Hayashi Kentaro, Matsuo Yoshitaka, Hayashi Yukishige, Shirakawa Kiyoshi, Kaminogo Makio
Department of Neurosurgery, Sasebo City General Hospital.
No Shinkei Geka. 2017 May;45(5):391-396. doi: 10.11477/mf.1436203520.
Duplication of the middle cerebral artery(MCA)is an anatomical variant of the MCA, originating from the distal portion of the internal carotid artery(ICA)and supplying blood flow to the tip of the temporal lobe. Cerebral aneurysms rarely develop at the bifurcation of the ICA and the duplicated MCA, but when they do develop, they may result in subarachnoid hemorrhage. We treated a 41-year-old man, who was urgently brought to our hospital because of severe headache. A computed tomography(CT)scan showed subarachnoid hemorrhage due to the rupture of an aneurysm at the origin of the duplicated MCA. The aneurysm was small and projected laterally, and coil embolization was performed employing a balloon catheter. The neck of the aneurysm was not embolized to preserve the origin of the duplicated MCA. The patient had an uneventful postoperative course, and he returned to his usual daily activities. Coil embolization is rapidly developing for treatment of cerebral aneurysms and may be the first-line treatment for duplicated MCA aneurysms. Owing to the relatively small size of such aneurysms, the risk of intraprocedural rupture should be considered, and a carefully performed balloon-assisted procedure is recommended.
大脑中动脉（MCA）重复是MCA的一种解剖变异，起源于颈内动脉（ICA）远端，为颞叶尖端供血。ICA与重复的MCA分叉处很少发生脑动脉瘤，但一旦发生，可能导致蛛网膜下腔出血。我们治疗了一名41岁男性，因剧烈头痛被紧急送往我院。计算机断层扫描（CT）显示，重复MCA起始处的动脉瘤破裂导致蛛网膜下腔出血。动脉瘤较小，向外侧突出，采用球囊导管进行了弹簧圈栓塞。未栓塞动脉瘤颈部以保留重复MCA的起始处。患者术后恢复顺利，恢复了日常活动。弹簧圈栓塞在脑动脉瘤治疗中发展迅速，可能是重复MCA动脉瘤的一线治疗方法。由于此类动脉瘤相对较小，应考虑术中破裂风险，建议谨慎进行球囊辅助操作。
