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Cerebral Aneurysm in the Long Fenestration at the Middle Portion of M1 Segment

  • Sim, Ki-Bum (Department of Neurosurgery, Jeju National University College of Medicine) ;
  • Lee, Chang-Sub (Department of Neurosurgery, Jeju National University College of Medicine) ;
  • Park, Jung-Cheol (Department of Neurosurgery, Jeju National University College of Medicine) ;
  • Huh, Ji-Soon (Department of Neurosurgery, Jeju National University College of Medicine)
  • Received : 2010.01.25
  • Accepted : 2010.11.22
  • Published : 2010.11.28

Abstract

We report a unique case of bilateral mirror image M1 aneurysms, one of which was an unruptured aneurysm arising from the proximal end of right middle cerebral artery fenestration with long loop and the other ruptured aneurysm from the contralateral side. We clipped ruptured aneurysm first and unruptured one in three months after the first operation. The difficulties of identifying this unusual vascular anomaly and possible problems during the surgery of an aneurysm at the site of fenestration are discussed with a review of the literature.

Keywords

References

  1. Baba M, Shimizu T, Kagawa M, Kitamura K, Kobayashi N : [A case of multiple anomalies of cerebral vessels--fenestration of the middle cerebral artery aneurysm of the anterior communicating artery and arteriovenous malformation on the frontopolar region (author's transl).] No Shinkei Geka 5 : 59-64, 1977
  2. Barbara H, Marek S, Stawomir B, Dabrowka S : Angiographic and CT-angiographic appearance of middle cerebral artery fenestration in a patient with spontaneous subarachnoid hemorrhage. Pol J Radiol 68 : 87-89, 2003
  3. Ciszek B : On a rare form of fenestration of the middle cerebral artery. Folia Morphol (Warsz) 54 : 9-13, 1995
  4. Crompton MR : The pathology of ruptured middle-cerebral aneurysms with special reference to the differences between the sexes. Lancet 280 : 421-425, 1962 https://doi.org/10.1016/S0140-6736(62)90281-7
  5. Deruty R, Pelissou-Guyotat I, Mottolese C, Bognar L, Laharotte JC, Turjman F : Fenestration of the middle cerebral artery and aneurysm at the site of the fenestration. Neurol Res 14 : 421-424, 1992 https://doi.org/10.1080/01616412.1992.11740097
  6. Finlay HM, Canham PB : The layered fabric of cerebral artery fenestrations. Stroke 25 : 1799-1806, 1994 https://doi.org/10.1161/01.STR.25.9.1799
  7. Fujimoto M, Nakahara I, Tanaka M, Iwamuro Y, Watanabe Y, Harada K : [Multiple intracranial aneurysms and vascular abnormalities associated with neurofibromatosis type 1 : a case report.] No Shinkei Geka 32 : 355-359, 2004
  8. Fuse T, Niwa Y, Harada S : Local intraarterial fibrinolytic therapy for embolic stroke associated with vascular anomalies--two case reports. Neurol Med Chir (Tokyo) 40 : 641-644, 2000 https://doi.org/10.2176/nmc.40.641
  9. Gailloud P, Albayram S, Fasel JH, Beauchamp NJ, Murphy KJ : Angiographic and embryologic considerations in five cases of middle cerebral artery fenestration. AJNR Am J Neuroradiol 23 : 585-587, 2002
  10. Ito J, Maeda H, Inoue K, Onishi Y : Fenestration of the middle cerebral artery. Neuroradiology 13 : 37-39, 1977 https://doi.org/10.1007/BF00335032
  11. Jeong SK, Kwak HS, Cho YI : Middle cerebral artery fenestration in patients with cerebral ischemia. J Neurol Sci 275 : 181-184, 2008 https://doi.org/10.1016/j.jns.2008.07.037
  12. Kalia KK, Ross DA, Gutin PH : Multiple arterial fenestrations, multiple aneurysms and an arteriovenous malformation in a patient with subarachnoid hemorrhage. Surg Neurol 35 : 45-48, 1991 https://doi.org/10.1016/0090-3019(91)90201-J
  13. Kim DW, Kang SD : Middle cerebral artery fenestration associated with an aneurysm. Korean J Cerebrovasc Surg 7 : 158-160, 2005
  14. Kim MS, Hur JW, Lee JW, Lee HK : Middle cerebral artery anomalies detected by conventional angiography and magnetic resonance angiography. J Korean Neurosurg Soc 37 : 263-267, 2005
  15. Kitami K, Kamiyama H, Yasui N : [Angiographic analysis of the middle cerebral artery in cerebral aneurysms--its branching pattern and socalled vascular anomalies.] No Shinkei Geka 13 : 283-290, 1985
  16. Lazar ML, Bland JE, North RR, Bringewald PR : Middle cerebral artery fenestration. Neurosurgery 6 : 297-300, 1980 https://doi.org/10.1227/00006123-198003000-00014
  17. Lee SJ, Hong SK : M1 fenestration in a patient with multiple cerebral arterial aneurysm : case report. J Korean Neurosurg Soc 27 : 536-539, 1998
  18. Nakamura H, Takada A, Hide T, Ushio Y : Fenestration of the middle cerebral artery associated with an aneurysm--case report. Neurol Med Chir (Tokyo) 34 : 555-557, 1994 https://doi.org/10.2176/nmc.34.555
  19. Nussbaum ES, Defillo A, Janjua TM, Nussbaum LA : Fenestration of the middle cerebral artery with an associated ruptured aneurysm. J Clin Neurosci 16 : 845-847, 2009 https://doi.org/10.1016/j.jocn.2008.08.039
  20. Okudera H, Koike J, Toba Y, Kuroyanagi T, Kyoshima K, Kobayashi S : [Fenestration of the middle cerebral artery associated with cerebral infarction. Report of two cases.] Neurol Med Chir (Tokyo) 27 : 559-563, 1987 https://doi.org/10.2176/nmc.27.559
  21. Osborn RE, Kirk G : Cerebral arterial fenestration. Comput Radiol 11 : 141-145, 1987 https://doi.org/10.1016/0730-4862(87)90039-4
  22. Parmar H, Sitoh YY, Hui F : Normal variants of the intracranial circulation demonstrated by MR angiography at 3T. Eur J Radiol 56 : 220-228, 2005 https://doi.org/10.1016/j.ejrad.2005.05.005
  23. Sanders WP, Sorek PA, Mehta BA : Fenestration of intracranial arteries with special attention to associated aneurysms and other anomalies. AJNR Am J Neuroradiol 14 : 675-680, 1993
  24. Schmieder K, Hardenack M, Harders A : Proximal long fenestration associated with an internal carotid artery aneurysm. Case illustration. J Neurosurg 86 : 733, 1997 https://doi.org/10.3171/jns.1997.86.4.0733
  25. Teal JS, Rumbaugh CL, Bergeron RT, Segall HD : Angiographic demonstration of fenestrations of the intradural intracranial arteries. Radiology 106 : 123-126, 1973 https://doi.org/10.1148/106.1.123
  26. Uchino A, Kato A, Abe M, Kudo S : Association of cerebral arteriovenous malformation with cerebral arterial fenestration. Eur Radiol 11 : 493-496, 2001 https://doi.org/10.1007/s003300000640
  27. Uchino A, Kato A, Takase Y, Kudo S : Middle cerebral artery variations detected by magnetic resonance angiography. Eur Radiol 10 : 560-563, 2000 https://doi.org/10.1007/s003300050960
  28. Uchino A, Takase Y, Nomiyama K, Egashira R, Kudo S : Fenestration of the middle cerebral artery detected by MR angiography. Magn Reson Med Sci 5 : 51-55, 2006 https://doi.org/10.2463/mrms.5.51
  29. Ueda T, Goya T, Kinoshita K : [Fenestration of the middle cerebral artery associated with an aneurysm.] Neurol Med Chir (Tokyo) 23 : 278-281, 1983 https://doi.org/10.2176/nmc.23.278
  30. Ueda T, Goya T, Kinoshita K, Wakuta Y, Mihara K : [Multiple anomalies of cerebral vessels. A case of multiple aneurysms associated with fenestration of the middle cerebral artery and persistent primitive trigeminal artery.] No Shinkei Geka 12 : 531-536, 1984
  31. Umansky F, Dujovny M, Ausman JI, Diaz FG, Mirchandani HG : Anomalies and variations of the middle cerebral artery : a microanatomical study. Neurosurgery 22 : 1023-1027, 1988 https://doi.org/10.1227/00006123-198806010-00008
  32. Wollschlaeger G, Wollschlaeger PB, Lucas FV, Lopez VF : Experience and result with postmortem cerebral angiography performed as routine procedure of the autopsy. Am J Roentgenol Radium Ther Nucl Med 101 : 68-87, 1967 https://doi.org/10.2214/ajr.101.1.68
  33. Yasargil MG : Microneurosurgery, New York : Thieme-Stratton Inc., 1984, pp72-91

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  2. Aneurysms Arising From the Fenestrated Middle Cerebral Artery : vol.30, pp.6, 2010, https://doi.org/10.1097/scs.0000000000005357