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Skip Jacques, C. Hunter Shelden, D. Thomas Rogers Jr., and Anthony C. Trippi

W hile posttraumatic occlusion of the extracranial vertebral and carotid arteries is well known, reports of occlusion of intracranial vessels following closed head trauma are rare; 7, 8 in fact, only 21 cases have been adequately documented. 6 We believe this occurrence is much more common than generally recognized and needs to be stressed because of the clinical similarity to other intracranial posttraumatic mass lesions. This communication will describe a single case of bilateral middle cerebral artery occlusion following closed head injury and comment on

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Charles R. Loar, William M. Chadduck, and G. Robert Nugent

T raumatic middle cerebral artery occlusion has rarely been discussed in the neurosurgical literature; in fact, only 20 cases have been adequately detailed and documented. 2–4, 7, 8, 10–13 We believe the entity deserves reemphasis because of its clinical similarity to other traumatic intracranial lesions, and are therefore reporting our experience with one case. Case Report A 40-year-old man was admitted unconscious to the West Virginia University Hospital 6 hours after a motorcycle accident. No description of the accident was available, but it was

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Tetsuyoshi Horiuchi, Yuichiro Tanaka, Hisayoshi Takasawa, Takahiro Murata, Takehiro Yako, and Kazuhiro Hongo

. J Neurosurg 48 : 369 – 382 , 1978 Bohmfalk GL, Story JL, Wissinger JP, et al: Bacterial intracranial aneurysm. J Neurosurg 48:369–382, 1978 2. Chyatte D , Porterfield R : Nuances of middle cerebral artery aneurysm microsurgery. Neurosurgery 48 : 339 – 346 , 2001 Chyatte D, Porterfield R: Nuances of middle cerebral artery aneurysm microsurgery. Neurosurgery 48:339–346, 2001 3. Gibo H , Carver CC , Rhoton AL Jr , et al : Microsurgical anatomy of the middle cerebral artery

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Jiro Suzuki, Takashi Yoshimoto, and Takamasa Kayama

T he majority of aneurysms of the middle cerebral artery (MCA) are found at the bifurcation of the M 1 and M 2 portions, located deep in the Sylvian fissure. We have developed a safe and definitive surgical technique for treating aneurysms in this region. 19 In the present paper, we discuss the surgical methods that we currently use, based upon our experience with 413 cases of MCA aneurysms that were treated surgically. Summary of Cases Clinical Material During the 20-year period from June, 1961, to June, 1981, 1621 patients with cerebral

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Perforating branches of the middle cerebral artery

Microsurgical anatomy of their extracerebral segments

Slobodan V. Marinković, Miroslav S. Kovačević, and Jelena M. Marinković

A neurysms are often located on the proximal (M 1 ) segment of the middle cerebral artery (MCA). 2, 9, 15, 24 Perforating (lenticulostriate) arteries that supply the basal ganglia and internal capsule 6, 12–14, 16, 17 may arise from the same portion of the MCA. Accordingly, a detailed knowledge of the anatomical features of these important vessels is necessary, in order to avoid injury to them during operative exposure of aneurysms. Although perforating arteries are mentioned very often in the literature, only a few authors have reported data about them. 6

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Richard G. Robinson

N orman Dott in 1930 seems to have been the first surgeon to have deliberately operated on a ruptured aneurysm of the middle cerebral artery. 2 The lesion was located by clinical acumen, the sac wrapped with muscle hammered onto gauze, and the patient survived another 12 years to die of a myocardial infarction. Yet surgery of cerebral aneurysms did not get underway until after World War II by which time carotid arteriography had become available. There are many reports on the surgical management of ruptured intracranial aneurysms, and most interest has

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Hirohiko Gibo, Christopher C. Carver, Albert L. Rhoton Jr., Carla Lenkey, and Robert J. Mitchell

T he middle cerebral artery (MCA) is the largest and most complex of the cerebral vessels. Some of its branches are exposed in most operations in the supratentorial area, whether the approach be to the cerebral convexity, parasagittal region, or along the cranial base. In the past, surgical interest in the MCA has been directed at avoiding damage to its branches during operations within its territory, but micro-operative techniques have now made reconstruction of the bypass to the MCA an important method of preserving and restoring blood flow to the cerebrum

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R. Michael Scott and H. Thomas Ballantine Jr.

W e are documenting the angiographic findings in a woman with a giant aneurysm of the middle cerebral artery diagnosed 5 years previously and left untreated. Case Report In March, 1971, this 50-year-old right-handed white woman was admitted for the third time to the Massachusetts General Hospital with the chief complaints of inability to concentrate and mild depression. When admitted in 1966 for evaluation of an intracranial calcification noted on a skull film ( Fig. 1 ), the patient had no abnormalities on neurological examination, but arteriography

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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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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