title: Aneurysm of a duplicate middle cerebral artery.
abstract: BACKGROUND
  Anatomic middle cerebral artery (MCA) anomalies are rare, but each of the described variants (eg, duplicate, fenestrated, accessory) can be of clinical significance.
  
  
  METHODS
  A 34-year-old man with a history of left hemispheric stroke was found to have an aberrant, early-arising duplicate left M1 segment of the MCA with an associated asymptomatic fusiform aneurysm. The patient was treated with a superficial temporal artery (STA) to distal MCA bypass followed by surgical trapping of the aneurysm.
  
  
  RESULTS
  Intraoperative and follow-up angiography performed postoperatively at 3 months showed complete isolation of the aneurysm from the circulation and patency of the bypass graft. The postoperative course was uneventful with the exception of a craniotomy flap infection, which was effectively managed with intravenous antibiotics, flap removal, and subsequent use of a fabricated replacement.
  
  
  CONCLUSIONS
  This rare case is presented and used as a framework for a brief discussion of the literature regarding both variant MCA anatomy and treatment considerations for these anomalies when associated with an aneurysm.
authors.affiliation: Department of Neurosurgery, Division of Interventional Neuroradiology, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: David V
authors.initials: DV
authors.lastname: LaBorde
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Mason
authors.forename: Jonathan
authors.initials: J
authors.lastname: Riley
authors.forename: Jacques E
authors.initials: JE
authors.lastname: Dion
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Barrow
mesh_terms: D000328:Adult; D017542:Aneurysm, Ruptured / Q000601:surgery; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002533:Cerebral Angiography; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D008297:Male; D020768:Middle Cerebral Artery / Q000002:abnormalities* / Q000473:pathology*; D019635:Neurosurgical Procedures / Q000379:methods*; D020521:Stroke / Q000209:etiology; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000209:etiology / Q000601:surgery / Q000628:therapy; D013699:Temporal Arteries / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents