Middle cerebral artery M3 segment aneurysm [Neurosurgery Wiki]

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=====Middle cerebral artery M3 segment aneurysm=====

There are just four reported cases of spontaneous dissecting aneurysms of the [[M3 segment of the middle cerebral artery]] or more distal locations
((Sakamoto S, Ikawa F, Kawamoto H, Ohbayashi N, Inagawa T. Acute surgery for
ruptured dissecting aneurysm of the M3 portion of the middle cerebral artery.
Neurol Med Chir (Tokyo). 2003 Apr;43(4):188-91. Review. PubMed PMID: 12760497.
))
, and only one case of saccular aneurysm has been reported in the literature
((Ahn JY, Han IB, Joo JY. Aneurysm in the penetrating artery of the distal
middle cerebral artery presenting as intracerebral haemorrhage. Acta Neurochir
(Wien). 2005 Dec;147(12):1287-90; discussion 1290. Epub 2005 Aug 29. PubMed PMID:
16133768.
)).

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

====Case reports====
A case of a ruptured [[dissecting pseudoaneurysm]] in the distal [[Middle cerebral artery]] (distal M3/proximal M4) prefrontal division in an healthy young patient (<60 years) successfully treated with a [[Pipeline Embolization Device]]. The PED was chosen both as the only vessel sparing option in the young patient as well as for its potential as a vessel sacrifice tool if the pseudoaneurysm was felt to be incompletely treated, which in this case was not necessary-though would have leveraged the thrombogenicity of the device as a therapeutic advantage
((Berwanger RP, Hoover MC, Scott JA, DeNardo AJ, Amuluru K, Payner TD, Kulwin CG, Sahlein DH. The Use of a Pipeline Embolization Device for Treatment of a Ruptured Dissecting Middle Cerebral Artery M3/M4 Aneurysm: Challenges and Technical Considerations. Neurointervention. 2022 Apr 7. doi: 10.5469/neuroint.2022.00045. Epub ahead of print. PMID: 35385900.)).

===2013===
Yılmaz et al. describes a rare case of a distal [[middle cerebral artery]] (dMCA) aneurysm, that developed a right intracerebral haematoma and subarachnoid haemorrhage. It was treated by surgical exploration and clipping via pterional approach
((Yılmaz M, Yurt A, Kalemci O, Yuksel ZK, Yücesoy K. Ruptured distal middle
cerebral artery aneurysm: Case report. Int J Surg Case Rep. 2013;4(10):837-8.
doi: 10.1016/j.ijscr.2013.06.015. Epub 2013 Jul 17. PubMed PMID: 23959413; PubMed
Central PMCID: PMC3785863.)).

===2003===
A 65-year-old woman presented with a ruptured dissecting aneurysm of the M3 segment of the [[middle cerebral artery]] (MCA) manifesting as disturbance of consciousness and motor aphasia. Computed tomography revealed subarachnoid hemorrhage. Emergent angiography demonstrated segmental aneurysmal dilatation of the M3 portion of the left MCA. Infectious aneurysm was excluded. Surgery was performed to prevent repeated hemorrhage from the aneurysm. The lesion was excised and flow to the distal MCA was preserved with an anastomosis of the superficial temporal artery to the MCA. Histological examination confirmed that the aneurysmal dilatation was due to arterial dissection caused by disruption of the internal elastic lamina. Distal dissecting aneurysm may occur in the absence of infectious disease. Such ruptured distal dissecting aneurysm should preferably be treated surgically in the acute stage, immediately after detection of the aneurysm. The parent artery of the proximal and distal sides of the aneurysm should be trapped because of the probable weakness of the arterial wall, and bypass surgery performed to preserve the distal circulation
((Sakamoto S, Ikawa F, Kawamoto H, Ohbayashi N, Inagawa T. Acute surgery for
ruptured dissecting aneurysm of the M3 portion of the middle cerebral artery.
Neurol Med Chir (Tokyo). 2003 Apr;43(4):188-91. Review. PubMed PMID: 12760497.
)).