{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T08:59:17Z","timestamp":1785488357286,"version":"3.56.0"},"reference-count":20,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n Twig-like middle cerebral artery (T-MCA) is a rare vascular anomaly characterized by stenosis or occlusion of the middle cerebral artery (MCA) with a plexiform network of collateral vessels, and its etiology, whether congenital or acquired, remains controversial.<\/jats:p>\n <\/jats:sec>\n \n Case Description:<\/jats:title>\n \n We report a rare case of\n de novo<\/jats:italic>\n T-MCA identified as an acquired lesion through long-term imaging surveillance. A 54-year-old woman had undergone annual magnetic resonance (MR) imaging and MR angiography (MRA) follow-up after an initial transient neurological episode. Ten years later, progressive stenosis of the right MCA emerged. At 12 years and 3 months, she developed transient dysarthria and left hemiparesis, yet no infarction or hypoperfusion was noted, and observation was continued. At 13 years and 4 months, a second transient ischemic attack occurred. MRA revealed high-grade MCA stenosis with a cluster of abnormal vessels, consistent with T-MCA, and perfusion studies demonstrated impaired cerebrovascular reserve in the right hemisphere. Given the unstable hemodynamic profile, superficial temporal artery (STA)\u2013MCA bypass was performed. Postoperatively, cerebral perfusion improved, and no further ischemic events were observed during 1 year of follow-up.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n \n To the best of our knowledge, this represents the third documented case of\n de novo<\/jats:italic>\n T-MCA. This case provides important insight into the dynamic nature of T-MCA and suggests that, in symptomatic patients with recurrent ischemia and hemodynamic compromise, STA\u2013MCA bypass may serve as a viable therapeutic strategy.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.25259\/sni_24_2026","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T08:22:32Z","timestamp":1785486152000},"page":"437","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["De novo<\/i>\n twig-like middle cerebral artery documented by 13-year imaging surveillance and treated after hemodynamic compromise"],"prefix":"10.25259","volume":"17","author":[{"given":"Shinichiro","family":"Matsuyama","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Yokohama City University Medical Center, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Hori","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yokohama City University Medical Center, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryosuke","family":"Takagi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yokohama City University Medical Center, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidetaka","family":"Onodera","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yokohama City University Medical Center, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katsumi","family":"Sakata","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yokohama City University Medical Center, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuya","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"10.25259\/SNI_24_2026\/ref-1","first-page":"653","article-title":"Letter to the Editor. 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