title: Management of aneurysms at the origin of duplicated middle cerebral artery: series of four patients with review of the literature.
abstract: OBJECTIVE
  To review the management of aneurysms arising at the origin of a duplicated middle cerebral artery (DMCA), which is an extremely rare entity.
  
  
  METHODS
  Four patients with internal carotid artery-DMCA aneurysms are presented, and 24 previously published cases are reviewed.
  
  
  RESULTS
  Of the 28 internal carotid artery-DMCA aneurysms, 17 were ruptured, and 11 were unruptured. The aneurysms were equally distributed on the right and left sides and were small in size (≤6 mm) except for two that were of medium size. All aneurysms were treated surgically except for two very small aneurysms, which have been managed conservatively and followed for 9 years.
  
  
  CONCLUSIONS
  Although all previously published clinical cases of internal carotid artery-DMCA aneurysms were treated surgically, conservative management with follow-up is a viable option in very small unruptured aneurysms.
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland. Electronic address: ext-ahmed.elsharkawy@hus.fi.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Elsharkawy
authors.forename: Keisuke
authors.initials: K
authors.lastname: Ishii
authors.forename: Mika
authors.initials: M
authors.lastname: Niemelä
authors.forename: Riku
authors.initials: R
authors.lastname: Kivisaari
authors.forename: Hanna
authors.initials: H
authors.lastname: Lehto
authors.forename: Juha
authors.initials: J
authors.lastname: Hernesniemi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000601:surgery; D002343:Carotid Artery, Internal / Q000002:abnormalities / Q000601:surgery; D004827:Epilepsy / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000002:abnormalities* / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome