Giant Middle Cerebral Artery Aneurysm with Feeding Artery Occlusion

Abstract

Two cases of giant middle cerebral artery aneurysm with feeding artery occlusion were presented. The first case was a 40-year-old male. The patient had had a transient ischemic attack and subsequently a complete stroke. Arteriography on admission revealed a large aneurysm of the right middle cerebral artery with intraluminal thrombus. Follow-up arteriography performed 6 days later revealed a right middle cerebral artery occlusion at the M1 portion, and no aneurysm. At surgery, the lumen of the aneurysm was filled with thrombus. Superficial temporal artery middle cerebral artery (STA-MCA) anastomosis and partial removal of the aneurysm were performed. The second case was a 65-year-old male with a fatal subarachnoid and intracerebral hemorrhage. Existence of a large aneurysm of the right middle cerebral artery with intraluminal thrombus and calcification of the wall was suspected from the plain skull film and CT scan. Arteriography revealed a right internal carotid artery occlusion at the C1 portion. Eleven cases reported in the literature were reviewed; ischemic attack due to compromised circulation through the middle cerebral artery is one of the important clinical symptoms, and the risk of rupture is present even in an aneurysm with calcification of the wall. Therefore, resection of the aneurysm together with STA-MCA anastomosis seemed to be the essential treatment of choice for the giant middle cerebral artery aneurysm.