Distal middle cerebral artery aneurysm [Neurosurgery Wiki]

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====== Distal middle cerebral artery aneurysm ======

Distal [[middle cerebral artery aneurysm]]s is a rarely seen encountered condition, constituting 1.1–5% of MCA lesions
((Dashti R., Hernesniemi J., Niemelä M., Rinne J., Lehecka M., Shen H. Microneurosurgical management of distal middle cerebral artery aneurysms. Surgical Neurology. 2007;67:553–563.))
((Yasargil M.G. Georg Thieme Verlag; Stuttgart: 1984. Microneurosurgery II: clinical considerations, surgery of the intracranial aneursyms and results; pp. 124–164.)).
In a large surgical series of 1012 patients, there were four patients with dMCA
((Dashti R., Hernesniemi J., Niemelä M., Rinne J., Lehecka M., Shen H. Microneurosurgical management of distal middle cerebral artery aneurysms. Surgical Neurology. 2007;67:553–563.)).
In the other large surgical series of 3005 patients, there were 18 patients with dMCA aneurysm
((Yasargil M.G. Georg Thieme Verlag; Stuttgart: 1984. Microneurosurgery II: clinical considerations, surgery of the intracranial aneursyms and results; pp. 124–164.)).

According to Gibo et al.,
((Gibo H, Carver CC, Rhoton AL Jr, Lenkey C, Mitchell RJ. Microsurgical anatomy 
of the middle cerebral artery. J Neurosurg. 1981 Feb;54(2):151-69. PubMed PMID:
7452329.
))
to locate MCA aneurysms the distal vessel was classified into four segments M2 (insular segment), M2–M3 junction, M3 (opercular segment) and M4 (cortical segment). 

see [[Middle cerebral artery M3 segment aneurysm]].

see [[Middle cerebral artery M4 segment aneurysm]].

Clinical findings and surgical approaches of dMCA aneurysm are different from proximal MCA aneurysms. Treatment of those aneurysms is difficult because of their deep location, small size and angio architecture.