{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T19:50:12Z","timestamp":1785527412918,"version":"3.56.0"},"reference-count":27,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n<jats:title>Background: <\/jats:title>\n<jats:p>Twig-like middle cerebral artery (T-MCA) is a rare vascular abnormality characterized by the replacement of the M1 segment of the middle cerebral artery (MCA) with a plexiform arterial network of small vessels. T-MCA is generally regarded as an embryological persistence. Conversely, T-MCA may also be a secondary sequela but no reports of cases of <jats:italic>de novo<\/jats:italic> formation exist. Here, we report the first case describing possible <jats:italic>de novo<\/jats:italic> T-MCA formation.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st2\">\n<jats:title>Case Description: <\/jats:title>\n<jats:p>A 41-year-old woman was referred to our hospital from a nearby clinic because of transient left hemiparesis. Magnetic resonance (MR) imaging revealed mild stenosis of the bilateral MCAs. The patient then underwent MR imaging follow-ups once a year. MR imaging at the age of 53 showed a right M1 occlusion. Cerebral angiography revealed a right M1 occlusion and formation of a plexiform network consistent with the occlusion site, leading to the diagnosis of <jats:italic>de novo<\/jats:italic> T-MCA.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st3\">\n<jats:title>Conclusion: <\/jats:title>\n<jats:p>This is the first case report describing possible <jats:italic>de novo<\/jats:italic> T-MCA formation. Although a detailed laboratory examination did not confirm the etiology, autoimmune disease was suspected to have precipitated this vascular lesion.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_274_2023","type":"journal-article","created":{"date-parts":[[2023,6,2]],"date-time":"2023-06-02T06:50:45Z","timestamp":1685688645000},"page":"192","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["<i>De novo<\/i> formation of twig-like middle cerebral artery: An illustrative case"],"prefix":"10.25259","volume":"14","author":[{"given":"Michihide","family":"Kajita","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiyoyuki","family":"Yanaka","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sho","family":"Hanai","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hitoshi","family":"Aiyama","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuyuki","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Radiology, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinji","family":"Saiki","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Tsukuba, Tsukuba, Ibaraki, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eiichi","family":"Ishikawa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Tsukuba, Tsukuba, Ibaraki, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","published-online":{"date-parts":[[2023,6,2]]},"reference":[{"key":"10.25259\/SNI_274_2023\/ref-1","doi-asserted-by":"crossref","first-page":"2013","DOI":"10.1016\/j.ejrad.2015.06.012","article-title":"Unfused or twig-like middle cerebral artery","volume":"84","author":"Akkan","year":"2015","journal-title":"Eur J Radiol"},{"key":"10.25259\/SNI_274_2023\/ref-2","first-page":"653","article-title":"Letter to the Editor. 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