cerebral artery (MCA) fenestration is a very rare anatomical variant of the MCA, incidentally found during magnetic resonance or computed tomography angiography. It has an incidence of 0.6%. Unlike fenestration of the posterior cerebral arterial circulation, fenestration of the anterior cerebral arterial circulation has not been well described.
We present the rare case of a patient who was admitted for a ruptured aneurysm of the MCA arising at the site of the fenestration of the MCA and also an unruptured fusiform aneurysm of the right posterior communicating artery and a distal anterior cerebral artery (ACA) aneurysm.
The patient underwent craniotomy with microsurgical aneurysm clipping and the previously undiagnosed ruptured aneurysm, at the site of the fenestration of the MCA, arose immediately. Postoperatively, the patient awoke without a deficit. After treatment of postoperative bacterial meningitis, he was discharged on the 26(th) postoperative day in good condition without any neurologic deficit. Six months after the first surgery, he was operated for the distal azygos ACA aneurysm.
Anomalies of the intracranial vasculature are common, and we describe a rare case of left MCA fenestration with an associated ruptured aneurysm at the site of the fenestration. In the literature, cases of fenestration of the MCA are sporadically reported and are only incidental findings.
大脑中动脉（MCA）开窗是MCA一种非常罕见的解剖变异，在磁共振成像或计算机断层血管造影时偶然发现。其发生率为0.6%。与大脑后动脉循环开窗不同，大脑前动脉循环开窗尚未得到充分描述。
我们报告了一例罕见病例，该患者因MCA开窗部位出现破裂动脉瘤入院，同时还患有右侧后交通动脉未破裂的梭形动脉瘤和大脑前动脉（ACA）远端动脉瘤。
患者接受了开颅显微手术夹闭动脉瘤，之前未诊断出的位于MCA开窗部位的破裂动脉瘤随即出现。术后，患者清醒且无神经功能缺损。在治疗术后细菌性脑膜炎后，他于术后第26天状况良好出院，无任何神经功能缺损。首次手术后6个月，他接受了大脑前动脉奇静脉远端动脉瘤手术。
颅内血管异常很常见，我们描述了一例罕见的左MCA开窗并在开窗部位伴有破裂动脉瘤的病例。在文献中，MCA开窗的病例报道较为零散，且多为偶然发现。
