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Stephen Nutik and Domenico Dilenge

T he purpose of this presentation is to define the characteristics of a rare anomalous cerebral artery and to discuss some possibilities concerning its origin. The vessel originates at the internal carotid artery at the branching of the ophthalmic artery, passes inferior to the optic nerve, and ascends anterior to the optic chiasm to join the anterior cerebral artery (ACA) near, or at, the anterior communicating system. The angiographic features are striking, especially in the frontal projection. The anomaly is virtually unknown: there are only seven

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Tohru Yamada, Tetsuji Inagawa and Tetsuji Takeda

F enestration of the anterior cerebral artery (ACA) is rare. We present the case of a patient who presented with a ruptured aneurysm arising from the proximal end of a fenestration of the ACA. The lesion was demonstrated by angiography and confirmed at surgery. Case Report This 43-year-old man suddenly developed severe headache on February 26, 1980, followed by gradual development of stupor. Examination . On admission on February 27, the significant findings were hemorrhage in the right ocular fundus and stiffness of the neck. Computerized tomography

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Felix Umansky, Francisco B. Gomes, Manuel Dujovny, Fernando G. Diaz, James I. Ausman, Haresh G. Mirchandani and S. Kim Berman

A lthough the perforating branches (PFB's) of the middle cerebral artery (MCA) were described by early anatomists, 17 and their role in the pathogenesis of intracerebral hemorrhage has been emphasized by Charcot and Bouchard, 11 the surgical significance of these vessels became apparent only with the introduction of the operating microscope and the development of interventional neuroradiology. The surgeon operating on aneurysms or performing vascular reconstruction procedures in the proximal segments of the MCA should be aware of the origin and course of the

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Arthur L. Day

H igh-grade middle cerebral artery (MCA) stenosis and occlusion (jointly termed “MCA obstructions” in this report) theoretically represent the most ideal lesions to treat with an extracranial-intracranial (EC-IC) bypass procedure, because the obstruction occurs distal to the usual collateral pathways (ophthalmic, anterior communicating, or posterior communicating arteries). The increased availability of this operation, in combination with earlier and safer arteriographic investigation of the stroke-prone patient, has resulted in the identification of greater

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Rune Aaslid, Thomas-Marc Markwalder and Helge Nornes

in the middle, anterior, and posterior cerebral arteries (MCA, ACA, and PCA) using a noninvasive transcranial Doppler ultrasound technique. Clinical Material and Methods Fifty healthy subjects with no history of cerebral vascular disease were investigated. Their ages ranged from 20 to 65 years, with a mean of 36 years. For the present study we used a laboratory prototype range-gated Doppler instrument with the following characteristics. Emitted ultrasonic frequency 2 mHz; burst repetition rate 6.8 to 18 kHz; burst length 10 µsec; high pass filter 100 Hz

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Accessory middle cerebral artery

Report of four cases

Tohru Watanabe and Makoto Togo

T he accessory middle cerebral artery has rarely been documented. We are reporting four cases of the anomalous artery as revealed by angiography to familiarize neurosurgeons with this condition and the associated features. Case Material Four accessory middle cerebral arteries originating from the anterior cerebral artery were noticed in 1240 carotid angiograms, an incidence of 0.32%. In two patients, the angiography was carried out because of positive neurological signs after head injury, and in the other two, because of cerebro-vascular stroke; all the

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Frederick A. Simeone and Philip Vinall

P ersistent constriction of the cerebral arteries, which can last for several days, is frequently seen following the rupture of a cerebral aneurysm. In this process a variable amount of blood leaks from the aneurysm and may bathe surrounding larger arteries. At autopsy it appears that the arachnoid sometimes envelops this hemorrhage, and thereby allows the blood to clot the periarterial subarachnoid space. Aneurysmal subarachnoid hemorrhage is the most common cause of prolonged cerebral arterial spasm, though surgical manipulation of the aneurysm

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Leonello Tacconi, Francis G. Johnston and Lindsay Symon

I t is of paramount importance that the vascular neurosurgeon is thoroughly conversant with the normal anatomy of the basal arteries of the brain and their cortical distributions as well as with that of the perforating systems. Many common abnormalities of these vascular systems are recognized both angiographically and at operation and may take the form of aplasia, hypoplasia, and duplications as well as persisting fetal arterial patterns. Although many of these anomalies are well recognized, others are not so well known. The accessory middle cerebral artery

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Eddy Garrido and Bennett M. Stein

D irect surgical treatment of occlusive intracranial vascular disease, either embolic or thrombotic, is far from well established as a treatment of choice. We were able to find only 35 cases reported in the English literature. We will report a case of middle cerebral artery embolectomy and review the previous reports on this subject. Case Report A 30-year-old right-handed woman was admitted to the New England Medical Center Neurology Service on July 27, 1974, for evaluation of chronic headaches of one year's duration. Examination Neurological

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Richard K. Simpson Jr. and Warren D. Parker

P osterior cerebral artery (PCA) aneurysms are a rather uncommon entity. 1, 17, 22 Fox 8 described approximately 50 PCA aneurysms in his recent review. Zeal and Rhoton 22 reviewed approximately 118 aneurysms of this type, although only 55 cases were found to have been reported in sufficient detail to merit comment. Posterior cerebral artery aneurysms represent a very small proportion (0.26% to 1.0%) of the total reported cases of intracranial aneurysms. 12, 17 Distal PCA aneurysms are exceedingly rare. Only 13% of all PCA aneurysms are considered to be