{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T19:49:49Z","timestamp":1785527389614,"version":"3.56.0"},"reference-count":26,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,12,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Twig-like middle cerebral artery (T-MCA) is a rare congenital anomaly that is difficult to distinguish from moyamoya angiopathy (MMA), given the similarity of the angioarchitectures. The aim of this study was to gain insights into the radiological and clinical features of T-MCA and to distinguish this condition from MMA.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A multicenter retrospective study was conducted in 29 patients with T-MCA and 57 patients with MMA. Demographic, radiological, and clinical data were compared between the patients with T-MCA and those with MMA.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>The T-MCA group tended to be older than the MMA group (mean age 47 \u00b1 18 vs 39 \u00b1 22 years). Twenty patients with T-MCA (69%) were initially diagnosed with MMA. All T-MCA cases had twig-like networks and steno-occlusive changes involving the MCA. The T-MCA group had a higher incidence of intracranial aneurysms (35% vs 11%) and coexisting arterial anomalies (48% vs 12%). T-MCA and MMA cases had significant differences in involvement of the internal carotid artery terminus (0% vs 100%) and posterior cerebral artery (0% vs 23%), and in transdural anastomosis (0% vs 51%). T-MCA cases were less likely to present with stroke (59% vs 86%) and more likely to be asymptomatic (28% vs 12%). Of the patients with stroke, those with T-MCA had more hemorrhagic strokes (41% vs 29%) and fewer ischemic strokes (59% vs 71%) compared to those with MMA.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>This study suggests that T-MCA is a different disease entity from MMA based on significant differences in the radiological and clinical features. Neurosurgeons should recognize this anomaly and understand the key features that differentiate T-MCA from MMA.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2022.2.jns212338","type":"journal-article","created":{"date-parts":[[2022,4,22]],"date-time":"2022-04-22T08:09:23Z","timestamp":1650614963000},"page":"1718-1726","source":"Crossref","is-referenced-by-count":22,"title":["Radiological and clinical features of twig-like middle cerebral artery in comparison with moyamoya angiopathy: a multicenter retrospective study"],"prefix":"10.3171","volume":"137","author":[{"given":"Yudai","family":"Goto","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto;"},{"name":"Department of Neurosurgery, Kyoto Daiichi Red Cross Hospital, Kyoto;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masataka","family":"Nanto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideki","family":"Oka","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Saiseikai Shigaken Hospital, Ritto;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobukuni","family":"Murakami","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kyoto Daini Red Cross Hospital, Kyoto;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toru","family":"Nakagawa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Saiseikai Suita Hospital, Suita;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Kimura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kyoto Daiichi Red Cross Hospital, Kyoto;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshihiro","family":"Iwamoto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kyoto Yamashiro General Medical Center, Kizugawa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuo","family":"Inoue","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Maizuru Medical Center, Maizuru;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keigo","family":"Matsumoto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, JCHO Kobe Central Hospital, Kobe; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junichi","family":"Miyamoto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Saiseikai Kyoto Hospital, Nagaokakyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoya","family":"Hashimoto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Cerebrovasc Dis","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1159\/000086119","article-title":"Aneurysms in twig-like middle cerebral artery","volume":"20","author":"Liu HM","year":"2005","unstructured":"Liu HM, Lai DM, Tu YK, Wang YH. 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