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Spontaneous fusiform middle cerebral artery aneurysms: characteristics and a proposed mechanism of formation

Arthur L. Day Department of Neurological Surgery, Brigham and Women's Hospital, Harvard University School of Medicine, Boston, Massachusetts; Department of Neurosurgery, Beijing Neurosurgery Institute, People's Republic of China; and Department of Neurological Surgery, Washington University School of Medicine at Washington University Medical Center, St. Louis, Missouri

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 M.D.
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Christopher G. Gaposchkin Department of Neurological Surgery, Brigham and Women's Hospital, Harvard University School of Medicine, Boston, Massachusetts; Department of Neurosurgery, Beijing Neurosurgery Institute, People's Republic of China; and Department of Neurological Surgery, Washington University School of Medicine at Washington University Medical Center, St. Louis, Missouri

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 M.D., Ph.D.
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Chun Jiang Yu Department of Neurological Surgery, Brigham and Women's Hospital, Harvard University School of Medicine, Boston, Massachusetts; Department of Neurosurgery, Beijing Neurosurgery Institute, People's Republic of China; and Department of Neurological Surgery, Washington University School of Medicine at Washington University Medical Center, St. Louis, Missouri

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Dennis J. Rivet Department of Neurological Surgery, Brigham and Women's Hospital, Harvard University School of Medicine, Boston, Massachusetts; Department of Neurosurgery, Beijing Neurosurgery Institute, People's Republic of China; and Department of Neurological Surgery, Washington University School of Medicine at Washington University Medical Center, St. Louis, Missouri

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Ralph G. Dacey Jr. Department of Neurological Surgery, Brigham and Women's Hospital, Harvard University School of Medicine, Boston, Massachusetts; Department of Neurosurgery, Beijing Neurosurgery Institute, People's Republic of China; and Department of Neurological Surgery, Washington University School of Medicine at Washington University Medical Center, St. Louis, Missouri

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228–240
Volume/Issue:
Volume 99: Issue 2
DOI link:
https://doi.org/10.3171/jns.2003.99.2.0228
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Object. The goal of this study was to identify the origins of spontaneous fusiform middle cerebral artery (MCA) aneurysms.

Methods. One hundred two cases of spontaneous fusiform MCA aneurysms were reviewed, including 40 from the authors' institutions and 62 identified from the literature. The mean age at symptom onset was 38 years, and the male/female ratio was 1.4:1. At presentation, the MCA lumen was stenosed or occluded in 12 patients, focally dilated in 57, and appeared “serpentine” in 33. Most lesions originated from the M1 or M2 segments, and most (80%) presented with nonhemorrhagic symptoms or were discovered incidentally.

The presenting clinical features correlated with morphological findings in the aneurysms, which could be observed to progress from a small focal dilation or vessel narrowing to a serpentine channel. Hemorrhage was the most common presentation in small lesions; the incidence of bleeding progressively diminished with larger lesions. Patients with stenoses or occluded vessels most often presented with ischemic symptoms, and occasionally with hemorrhage. Giant focal dilations or serpentine aneurysms were rarely associated with acute bleeding; clinical presentation was most often prompted by mass effect or thromboembolic stroke.

Conclusions. Analysis of results after various treatments indicates that for symptomatic lesions, therapies that reverse intraaneurysmal blood flow and augment distal cerebral perfusion are associated with better outcomes than other strategies, including conservative management. Based on the spectrum of clinical, pathological, neuroimaging, and intraoperative findings, dissection is proposed as the underlying cause of these lesions.

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Volume 99: Issue 2

Contributor Notes

Address reprint requests to: Arthur L. Day, M.D., Department of Neurosurgery, Harvard University School of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115. email: aday1@partners.org.
  • 1.

    Adams HP Jr, , Aschenbrener CA, & Kassell NF, et al: Intracranial hemorrhage produced by spontaneous dissecting intracranial aneurysm. Arch Neurol 39:773–776, 1982 Adams HP Jr, Aschenbrener CA, Kassell NF, et al: Intracranial hemorrhage produced by spontaneous dissecting intracranial aneurysm. Arch Neurol 39:773–776, 1982

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    al-Yamany M, & Ross IB: Giant fusiform aneurysm of the middle cerebral artery: successful Hunterian ligation without distal bypass. Br J Neurosurg 12:572–575, 1998 al-Yamany M, Ross IB: Giant fusiform aneurysm of the middle cerebral artery: successful Hunterian ligation without distal bypass. Br J Neurosurg 12:572–575, 1998

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Ammerman BJ, & Smith DR: Giant fusiform middle cerebral aneurysm: successful treatment utilizing microvascular bypass. Surg Neurol 7:255–257, 1977 Ammerman BJ, Smith DR: Giant fusiform middle cerebral aneurysm: successful treatment utilizing microvascular bypass. Surg Neurol 7:255–257, 1977

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Andoh T, , Shirakami S, & Nakashima T, et al: Clinical analysis of a series of vertebral aneurysm cases. Neurosurgery 31:987–993, 1992 Andoh T, Shirakami S, Nakashima T, et al: Clinical analysis of a series of vertebral aneurysm cases. Neurosurgery 31:987–993, 1992

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Anson J, & Crowell RM: Cervicocranial arterial dissection. Neurosurgery 29:89–96, 1991 Anson J, Crowell RM: Cervicocranial arterial dissection. Neurosurgery 29:89–96, 1991

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Anson JA, , Lawton MT, & Spetzler RF: Characteristics and surgical treatment of dolichoectatic and fusiform aneurysms. J Neurosurg 84:185–193, 1996 Anson JA, Lawton MT, Spetzler RF: Characteristics and surgical treatment of dolichoectatic and fusiform aneurysms. J Neurosurg 84:185–193, 1996

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Barbour PJ, , Castaldo JE, & Rae-Grant AD, et al: Internal carotid artery redundancy is significantly associated with dissection. Stroke 25:1201–1206, 1994 Barbour PJ, Castaldo JE, Rae-Grant AD, et al: Internal carotid artery redundancy is significantly associated with dissection. Stroke 25:1201–1206, 1994

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Bederson JB, & Spetzler RF: Anastomosis of the anterior temporal artery to a secondary trunk of the middle cerebral artery for treatment of a giant M1 segment aneurysm. Case report. J Neurosurg 76:863–866, 1992 Bederson JB, Spetzler RF: Anastomosis of the anterior temporal artery to a secondary trunk of the middle cerebral artery for treatment of a giant M1 segment aneurysm. Case report. J Neurosurg 76:863–866, 1992

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Belec L, , Cesaro P, & Brugieres P, et al: Tumor-simulating giant serpentine aneurysm of the posterior cerebral artery. Surg Neurol 29:210–215, 1988 Belec L, Cesaro P, Brugieres P, et al: Tumor-simulating giant serpentine aneurysm of the posterior cerebral artery. Surg Neurol 29:210–215, 1988

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Benashvili GM, , Alexander LF, & Zubkov YN: Thrombosis of a giant aneurysm after extracranial-intracranial bypass. Neurosurgery 31:360–364, 1992 Benashvili GM, Alexander LF, Zubkov YN: Thrombosis of a giant aneurysm after extracranial-intracranial bypass. Neurosurgery 31:360–364, 1992

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Berger MS, & Wilson CB: Intracranial dissecting aneurysms of the posterior circulation. Report of six cases and review of the literature. J Neurosurg 61:882–894, 1984 Berger MS, Wilson CB: Intracranial dissecting aneurysms of the posterior circulation. Report of six cases and review of the literature. J Neurosurg 61:882–894, 1984

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Borzone M, , Altomonte M, & Baldini M, et al: Giant fusiform aneurysm in middle cerebral artery branches: a report of two cases and a review of the literature. Acta Neurochir 125:184–187, 1993 Borzone M, Altomonte M, Baldini M, et al: Giant fusiform aneurysm in middle cerebral artery branches: a report of two cases and a review of the literature. Acta Neurochir 125:184–187, 1993

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Cantu RC, & LeMay M: A large middle cerebral aneurysm presenting as a bizarre vascular malformation. Br J Radiol 39:317–319, 1966 Cantu RC, LeMay M: A large middle cerebral aneurysm presenting as a bizarre vascular malformation. Br J Radiol 39:317–319, 1966

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Choudhury AR, , al Amiri NH, & al Moutaery KR, et al: Giant middle cerebral aneurysm presenting as hemiathetosis in a child and its spontaneous thrombosis. Childs Nerv Syst 7:59–61, 1991 Choudhury AR, al Amiri NH, al Moutaery KR, et al: Giant middle cerebral aneurysm presenting as hemiathetosis in a child and its spontaneous thrombosis. Childs Nerv Syst 7:59–61, 1991

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Cohen MM, , Hemalatha CP, & D'Addario RT, et al: Embolization from a fusiform middle cerebral artery aneurysm. Stroke 11:158–161, 1980 Cohen MM, Hemalatha CP, D'Addario RT, et al: Embolization from a fusiform middle cerebral artery aneurysm. Stroke 11:158–161, 1980

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    De Baets P, , Delanote G, & Jackers G, et al: Atherosclerosic dissection of the cervical internal carotid artery—a case report. Angiology 41:161–163, 1990 De Baets P, Delanote G, Jackers G, et al: Atherosclerosic dissection of the cervical internal carotid artery—a case report. Angiology 41:161–163, 1990

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Dolenc V: Treatment of fusiform aneurysms of the peripheral cerebral arteries. Report of two cases. J Neurosurg 49:272–277, 1978 Dolenc V: Treatment of fusiform aneurysms of the peripheral cerebral arteries. Report of two cases. J Neurosurg 49:272–277, 1978

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Drake CG, & Peerless SJ: Giant fusiform intracranial aneurysms: review of 120 patients treated surgically from 1965 to 1992. J Neurosurg 87:141–162, 1997 Drake CG, Peerless SJ: Giant fusiform intracranial aneurysms: review of 120 patients treated surgically from 1965 to 1992. J Neurosurg 87:141–162, 1997

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Duong H, , Lycette C, & Pile-Spellman J, et al: Guglielmi detachable coil treatment of a serpentine middle cerebral aneurysm. J Neurovasc Dis 1:32–38, 1996 (Reference unverified) Duong H, Lycette C, Pile-Spellman J, et al: Guglielmi detachable coil treatment of a serpentine middle cerebral aneurysm. J Neurovasc Dis 1:32–38, 1996 (Reference unverified)

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Endo S, , Nishijima M, & Nomura H, et al: A pathological study of intracranial posterior circulation dissecting aneurysms with sub-arachnoid hemorrhage: report of three autopsied cases and review of the literature. Neurosurgery 33:732–738, 1993 Endo S, Nishijima M, Nomura H, et al: A pathological study of intracranial posterior circulation dissecting aneurysms with sub-arachnoid hemorrhage: report of three autopsied cases and review of the literature. Neurosurgery 33:732–738, 1993

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Fodstad H, , Liliequist B, & Wirell S, et al: Giant serpentine intracranial aneurysm after carotid ligation. Case report. J Neurosurg 49:903–909, 1978 Fodstad H, Liliequist B, Wirell S, et al: Giant serpentine intracranial aneurysm after carotid ligation. Case report. J Neurosurg 49:903–909, 1978

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Fujii K, , Fukui M, & Matsubara T, et al: Microsurgical procedures for management of giant middle cerebral aneurysm causing increased intracranial pressure. Surg Neurol 32:366–371, 1989 Fujii K, Fukui M, Matsubara T, et al: Microsurgical procedures for management of giant middle cerebral aneurysm causing increased intracranial pressure. Surg Neurol 32:366–371, 1989

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Gibo H, , Carver CC, & Rhoton AL Jr, et al: Microsurgical anatomy of the middle cerebral artery. J Neurosurg 54:151–169, 1981 Gibo H, Carver CC, Rhoton AL Jr, et al: Microsurgical anatomy of the middle cerebral artery. J Neurosurg 54:151–169, 1981

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Greene KA, , Anson JA, & Spetzler RF: Giant serpentine middle cerebral artery aneurysm treated by extracranial-intracranial bypass. Case report. J Neurosurg 78:974–978, 1993 Greene KA, Anson JA, Spetzler RF: Giant serpentine middle cerebral artery aneurysm treated by extracranial-intracranial bypass. Case report. J Neurosurg 78:974–978, 1993

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Guridi J, , Gallego J, & Monzon F, et al: Intracerebral hemorrhage caused by transmural dissection of the anterior cerebral artery. Stroke 24:1400–1402, 1993 Guridi J, Gallego J, Monzon F, et al: Intracerebral hemorrhage caused by transmural dissection of the anterior cerebral artery. Stroke 24:1400–1402, 1993

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Haddad GF, & Haddad FS: Cerebral giant serpentine aneurysm: case report and review of the literature. Neurosurgery 23:92–97, 1988 Haddad GF, Haddad FS: Cerebral giant serpentine aneurysm: case report and review of the literature. Neurosurgery 23:92–97, 1988

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Hart RG, & Easton JD: Dissections of cervical and cerebral arteries. Neurol Clin 1:155–182, 1983 Hart RG, Easton JD: Dissections of cervical and cerebral arteries. Neurol Clin 1:155–182, 1983

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Higashida RT, , Smith W, & Gress D, et al: Intravascular stent and endovascular coil placement for a ruptured fusiform aneurysm of the basilar artery. Case report and review of the literature. J Neurosurg 87:944–949, 1997 Higashida RT, Smith W, Gress D, et al: Intravascular stent and endovascular coil placement for a ruptured fusiform aneurysm of the basilar artery. Case report and review of the literature. J Neurosurg 87:944–949, 1997

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Horowitz MB, , Yonas H, & Jungreis C, et al: Management of a giant middle cerebral artery fusiform serpentine aneurysm with distal clip application and retrograde thrombosis: case report and review of the literature. Surg Neurol 41:221–225, 1994 Horowitz MB, Yonas H, Jungreis C, et al: Management of a giant middle cerebral artery fusiform serpentine aneurysm with distal clip application and retrograde thrombosis: case report and review of the literature. Surg Neurol 41:221–225, 1994

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Ikeda K, , Yamashita J, & Higashi S: Giant fusiform aneurysm at the horizontal portion of the middle cerebral artery in a child—case report. Neurol Med Chir 34:30–34, 1994 Ikeda K, Yamashita J, Higashi S: Giant fusiform aneurysm at the horizontal portion of the middle cerebral artery in a child—case report. Neurol Med Chir 34:30–34, 1994

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Isla A, , Alvarez F, & Roda JM, et al: Serpentine aneurysm: regrowth after a superficial temporal artery-middle cerebral artery bypass and internal carotid artery ligation: case report. Neurosurgery 34:1072–1074, 1994 Isla A, Alvarez F, Roda JM, et al: Serpentine aneurysm: regrowth after a superficial temporal artery-middle cerebral artery bypass and internal carotid artery ligation: case report. Neurosurgery 34:1072–1074, 1994

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Johnson AC, , Graves VB, & Pfaff JP Jr: Dissecting aneurysm of intracranial arteries. Surg Neurol 7:49–52, 1977 Johnson AC, Graves VB, Pfaff JP Jr: Dissecting aneurysm of intracranial arteries. Surg Neurol 7:49–52, 1977

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Kitanaka C, , Sasaki T, & Eguchi T, et al: Intracranial vertebral artery dissections: clinical, radiological features, and surgical considerations. Neurosurgery 34:620–627, 1994 Kitanaka C, Sasaki T, Eguchi T, et al: Intracranial vertebral artery dissections: clinical, radiological features, and surgical considerations. Neurosurgery 34:620–627, 1994

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Kitano I, , Fukui M, & Kinoshita K: Infantile cerebral aneurysm. Surg Neurol 16:386–390, 1981 Kitano I, Fukui M, Kinoshita K: Infantile cerebral aneurysm. Surg Neurol 16:386–390, 1981

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Kumabe T, , Kaneko U, & Ishibashi T, et al: Two cases of giant serpentine aneurysm. Neurosurgery 26:1027–1033, 1990 Kumabe T, Kaneko U, Ishibashi T, et al: Two cases of giant serpentine aneurysm. Neurosurgery 26:1027–1033, 1990

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Kunze S, & Schiefer W: Angiographic demonstration of a dissecting aneurysm of the middle cerebral artery. Neuroradiology 2:201–206, 1971 Kunze S, Schiefer W: Angiographic demonstration of a dissecting aneurysm of the middle cerebral artery. Neuroradiology 2:201–206, 1971

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Lansen TA, , Kasoff SS, & Arguelles JH: Giant pediatric aneurysm treated with ligation of the middle cerebral artery with the Drake tourniquet and extracranial-intracranial bypass. Neurosurgery 25:81–85, 1989 Lansen TA, Kasoff SS, Arguelles JH: Giant pediatric aneurysm treated with ligation of the middle cerebral artery with the Drake tourniquet and extracranial-intracranial bypass. Neurosurgery 25:81–85, 1989

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Lee SY, & Sekhar LN: Treatment of aneurysms by excision or trapping with arterial reimplantation or interpositional grafting. Report of three cases. J Neurosurg 85:178–185, 1996 Lee SY, Sekhar LN: Treatment of aneurysms by excision or trapping with arterial reimplantation or interpositional grafting. Report of three cases. J Neurosurg 85:178–185, 1996

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Li ZB, , Zhao H, & Zhang S: Giant serpentine intracranial aneurysm. A case report. Chin Med J 101:55–57, 1988 Li ZB, Zhao H, Zhang S: Giant serpentine intracranial aneurysm. A case report. Chin Med J 101:55–57, 1988

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Locksley HB, , Sahs AL, & Knowler L: Report on the cooperative study of intracranial aneurysms and subarachnoid hemorrhage. Section II. General survey of cases in the central registry and characteristics of the sample population. J Neurosurg 24:922–932, 1966 Locksley HB, Sahs AL, Knowler L: Report on the cooperative study of intracranial aneurysms and subarachnoid hemorrhage. Section II. General survey of cases in the central registry and characteristics of the sample population. J Neurosurg 24:922–932, 1966

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    Lukin RR, , Chambers AA, & McLaurin R, et al: Thrombosed giant middle cerebral aneurysms. Neuroradiology 10:125–129, 1975 Lukin RR, Chambers AA, McLaurin R, et al: Thrombosed giant middle cerebral aneurysms. Neuroradiology 10:125–129, 1975

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42.

    Miyamoto S, , Nagata I, & Yamada K, et al: Delayed thrombus propagation after parent artery clipping for giant fusiform aneurysms of the circle of Willis. Surg Neurol 51:89–93, 1999 Miyamoto S, Nagata I, Yamada K, et al: Delayed thrombus propagation after parent artery clipping for giant fusiform aneurysms of the circle of Willis. Surg Neurol 51:89–93, 1999

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43.

    Mizutani T, , Goldberg HI, & Parr J, et al: Cerebral dissecting aneurysm and intimal fibroelastic thickening of cerebral arteries. Case report. J Neurosurg 56:571–576, 1982 Mizutani T, Goldberg HI, Parr J, et al: Cerebral dissecting aneurysm and intimal fibroelastic thickening of cerebral arteries. Case report. J Neurosurg 56:571–576, 1982

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44.

    Mull M, , Kosinski C, & Biniek R, et al: Regression of a conservatively treated gigantic fusiform aneurysm of the middle cerebral artery. Eur Neurol 37:255–257, 1997 Mull M, Kosinski C, Biniek R, et al: Regression of a conservatively treated gigantic fusiform aneurysm of the middle cerebral artery. Eur Neurol 37:255–257, 1997

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45.

    Nakatomi H, , Segawa H, & Kurata A, et al: Clinicopathological study of intracranial fusiform and dolichoectatic aneurysms: insight on the mechanism of growth. Stroke 31:896–900, 2000 Nakatomi H, Segawa H, Kurata A, et al: Clinicopathological study of intracranial fusiform and dolichoectatic aneurysms: insight on the mechanism of growth. Stroke 31:896–900, 2000

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46.

    Norman RM, & Urich H: Dissecting aneurysm of the middle cerebral artery as a cause of acute infantile hemiplegia. J Pathol Bacteriol 73:580–582, 1957 Norman RM, Urich H: Dissecting aneurysm of the middle cerebral artery as a cause of acute infantile hemiplegia. J Pathol Bacteriol 73:580–582, 1957

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47.

    Patel DV, , Sherman IC, & Hemmati M, et al: Giant serpentine intracranial aneurysm. Surg Neurol 16:402–407, 1981 Patel DV, Sherman IC, Hemmati M, et al: Giant serpentine intracranial aneurysm. Surg Neurol 16:402–407, 1981

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48.

    Piepgras DG, , McGrail KM, & Tazelaar HD: Intracranial dissection of the distal middle cerebral artery as an uncommon cause of distal cerebral artery aneurysm. Case report. J Neurosurg 80:909–913, 1994 Piepgras DG, McGrail KM, Tazelaar HD: Intracranial dissection of the distal middle cerebral artery as an uncommon cause of distal cerebral artery aneurysm. Case report. J Neurosurg 80:909–913, 1994

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 49.

    Pilz P, & Hartjes HJ: Fibromuscular dysplasia and multiple dissecting aneurysms of intracranial arteries. A further cause of Moyamoya syndrome. Stroke 7:393–398, 1976 Pilz P, Hartjes HJ: Fibromuscular dysplasia and multiple dissecting aneurysms of intracranial arteries. A further cause of Moyamoya syndrome. Stroke 7:393–398, 1976

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50.

    Pinto RS, , Kricheff II, & Butler AR, et al: Correlation of computed tomographic, angiographic, and neuropathological changes in giant cerebral aneurysms. Radiology 132:85–92, 1979 Pinto RS, Kricheff II, Butler AR, et al: Correlation of computed tomographic, angiographic, and neuropathological changes in giant cerebral aneurysms. Radiology 132:85–92, 1979

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 51.

    Poppen JL: Specific treatment of intracranial aneurysms. Experiences with 143 surgically treated patients. J Neurosurg 8:75–78, 1951 Poppen JL: Specific treatment of intracranial aneurysms. Experiences with 143 surgically treated patients. J Neurosurg 8:75–78, 1951

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 52.

    Pozzati E, , Andreoli A, & Limoni P, et al: Dissecting aneurysms of the vertebrobasilar system: study of 16 cases. Surg Neurol 41:119–124, 1994 Pozzati E, Andreoli A, Limoni P, et al: Dissecting aneurysms of the vertebrobasilar system: study of 16 cases. Surg Neurol 41:119–124, 1994

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 53.

    Ramina R, , Arruda WO, & Prestes AC, et al: Arterial graft reconstruction in an aneurysm of the middle cerebral artery. Neurosurgery 26:327–329, 1990 Ramina R, Arruda WO, Prestes AC, et al: Arterial graft reconstruction in an aneurysm of the middle cerebral artery. Neurosurgery 26:327–329, 1990

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 54.

    Rhoton AL Jr: Anatomic foundations of aneurysm surgery (honored guest lecture). Clin Neurosurg 41:289–324, 1994 Rhoton AL Jr: Anatomic foundations of aneurysm surgery (honored guest lecture). Clin Neurosurg 41:289–324, 1994

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 55.

    Rhoton AL Jr, , Saeki N, & Perlmutter D, et al: Microsurgical anatomy of common aneurysm sites. Clin Neurosurg 26:248–306, 1979 Rhoton AL Jr, Saeki N, Perlmutter D, et al: Microsurgical anatomy of common aneurysm sites. Clin Neurosurg 26:248–306, 1979

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 56.

    Robert F, , Maltais R, & Giroux JC: Dissecting aneurysm of middle cerebral artery. Case report. J Neurosurg 21:413–415, 1964 Robert F, Maltais R, Giroux JC: Dissecting aneurysm of middle cerebral artery. Case report. J Neurosurg 21:413–415, 1964

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 57.

    Sadik AR, , Budzilovich GN, & Shulman K: Giant aneurysm of middle cerebral artery. A case report. J Neurosurg 22:177–181, 1965 Sadik AR, Budzilovich GN, Shulman K: Giant aneurysm of middle cerebral artery. A case report. J Neurosurg 22:177–181, 1965

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 58.

    Sakaguchi M, , Murata K, & Nishio A, et al: Surgical treatment and radiological consideration of supergiant cerebral aneurysms. Surg Neurol 31:300–309, 1989 Sakaguchi M, Murata K, Nishio A, et al: Surgical treatment and radiological consideration of supergiant cerebral aneurysms. Surg Neurol 31:300–309, 1989

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 59.

    Sasaki O, , Koike T, & Takeuchi S, et al: Serial angiography in a spontaneous dissecting anterior cerebral artery aneurysm. Surg Neurol 36:49–53, 1991 Sasaki O, Koike T, Takeuchi S, et al: Serial angiography in a spontaneous dissecting anterior cerebral artery aneurysm. Surg Neurol 36:49–53, 1991

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 60.

    Sasaki O, , Koike T, & Tanaka R, et al: Subarachnoid hemorrhage from a dissecting aneurysm of the middle cerebral artery. Case report. J Neurosurg 74:504–507, 1991 Sasaki O, Koike T, Tanaka R, et al: Subarachnoid hemorrhage from a dissecting aneurysm of the middle cerebral artery. Case report. J Neurosurg 74:504–507, 1991

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 61.

    Schievink WI, , Mokri B, & Michels VV, et al: Familial association of intracranial aneurysms and cervical artery dissections. Stroke 22:1426–1430, 1991 Schievink WI, Mokri B, Michels VV, et al: Familial association of intracranial aneurysms and cervical artery dissections. Stroke 22:1426–1430, 1991

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 62.

    Schievink WI, , Mokri B, & Piepgras DG: Spontaneous dissections of cervicocephalic arteries in childhood and adolescence. Neurology 44:1607–1612, 1994 Schievink WI, Mokri B, Piepgras DG: Spontaneous dissections of cervicocephalic arteries in childhood and adolescence. Neurology 44:1607–1612, 1994

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 63.

    Schievink WI, , Prakash UB, & Piepgras DG, et al: Alpha 1-antitrypsin deficiency in intracranial aneurysms and cervical artery dissection. Lancet 343:452–453, 1994 Schievink WI, Prakash UB, Piepgras DG, et al: Alpha 1-antitrypsin deficiency in intracranial aneurysms and cervical artery dissection. Lancet 343:452–453, 1994

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 64.

    Schievink WI, , Puumala MR, & Meyer FB, et al: Giant intracranial aneurysm and fibromuscular dysplasia in an adolescent with alpha 1-antitrypsin deficiency. J Neurosurg 85:503–506, 1996 Schievink WI, Puumala MR, Meyer FB, et al: Giant intracranial aneurysm and fibromuscular dysplasia in an adolescent with alpha 1-antitrypsin deficiency. J Neurosurg 85:503–506, 1996

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 65.

    Schoning M, , Grunert D, & Hassler W, et al: Demonstration of giant MCA aneurysm by transcranial duplex sonography and color Doppler imaging. Childs Nerv Syst 9:110–114, 1993 Schoning M, Grunert D, Hassler W, et al: Demonstration of giant MCA aneurysm by transcranial duplex sonography and color Doppler imaging. Childs Nerv Syst 9:110–114, 1993

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 66.

    Scott GE, , Neubuerger KT, & Denst J: Dissecting aneurysms of intracranial arteries. Neurology 10:22–27, 1960 Scott GE, Neubuerger KT, Denst J: Dissecting aneurysms of intracranial arteries. Neurology 10:22–27, 1960

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 67.

    Segal HD, & McLaurin RL: Giant serpentine aneurysm. Report of two cases. J Neurosurg 46:115–120, 1977 Segal HD, McLaurin RL: Giant serpentine aneurysm. Report of two cases. J Neurosurg 46:115–120, 1977

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 68.

    Shimauchi M, , Yamakawa Y, & Maruoka N, et al: Ruptured intracranial aneurysm in a 19-day-old infant—case report. Neurol Med Chir 29:1047–1050, 1989 Shimauchi M, Yamakawa Y, Maruoka N, et al: Ruptured intracranial aneurysm in a 19-day-old infant—case report. Neurol Med Chir 29:1047–1050, 1989

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 69.

    Shimoji T, , Bando K, & Nakajima K, et al: Dissecting aneurysm of the vertebral artery. Report of seven cases and angiographic findings. J Neurosurg 61:1038–1046, 1984 Shimoji T, Bando K, Nakajima K, et al: Dissecting aneurysm of the vertebral artery. Report of seven cases and angiographic findings. J Neurosurg 61:1038–1046, 1984

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 70.

    Sinclair W Jr: Dissecting aneurysm of the middle cerebral artery associated with migraine syndrome. Am J Pathol 29:1083–1091, 1953 Sinclair W Jr: Dissecting aneurysm of the middle cerebral artery associated with migraine syndrome. Am J Pathol 29:1083–1091, 1953

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 71.

    Sundt TM: Surgical Techniques for Saccular and Giant Intracranial Aneurysms. New York: Williams & Wilkins, 1990, pp 198–210 Sundt TM: Surgical Techniques for Saccular and Giant Intracranial Aneurysms. New York: Williams & Wilkins, 1990, pp 198–210

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 72.

    Suzuki S, , Takahashi T, & Ohkuma H, et al: Management of giant serpentine aneurysms of the middle cerebral artery—review of literature and report of a case successfully treated by STA-MCA anastomosis only. Acta Neurochir 117:23–29, 1992 Suzuki S, Takahashi T, Ohkuma H, et al: Management of giant serpentine aneurysms of the middle cerebral artery—review of literature and report of a case successfully treated by STA-MCA anastomosis only. Acta Neurochir 117:23–29, 1992

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 73.

    Terao H, & Muraoka I: Giant aneurysm of the middle cerebral artery containing an important blood channel. Case report. J Neurosurg 37:352–356, 1972 Terao H, Muraoka I: Giant aneurysm of the middle cerebral artery containing an important blood channel. Case report. J Neurosurg 37:352–356, 1972

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 74.

    Tognetti F, , Andreoli A, & Testa C: Giant fusiform aneurysm of the middle cerebral artery treated with extracranial-intracranial arterial bypass and Drake tourniquet. Surg Neurol 22:33–35, 1984 Tognetti F, Andreoli A, Testa C: Giant fusiform aneurysm of the middle cerebral artery treated with extracranial-intracranial arterial bypass and Drake tourniquet. Surg Neurol 22:33–35, 1984

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 75.

    Tomasello F, , Albanese V, & Cioffi FA: Giant serpentine aneurysms: a separate entity. Surg Neurol 12:429–432, 1979 Tomasello F, Albanese V, Cioffi FA: Giant serpentine aneurysms: a separate entity. Surg Neurol 12:429–432, 1979

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 76.

    Umansky F, , Gomes FB, & Dujovny M, et al: The perforating branches of the middle cerebral artery. A microanatomical study. J Neurosurg 62:261–268, 1985 Umansky F, Gomes FB, Dujovny M, et al: The perforating branches of the middle cerebral artery. A microanatomical study. J Neurosurg 62:261–268, 1985

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 77.

    Watanabe T, , Sato K, & Yoshimoto T: Basilar artery occlusion caused by thrombosis of atherosclerotic fusiform aneurysm of the basilar artery. Stroke 25:1068–1070, 1994 Watanabe T, Sato K, Yoshimoto T: Basilar artery occlusion caused by thrombosis of atherosclerotic fusiform aneurysm of the basilar artery. Stroke 25:1068–1070, 1994

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 78.

    Wijdicks EF: Giant fusiform aneurysm presenting as fatal basilar artery occlusion. Mayo Clin Proc 72:437–439, 1997 Wijdicks EF: Giant fusiform aneurysm presenting as fatal basilar artery occlusion. Mayo Clin Proc 72:437–439, 1997

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 79.

    Yamashita M, , Tanaka K, & Matsuo T, et al: Cerebral dissecting aneurysms in patients with moyamoya disease. Report of two cases. J Neurosurg 58:120–125, 1983 Yamashita M, Tanaka K, Matsuo T, et al: Cerebral dissecting aneurysms in patients with moyamoya disease. Report of two cases. J Neurosurg 58:120–125, 1983

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 80.

    Yamaura A, , Watanabe Y, & Saeki N: Dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 72:183–188, 1990 Yamaura A, Watanabe Y, Saeki N: Dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 72:183–188, 1990

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 81.

    Yeh YS: Normal anatomy and aneurysms of the middle cerebral artery: a morphological, neuroradiological and clinical study. Neurol Res 6:41–48, 1984 Yeh YS: Normal anatomy and aneurysms of the middle cerebral artery: a morphological, neuroradiological and clinical study. Neurol Res 6:41–48, 1984

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 82.

    Yonas H, , Agamanolis D, & Takaoka Y, et al: Dissecting intracranial aneurysms. Surg Neurol 8:407–415, 1977 Yonas H, Agamanolis D, Takaoka Y, et al: Dissecting intracranial aneurysms. Surg Neurol 8:407–415, 1977

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 83.

    Zhang QJ, , Kobayashi S, & Gibo H, et al: Vertebrobasilar junction fenestration associated with dissecting aneurysm of intracranial vertebral artery. Stroke 25:1273–1275, 1994 Zhang QJ, Kobayashi S, Gibo H, et al: Vertebrobasilar junction fenestration associated with dissecting aneurysm of intracranial vertebral artery. Stroke 25:1273–1275, 1994

    • PubMed
    • Search Google Scholar
    • Export Citation

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