Distal Middle Cerebral Artery M4 Aneurysm Surgery Using Navigation-CT Angiography

Area of Science:

• Neurology
• Neurosurgery
• Vascular Neurology

Background:

• Dissecting aneurysms of the middle cerebral artery (MCA) are uncommon vascular lesions.
• Complete ipsilateral internal cerebral artery (ICA) occlusion is a rare concomitant finding.
• The simultaneous occurrence of these conditions in the MCA's M4 segment has not been previously documented.

Observation:

• A 41-year-old male presented with acute neurological deficits, including left-sided weakness and dysarthria.
• Magnetic resonance angiography confirmed a subacute infarction in the right MCA territory and complete occlusion of the right ICA.
• Cerebral angiography revealed an unruptured dissecting aneurysm at the M4 segment of the right MCA.

Findings:

• Surgical management involved proximal clipping of the MCA dissecting aneurysm to prevent rupture.
• Cerebral blood flow to the distal MCA was successfully restored using a superficial temporal artery-middle cerebral artery (STA-MCA) bypass.
• Navigation-CT angiography provided crucial guidance during the surgical procedure.

Implications:

• This case highlights the importance of considering rare vascular pathologies in the diagnosis of ischemic stroke.
• Successful surgical management, including bypass, can be achieved in complex MCA aneurysms with concurrent ICA occlusion.
• Reporting such rare cases contributes valuable data for understanding and managing cerebrovascular diseases.