Management of Aneurysms at the Origin of Duplicated Middle Cerebral Artery: Series of Four Patients with Review of the Literature

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.