{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:03:02Z","timestamp":1787025782838,"version":"build-2736575974"},"reference-count":66,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"22","license":[{"start":{"date-parts":[[2022,5,30]],"date-time":"2022-05-30T00:00:00Z","timestamp":1653868800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,5,30]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Aplastic or twiglike middle cerebral artery (Ap\/T-MCA) is a rare anomaly characterized by a unilateral MCA occlusion with plexiform vessels that causes hemorrhagic and (less commonly) ischemic strokes. The reasons for this are rarely discussed, and thus optimal treatment for ischemic Ap\/T-MCA remains controversial. Here, the authors report a case of Ap\/T-MCA with transient ischemic attacks treated by bypass surgery and discuss the mechanism of ischemic development and treatment methods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 62-year-old hypertensive man with transient, recurrent left hemiparesis visited the authors\u2019 hospital. Magnetic resonance angiography showed proximal occlusion of the right MCA and stenosis in the left MCA. Digital subtraction angiography revealed occlusion of the right MCA and abnormal vascular networks, leading to a diagnosis of Ap\/T-MCA with contralateral MCA stenosis. Antiplatelet therapy with aspirin was insufficient, and a superficial temporal artery\u2013MCA bypass was performed. There were no ischemic or hemorrhagic events postoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Atherosclerosis seems to have a significant impact on the development of ischemic stroke in patients with Ap\/T-MCA, and the presence of coexisting atherosclerotic stenotic vascular lesions outside the Ap\/T-MCA site is substantial in its development. Bypass surgery is a promising treatment option for ischemic Ap\/T-MCA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case22121","type":"journal-article","created":{"date-parts":[[2022,5,30]],"date-time":"2022-05-30T03:09:20Z","timestamp":1653880160000},"source":"Crossref","is-referenced-by-count":11,"title":["Aplastic or twiglike middle cerebral artery with contralateral middle cerebral artery stenosis showing transient ischemic attack: illustrative case"],"prefix":"10.3171","volume":"3","author":[{"given":"Hayato","family":"Takeda","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Tsukuba Memorial Hospital, Ibaraki, Japan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiyoyuki","family":"Yanaka","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tsukuba Memorial Hospital, Ibaraki, Japan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuniyuki","family":"Onuma","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tsukuba Memorial Hospital, Ibaraki, Japan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhiro","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tsukuba Memorial Hospital, Ibaraki, Japan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhiro","family":"Ishii","sequence":"additional","affiliation":[{"name":"Departments of Neurology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eiichi","family":"Ishikawa","sequence":"additional","affiliation":[{"name":"Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"b1","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1472","DOI":"10.1227\/NEU.0b013e318246a510","article-title":"Clinical and radiological features of patients with aplastic or twiglike middle cerebral arteries","volume":"70","author":"Seo BS","year":"2012","unstructured":"Seo BS, Lee YS, Lee HG, Lee JH, Ryu KY, Kang DG. Clinical and radiological features of patients with aplastic or twiglike middle cerebral arteries. Neurosurgery. 2012;70(6):1472\u20131480.10.1227\/NEU.0b013e318246a510"},{"issue":"2","key":"b2","series-title":"Interv Neuroradiol","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1177\/1591019920970430","article-title":"Hemorrhagic events associated with unfused or twig-like configuration of the middle cerebral artery: a rare vascular anomaly with clinical relevance","volume":"27","author":"Viso R","year":"2021","unstructured":"Viso R, Lylyk I, Albi\u00f1a P, Lundquist J, Scrivano E, Lylyk P. Hemorrhagic events associated with unfused or twig-like configuration of the middle cerebral artery: a rare vascular anomaly with clinical relevance. Interv Neuroradiol. 2021;27(2):285\u2013290.10.1177\/1591019920970430"},{"issue":"1","key":"b3","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. Aneurysms in twig-like middle cerebral artery. Cerebrovasc Dis. 2005;20(1):1\u20135.10.1159\/000086119"},{"issue":"10","key":"b4","series-title":"Eur J Radiol","doi-asserted-by":"publisher","first-page":"2013","DOI":"10.1016\/j.ejrad.2015.06.012","article-title":"Unfused or twig-like middle cerebral artery","volume":"84","author":"Akkan K","year":"2015","unstructured":"Akkan K, Ucar M, Kilic K, Celtikci E, Ilgit E, Onal B. Unfused or twig-like middle cerebral artery. Eur J Radiol. 2015;84(10):2013\u20132018.10.1016\/j.ejrad.2015.06.01228790215"},{"key":"b5","series-title":"Clin Imaging","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/j.clinimag.2020.11.049","article-title":"Twig-like middle cerebral arteries: clinical and radiological findings","volume":"73","author":"Onoue K","year":"2021","unstructured":"Onoue K, Nguyen TN, Mian A, Dasenbrock H, Bedi H, Abdalkader M. Twig-like middle cerebral arteries: clinical and radiological findings. Clin Imaging. 2021;73:31\u201337.10.1016\/j.clinimag.2020.11.049"},{"key":"b6","series-title":"First Report: Clinical Course and Angiographical Findings","first-page":"36","article-title":"Middle cerebral artery occlusion with moyamoya phenomenon","author":"Fukawa O","year":"1981","unstructured":"Fukawa O, Aihara H, Ishii K,  Middle cerebral artery occlusion with moyamoya phenomenon. In: First Report: Clinical Course and Angiographical Findings. 10th Conference of Surgery for Cerebral Stroke, Tokyo, Japan. 1981;36\u201341.9266566"},{"key":"b7","series-title":"Front Neurol","doi-asserted-by":"publisher","first-page":"119","DOI":"10.3389\/fneur.2010.00119","article-title":"Middle cerebral artery stenosis associated with moyamoya pattern collateralization","volume":"1","author":"Edgell RC","year":"2010","unstructured":"Edgell RC, Boulos AS, Borhani Haghighi A, Bernardini GL, Yavagal DR. Middle cerebral artery stenosis associated with moyamoya pattern collateralization. Front Neurol. 2010;1:119.10.3389\/fneur.2010.0011926856268"},{"key":"b8","series-title":"Jpn J Stroke","doi-asserted-by":"publisher","first-page":"190","DOI":"10.3995\/jstroke.10707","article-title":"Aplastic or twig-like cerebral artery with short-term ischemia and bleeding","volume":"42","author":"Yamada D","year":"2020","unstructured":"Yamada D, Ishibashi R, Kinosada M,  Aplastic or twig-like cerebral artery with short-term ischemia and bleeding. Jpn J Stroke. 2020;42:190\u2013195.10.3995\/jstroke.10707"},{"issue":"9","key":"b9","series-title":"Neuroradiology","doi-asserted-by":"publisher","first-page":"690","DOI":"10.1007\/s00234-005-1407-3","article-title":"Endovascular treatment of an \u201canterior cerebral artery\u201d aneurysm in a patient with \u201cembryonic unfused middle cerebral artery\u201d anomaly: a case report","volume":"47","author":"Cekirge HS","year":"2005","unstructured":"Cekirge HS, Peynircioglu B, Saatci I. Endovascular treatment of an \u201canterior cerebral artery\u201d aneurysm in a patient with \u201cembryonic unfused middle cerebral artery\u201d anomaly: a case report. Neuroradiology. 2005;47(9):690\u2013694.10.1007\/s00234-005-1407-3"},{"issue":"9","key":"b10","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"1637","DOI":"10.1007\/s00701-014-2165-y","article-title":"Flow-related intracranial aneurysms associated with unfused arterial twigs relevant to different vascular anomalies: embryologic and hemodynamic considerations","volume":"156","author":"Shin HS","year":"2014","unstructured":"Shin HS, Lee SH, Ryu CW, Koh JS. Flow-related intracranial aneurysms associated with unfused arterial twigs relevant to different vascular anomalies: embryologic and hemodynamic considerations. Acta Neurochir (Wien). 2014;156(9):1637\u20131646.10.1007\/s00701-014-2165-y"},{"issue":"6","key":"b11","series-title":"J Stroke Cerebrovasc Dis","doi-asserted-by":"publisher","first-page":"e77","DOI":"10.1016\/j.jstrokecerebrovasdis.2016.03.029","article-title":"Nonaneurysmal subarachnoid hemorrhage due to unfused or twiglike middle cerebral artery rupture: two case reports","volume":"25","author":"Tashiro R","year":"2016","unstructured":"Tashiro R, Inoue T, Shibahara I,  Nonaneurysmal subarachnoid hemorrhage due to unfused or twiglike middle cerebral artery rupture: two case reports. J Stroke Cerebrovasc Dis. 2016;25(6):e77\u2013e78.10.1016\/j.jstrokecerebrovasdis.2016.03.029"},{"issue":"6","key":"b12","series-title":"Neurol Med Chir (Tokyo)","doi-asserted-by":"publisher","first-page":"261","DOI":"10.2176\/nmc.ra.2017-0043","article-title":"Anomalies of the middle cerebral artery","volume":"57","author":"Uchiyama N","year":"2017","unstructured":"Uchiyama N. Anomalies of the middle cerebral artery. Neurol Med Chir (Tokyo). 2017;57(6):261\u2013266.10.2176\/nmc.ra.2017-004328790215"},{"issue":"4","key":"b13","series-title":"Neurosurg Rev","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1007\/s10143-011-0342-5","article-title":"Aneurysms associated with non-moyamoya collateral arterial networks: report of three cases and review of literature","volume":"34","author":"Rodr\u00edguez-Hern\u00e1ndez A","year":"2011","unstructured":"Rodr\u00edguez-Hern\u00e1ndez A, Lu DC, Miric S, Lawton MT. Aneurysms associated with non-moyamoya collateral arterial networks: report of three cases and review of literature. Neurosurg Rev. 2011;34(4):517\u2013522.10.1007\/s10143-011-0342-5"},{"issue":"2","key":"b14","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"332","DOI":"10.3171\/jns.2004.100.2.0332","article-title":"Aneurysm rupture at an anomalous collateral artery that extended from the proximal A2 segment to the middle of the M1 segment, bypassing atresia of the internal carotid artery bifurcation. Case report","volume":"100","author":"Park J","year":"2004","unstructured":"Park J, Hwang JH, Hamm IS. Aneurysm rupture at an anomalous collateral artery that extended from the proximal A2 segment to the middle of the M1 segment, bypassing atresia of the internal carotid artery bifurcation. Case report. J Neurosurg. 2004;100(2):332\u2013334.10.3171\/jns.2004.100.2.03329266566"},{"issue":"2","key":"b15","series-title":"Jpn J Stroke","doi-asserted-by":"publisher","first-page":"75","DOI":"10.3995\/jstroke.10506","article-title":"A case of aplastic or twig-like middle cerebral artery associated with a ruptured A1 aneurysm at the origin of the anomalous collateral artery","volume":"40","author":"Fukuda Y","year":"2018","unstructured":"Fukuda Y, Matsunaga Y, Hirayama K,  A case of aplastic or twig-like middle cerebral artery associated with a ruptured A1 aneurysm at the origin of the anomalous collateral artery. Jpn J Stroke. 2018;40(2): 75\u201380.10.3995\/jstroke.1050626856268"},{"issue":"6","key":"b16","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1016\/j.surneu.2005.03.022","article-title":"Aneurysms located at the proximal anterior cerebral artery and anterior communicating artery associated with middle cerebral artery aplasia: case report","volume":"64","author":"Kim MS","year":"2005","unstructured":"Kim MS, Oh CW, Hur JW, Lee JW, Lee HK. Aneurysms located at the proximal anterior cerebral artery and anterior communicating artery associated with middle cerebral artery aplasia: case report. Surg Neurol. 2005;64(6):534\u2013537.10.1016\/j.surneu.2005.03.022"},{"key":"b17","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"1042.e5","DOI":"10.1016\/j.wneu.2017.06.166","article-title":"Microsurgical repair of ruptured aneurysms associated with moyamoya-pattern collateral vessels of the middle cerebral artery: a report of two cases","volume":"105","author":"Lang M","year":"2017","unstructured":"Lang M, Moore NZ, Witek AM, Kshettry VR, Bain MD. Microsurgical repair of ruptured aneurysms associated with moyamoya-pattern collateral vessels of the middle cerebral artery: a report of two cases. World Neurosurg. 2017;105:1042.e5\u20131042.e10.10.1016\/j.wneu.2017.06.166"},{"issue":"1","key":"b18","series-title":"Interv Neuroradiol","doi-asserted-by":"publisher","first-page":"96","DOI":"10.15274\/INR-2014-10014","article-title":"Middle cerebral artery occlusion with moyamoya-like vessels and aneurysms. A report of two cases","volume":"20","author":"Rivera R","year":"2014","unstructured":"Rivera R, Sordo J, Badilla L, Bravo E, Riveros R, Giacaman P. Middle cerebral artery occlusion with moyamoya-like vessels and aneurysms. A report of two cases. Interv Neuroradiol. 2014;20(1):96\u201399.10.15274\/INR-2014-10014"},{"issue":"10","key":"b19","series-title":"No To Shinkei","first-page":"995","article-title":"Middle cerebral artery occlusion with unilateral moyamoya like vessels and with ruptured anterior cerebral artery aneurysm \u2013 its relation to the antiphospholipid antibody syndrome. Article in Japanese","volume":"46","author":"Inoue R","year":"1994","unstructured":"Inoue R, Katayama S, Kasai N, Hori S. Middle cerebral artery occlusion with unilateral moyamoya like vessels and with ruptured anterior cerebral artery aneurysm \u2013 its relation to the antiphospholipid antibody syndrome. Article in Japanese. No To Shinkei. 1994;46(10):995\u2013998."},{"issue":"11","key":"b20","series-title":"Neurol Med Chir (Tokyo)","doi-asserted-by":"publisher","first-page":"574","DOI":"10.2176\/nmc.45.574","article-title":"Surgical treatment of a lenticulostriate artery aneurysm. Case report","volume":"45","author":"Sakai K","year":"2005","unstructured":"Sakai K, Mizumatsu S, Terasaka K, Sugatani H, Higashi T. Surgical treatment of a lenticulostriate artery aneurysm. Case report. Neurol Med Chir (Tokyo). 2005;45(11):574\u2013577.10.2176\/nmc.45.574"},{"issue":"6","key":"b21","series-title":"No Shinkei Geka","first-page":"533","article-title":"Ruptured aneurysm of an aplastic or twig-like middle cerebral artery with ring finger protein 213 mutation: a case report. Article in Japanese","volume":"48","author":"Fukuyama R","year":"2020","unstructured":"Fukuyama R, Yamamura K, Murata H, Miyatake S, Matsumoto N, Abe H. Ruptured aneurysm of an aplastic or twig-like middle cerebral artery with ring finger protein 213 mutation: a case report. Article in Japanese. No Shinkei Geka. 2020;48(6):533\u2013540."},{"issue":"8","key":"b22","series-title":"No Shinkei Geka","first-page":"691","article-title":"A case of ruptured distal anterior choroidal artery aneurysm associated with a twig-like middle cerebral artery, treated with single-stage aneurysm clipping and STA-MCA double anastomoses in the acute phase. Article in Japanese","volume":"45","author":"Seno T","year":"2017","unstructured":"Seno T, Kohno K, Tanaka H,  A case of ruptured distal anterior choroidal artery aneurysm associated with a twig-like middle cerebral artery, treated with single-stage aneurysm clipping and STA-MCA double anastomoses in the acute phase. Article in Japanese. No Shinkei Geka. 2017;45(8):691\u2013697."},{"key":"b23","series-title":"Diagnoses and treatments of Occlusion of the Circle of Willis research of 2012","first-page":"20","article-title":"Moyamoya disease (occlusion of the circle of Willis) research group database aggregation of 2012","author":"Konoeda F","year":"2012","unstructured":"Konoeda F, Ito Y, Yamada T, Suzuki N. Moyamoya disease (occlusion of the circle of Willis) research group database aggregation of 2012. Diagnoses and treatments of Occlusion of the Circle of Willis research of 2012. 2012, 20\u201324."},{"key":"b24","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"S116","DOI":"10.1227\/NEU.0000000000000229","article-title":"Advances and surgical considerations in the treatment of moyamoya disease","volume":"74","author":"Arias EJ","year":"2014","unstructured":"Arias EJ, Derdeyn CP, Dacey RG Jr, Zipfel GJ. Advances and surgical considerations in the treatment of moyamoya disease. Neurosurgery. 2014;74(Suppl 1):S116\u2013S125.10.1227\/NEU.0000000000000229"},{"issue":"5","key":"b25","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1415","DOI":"10.1161\/STROKEAHA.113.004386","article-title":"Effects of extracranial-intracranial bypass for patients with hemorrhagic moyamoya disease: results of the Japan Adult Moyamoya Trial","volume":"45","author":"Miyamoto S","year":"2014","unstructured":"Miyamoto S, Yoshimoto T, Hashimoto N,  Effects of extracranial-intracranial bypass for patients with hemorrhagic moyamoya disease: results of the Japan Adult Moyamoya Trial. Stroke. 2014;45(5):1415\u20131421.10.1161\/STROKEAHA.113.004386"},{"issue":"9","key":"b26","series-title":"J Neurosurg Case Lessons","doi-asserted-by":"publisher","DOI":"10.3171\/CASE21360","article-title":"Aplastic or twig-like middle cerebral artery harboring unruptured cerebral aneurysms treated by clipping and bypass surgery: illustrative case","volume":"2","author":"Takarada A","year":"2021","unstructured":"Takarada A, Yanaka K, Onuma K, Nakamura K, Takahashi N, Ishikawa E. Aplastic or twig-like middle cerebral artery harboring unruptured cerebral aneurysms treated by clipping and bypass surgery: illustrative case. J Neurosurg Case Lessons. 2021;2(9):CASE2136010.3171\/CASE21360"},{"key":"b27","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"e495","DOI":"10.1016\/j.wneu.2021.01.009","article-title":"Preventive effect of bypass surgery on rebleeding in patients with hemorrhagic twiglike middle cerebral artery","volume":"148","author":"Fuse Y","year":"2021","unstructured":"Fuse Y, Takasu S, Seki Y. Preventive effect of bypass surgery on rebleeding in patients with hemorrhagic twiglike middle cerebral artery. World Neurosurg. 2021;148:e495\u2013e501.10.1016\/j.wneu.2021.01.009"},{"issue":"8","key":"b28","series-title":"No Shinkei Geka","first-page":"727","article-title":"A case of spontaneous middle cerebral artery occlusion associated with a cerebral aneurysm angiographically disappearing after STA-MCA anastomosis. Article in Japanese","volume":"25","author":"Takahashi M","year":"1997","unstructured":"Takahashi M, Fujimoto T, Suzuki R, Asai J, Miyo T, Hokaku H. A case of spontaneous middle cerebral artery occlusion associated with a cerebral aneurysm angiographically disappearing after STA-MCA anastomosis. Article in Japanese. No Shinkei Geka. 1997;25(8):727\u2013732."},{"issue":"2","key":"b29","series-title":"No Shinkei Geka","first-page":"143","article-title":"A case of aplastic or twig-like middle cerebral artery presenting with an intracranial hemorrhage two years after a transient ischemic attack. Article in Japanese","volume":"44","author":"Uchiyama T","year":"2016","unstructured":"Uchiyama T, Okamoto H, Koguchi M, Tajima Y, Suzuyama K. A case of aplastic or twig-like middle cerebral artery presenting with an intracranial hemorrhage two years after a transient ischemic attack. Article in Japanese. No Shinkei Geka. 2016;44(2):143\u2013148."},{"issue":"4","key":"b30","series-title":"No Shinkei Geka Sokuho","first-page":"410","article-title":"Report of 3 cases of twig-like middle cerebral artery and review of the literature","volume":"28","author":"Hirai S","year":"2018","unstructured":"Hirai S, Ogawa Y, Takai Y,  Report of 3 cases of twig-like middle cerebral artery and review of the literature. No Shinkei Geka Sokuho. 2018;28(4):410\u2013416."},{"issue":"3","key":"b31","series-title":"Clin Neuroradiol","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1007\/s00062-017-0613-9","article-title":"Twig-like middle cerebral artery: a seldom vessel anomaly of important relevance","volume":"28","author":"Lutz T","year":"2018","unstructured":"Lutz T, M\u00f6nnings P, Ayzenberg I, Lukas C. Twig-like middle cerebral artery: a seldom vessel anomaly of important relevance. Clin Neuroradiol. 2018;28(3):441\u2013443.10.1007\/s00062-017-0613-9"},{"issue":"5","key":"b32","series-title":"J Stroke Cerebrovasc Dis","doi-asserted-by":"publisher","first-page":"e78","DOI":"10.1016\/j.jstrokecerebrovasdis.2017.12.004","article-title":"Revascularization for aplastic or twiglike middle cerebral artery: a case report","volume":"27","author":"Matsunaga Y","year":"2018","unstructured":"Matsunaga Y, Izumo T, Morofuji Y, Horie N, Hayashi K, Matsuo T. Revascularization for aplastic or twiglike middle cerebral artery: a case report. J Stroke Cerebrovasc Dis. 2018;27(5):e78\u2013e79.10.1016\/j.jstrokecerebrovasdis.2017.12.004"},{"issue":"2","key":"b33","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"453","DOI":"10.3171\/2018.2.JNS1832","article-title":"Rete middle cerebral artery anomalies: a unifying name, case series, and literature review","volume":"131","author":"Cho KC","year":"2018","unstructured":"Cho KC, Kim JJ, Jang CK, Hong CK, Joo JY, Kim YB. Rete middle cerebral artery anomalies: a unifying name, case series, and literature review. J Neurosurg. 2018;131(2):453\u2013461.10.3171\/2018.2.JNS1832"},{"issue":"6","key":"b1","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1472","DOI":"10.1227\/NEU.0b013e318246a510","article-title":"Clinical and radiological features of patients with aplastic or twiglike middle cerebral arteries","volume":"70","author":"Seo BS","year":"2012","unstructured":"Seo BS, Lee YS, Lee HG, Lee JH, Ryu KY, Kang DG. Clinical and radiological features of patients with aplastic or twiglike middle cerebral arteries. Neurosurgery. 2012;70(6):1472\u20131480.10.1227\/NEU.0b013e318246a510"},{"issue":"2","key":"b2","series-title":"Interv Neuroradiol","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1177\/1591019920970430","article-title":"Hemorrhagic events associated with unfused or twig-like configuration of the middle cerebral artery: a rare vascular anomaly with clinical relevance","volume":"27","author":"Viso R","year":"2021","unstructured":"Viso R, Lylyk I, Albi\u00f1a P, Lundquist J, Scrivano E, Lylyk P. Hemorrhagic events associated with unfused or twig-like configuration of the middle cerebral artery: a rare vascular anomaly with clinical relevance. Interv Neuroradiol. 2021;27(2):285\u2013290.10.1177\/1591019920970430"},{"issue":"1","key":"b3","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. Aneurysms in twig-like middle cerebral artery. Cerebrovasc Dis. 2005;20(1):1\u20135.10.1159\/000086119"},{"issue":"10","key":"b4","series-title":"Eur J Radiol","doi-asserted-by":"publisher","first-page":"2013","DOI":"10.1016\/j.ejrad.2015.06.012","article-title":"Unfused or twig-like middle cerebral artery","volume":"84","author":"Akkan K","year":"2015","unstructured":"Akkan K, Ucar M, Kilic K, Celtikci E, Ilgit E, Onal B. Unfused or twig-like middle cerebral artery. Eur J Radiol. 2015;84(10):2013\u20132018.10.1016\/j.ejrad.2015.06.012"},{"key":"b5","series-title":"Clin Imaging","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/j.clinimag.2020.11.049","article-title":"Twig-like middle cerebral arteries: clinical and radiological findings","volume":"73","author":"Onoue K","year":"2021","unstructured":"Onoue K, Nguyen TN, Mian A, Dasenbrock H, Bedi H, Abdalkader M. Twig-like middle cerebral arteries: clinical and radiological findings. Clin Imaging. 2021;73:31\u201337.10.1016\/j.clinimag.2020.11.049"},{"key":"b6","series-title":"First Report: Clinical Course and Angiographical Findings","first-page":"36","article-title":"Middle cerebral artery occlusion with moyamoya phenomenon","author":"Fukawa O","year":"1981","unstructured":"Fukawa O, Aihara H, Ishii K,  Middle cerebral artery occlusion with moyamoya phenomenon. In: First Report: Clinical Course and Angiographical Findings. 10th Conference of Surgery for Cerebral Stroke, Tokyo, Japan. 1981;36\u201341."},{"key":"b7","series-title":"Front Neurol","doi-asserted-by":"publisher","first-page":"119","DOI":"10.3389\/fneur.2010.00119","article-title":"Middle cerebral artery stenosis associated with moyamoya pattern collateralization","volume":"1","author":"Edgell RC","year":"2010","unstructured":"Edgell RC, Boulos AS, Borhani Haghighi A, Bernardini GL, Yavagal DR. Middle cerebral artery stenosis associated with moyamoya pattern collateralization. Front Neurol. 2010;1:119.10.3389\/fneur.2010.00119"},{"key":"b8","series-title":"Jpn J Stroke","doi-asserted-by":"publisher","first-page":"190","DOI":"10.3995\/jstroke.10707","article-title":"Aplastic or twig-like cerebral artery with short-term ischemia and bleeding","volume":"42","author":"Yamada D","year":"2020","unstructured":"Yamada D, Ishibashi R, Kinosada M,  Aplastic or twig-like cerebral artery with short-term ischemia and bleeding. Jpn J Stroke. 2020;42:190\u2013195.10.3995\/jstroke.10707"},{"issue":"9","key":"b9","series-title":"Neuroradiology","doi-asserted-by":"publisher","first-page":"690","DOI":"10.1007\/s00234-005-1407-3","article-title":"Endovascular treatment of an \u201canterior cerebral artery\u201d aneurysm in a patient with \u201cembryonic unfused middle cerebral artery\u201d anomaly: a case report","volume":"47","author":"Cekirge HS","year":"2005","unstructured":"Cekirge HS, Peynircioglu B, Saatci I. Endovascular treatment of an \u201canterior cerebral artery\u201d aneurysm in a patient with \u201cembryonic unfused middle cerebral artery\u201d anomaly: a case report. Neuroradiology. 2005;47(9):690\u2013694.10.1007\/s00234-005-1407-3"},{"issue":"9","key":"b10","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"1637","DOI":"10.1007\/s00701-014-2165-y","article-title":"Flow-related intracranial aneurysms associated with unfused arterial twigs relevant to different vascular anomalies: embryologic and hemodynamic considerations","volume":"156","author":"Shin HS","year":"2014","unstructured":"Shin HS, Lee SH, Ryu CW, Koh JS. Flow-related intracranial aneurysms associated with unfused arterial twigs relevant to different vascular anomalies: embryologic and hemodynamic considerations. Acta Neurochir (Wien). 2014;156(9):1637\u20131646.10.1007\/s00701-014-2165-y"},{"issue":"6","key":"b11","series-title":"J Stroke Cerebrovasc Dis","doi-asserted-by":"publisher","first-page":"e77","DOI":"10.1016\/j.jstrokecerebrovasdis.2016.03.029","article-title":"Nonaneurysmal subarachnoid hemorrhage due to unfused or twiglike middle cerebral artery rupture: two case reports","volume":"25","author":"Tashiro R","year":"2016","unstructured":"Tashiro R, Inoue T, Shibahara I,  Nonaneurysmal subarachnoid hemorrhage due to unfused or twiglike middle cerebral artery rupture: two case reports. J Stroke Cerebrovasc Dis. 2016;25(6):e77\u2013e78.10.1016\/j.jstrokecerebrovasdis.2016.03.029"},{"issue":"6","key":"b12","series-title":"Neurol Med Chir (Tokyo)","doi-asserted-by":"publisher","first-page":"261","DOI":"10.2176\/nmc.ra.2017-0043","article-title":"Anomalies of the middle cerebral artery","volume":"57","author":"Uchiyama N","year":"2017","unstructured":"Uchiyama N. Anomalies of the middle cerebral artery. Neurol Med Chir (Tokyo). 2017;57(6):261\u2013266.10.2176\/nmc.ra.2017-0043"},{"issue":"4","key":"b13","series-title":"Neurosurg Rev","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1007\/s10143-011-0342-5","article-title":"Aneurysms associated with non-moyamoya collateral arterial networks: report of three cases and review of literature","volume":"34","author":"Rodr\u00edguez-Hern\u00e1ndez A","year":"2011","unstructured":"Rodr\u00edguez-Hern\u00e1ndez A, Lu DC, Miric S, Lawton MT. Aneurysms associated with non-moyamoya collateral arterial networks: report of three cases and review of literature. Neurosurg Rev. 2011;34(4):517\u2013522.10.1007\/s10143-011-0342-5"},{"issue":"2","key":"b14","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"332","DOI":"10.3171\/jns.2004.100.2.0332","article-title":"Aneurysm rupture at an anomalous collateral artery that extended from the proximal A2 segment to the middle of the M1 segment, bypassing atresia of the internal carotid artery bifurcation. Case report","volume":"100","author":"Park J","year":"2004","unstructured":"Park J, Hwang JH, Hamm IS. Aneurysm rupture at an anomalous collateral artery that extended from the proximal A2 segment to the middle of the M1 segment, bypassing atresia of the internal carotid artery bifurcation. Case report. J Neurosurg. 2004;100(2):332\u2013334.10.3171\/jns.2004.100.2.0332"},{"issue":"2","key":"b15","series-title":"Jpn J Stroke","doi-asserted-by":"publisher","first-page":"75","DOI":"10.3995\/jstroke.10506","article-title":"A case of aplastic or twig-like middle cerebral artery associated with a ruptured A1 aneurysm at the origin of the anomalous collateral artery","volume":"40","author":"Fukuda Y","year":"2018","unstructured":"Fukuda Y, Matsunaga Y, Hirayama K,  A case of aplastic or twig-like middle cerebral artery associated with a ruptured A1 aneurysm at the origin of the anomalous collateral artery. Jpn J Stroke. 2018;40(2): 75\u201380.10.3995\/jstroke.10506"},{"issue":"6","key":"b16","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1016\/j.surneu.2005.03.022","article-title":"Aneurysms located at the proximal anterior cerebral artery and anterior communicating artery associated with middle cerebral artery aplasia: case report","volume":"64","author":"Kim MS","year":"2005","unstructured":"Kim MS, Oh CW, Hur JW, Lee JW, Lee HK. Aneurysms located at the proximal anterior cerebral artery and anterior communicating artery associated with middle cerebral artery aplasia: case report. Surg Neurol. 2005;64(6):534\u2013537.10.1016\/j.surneu.2005.03.022"},{"key":"b17","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"1042.e5","DOI":"10.1016\/j.wneu.2017.06.166","article-title":"Microsurgical repair of ruptured aneurysms associated with moyamoya-pattern collateral vessels of the middle cerebral artery: a report of two cases","volume":"105","author":"Lang M","year":"2017","unstructured":"Lang M, Moore NZ, Witek AM, Kshettry VR, Bain MD. Microsurgical repair of ruptured aneurysms associated with moyamoya-pattern collateral vessels of the middle cerebral artery: a report of two cases. World Neurosurg. 2017;105:1042.e5\u20131042.e10.10.1016\/j.wneu.2017.06.166"},{"issue":"1","key":"b18","series-title":"Interv Neuroradiol","doi-asserted-by":"publisher","first-page":"96","DOI":"10.15274\/INR-2014-10014","article-title":"Middle cerebral artery occlusion with moyamoya-like vessels and aneurysms. A report of two cases","volume":"20","author":"Rivera R","year":"2014","unstructured":"Rivera R, Sordo J, Badilla L, Bravo E, Riveros R, Giacaman P. Middle cerebral artery occlusion with moyamoya-like vessels and aneurysms. A report of two cases. Interv Neuroradiol. 2014;20(1):96\u201399.10.15274\/INR-2014-10014"},{"issue":"10","key":"b19","series-title":"No To Shinkei","first-page":"995","article-title":"Middle cerebral artery occlusion with unilateral moyamoya like vessels and with ruptured anterior cerebral artery aneurysm \u2013 its relation to the antiphospholipid antibody syndrome. Article in Japanese","volume":"46","author":"Inoue R","year":"1994","unstructured":"Inoue R, Katayama S, Kasai N, Hori S. Middle cerebral artery occlusion with unilateral moyamoya like vessels and with ruptured anterior cerebral artery aneurysm \u2013 its relation to the antiphospholipid antibody syndrome. Article in Japanese. No To Shinkei. 1994;46(10):995\u2013998."},{"issue":"11","key":"b20","series-title":"Neurol Med Chir (Tokyo)","doi-asserted-by":"publisher","first-page":"574","DOI":"10.2176\/nmc.45.574","article-title":"Surgical treatment of a lenticulostriate artery aneurysm. Case report","volume":"45","author":"Sakai K","year":"2005","unstructured":"Sakai K, Mizumatsu S, Terasaka K, Sugatani H, Higashi T. Surgical treatment of a lenticulostriate artery aneurysm. Case report. Neurol Med Chir (Tokyo). 2005;45(11):574\u2013577.10.2176\/nmc.45.574"},{"issue":"6","key":"b21","series-title":"No Shinkei Geka","first-page":"533","article-title":"Ruptured aneurysm of an aplastic or twig-like middle cerebral artery with ring finger protein 213 mutation: a case report. Article in Japanese","volume":"48","author":"Fukuyama R","year":"2020","unstructured":"Fukuyama R, Yamamura K, Murata H, Miyatake S, Matsumoto N, Abe H. Ruptured aneurysm of an aplastic or twig-like middle cerebral artery with ring finger protein 213 mutation: a case report. Article in Japanese. No Shinkei Geka. 2020;48(6):533\u2013540."},{"issue":"8","key":"b22","series-title":"No Shinkei Geka","first-page":"691","article-title":"A case of ruptured distal anterior choroidal artery aneurysm associated with a twig-like middle cerebral artery, treated with single-stage aneurysm clipping and STA-MCA double anastomoses in the acute phase. Article in Japanese","volume":"45","author":"Seno T","year":"2017","unstructured":"Seno T, Kohno K, Tanaka H,  A case of ruptured distal anterior choroidal artery aneurysm associated with a twig-like middle cerebral artery, treated with single-stage aneurysm clipping and STA-MCA double anastomoses in the acute phase. Article in Japanese. No Shinkei Geka. 2017;45(8):691\u2013697."},{"key":"b23","series-title":"Diagnoses and treatments of Occlusion of the Circle of Willis research of 2012","first-page":"20","article-title":"Moyamoya disease (occlusion of the circle of Willis) research group database aggregation of 2012","author":"Konoeda F","year":"2012","unstructured":"Konoeda F, Ito Y, Yamada T, Suzuki N. Moyamoya disease (occlusion of the circle of Willis) research group database aggregation of 2012. Diagnoses and treatments of Occlusion of the Circle of Willis research of 2012. 2012, 20\u201324."},{"key":"b24","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"S116","DOI":"10.1227\/NEU.0000000000000229","article-title":"Advances and surgical considerations in the treatment of moyamoya disease","volume":"74","author":"Arias EJ","year":"2014","unstructured":"Arias EJ, Derdeyn CP, Dacey RG Jr, Zipfel GJ. Advances and surgical considerations in the treatment of moyamoya disease. Neurosurgery. 2014;74(Suppl 1):S116\u2013S125.10.1227\/NEU.0000000000000229"},{"issue":"5","key":"b25","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1415","DOI":"10.1161\/STROKEAHA.113.004386","article-title":"Effects of extracranial-intracranial bypass for patients with hemorrhagic moyamoya disease: results of the Japan Adult Moyamoya Trial","volume":"45","author":"Miyamoto S","year":"2014","unstructured":"Miyamoto S, Yoshimoto T, Hashimoto N,  Effects of extracranial-intracranial bypass for patients with hemorrhagic moyamoya disease: results of the Japan Adult Moyamoya Trial. Stroke. 2014;45(5):1415\u20131421.10.1161\/STROKEAHA.113.004386"},{"issue":"9","key":"b26","series-title":"J Neurosurg Case Lessons","doi-asserted-by":"publisher","DOI":"10.3171\/CASE21360","article-title":"Aplastic or twig-like middle cerebral artery harboring unruptured cerebral aneurysms treated by clipping and bypass surgery: illustrative case","volume":"2","author":"Takarada A","year":"2021","unstructured":"Takarada A, Yanaka K, Onuma K, Nakamura K, Takahashi N, Ishikawa E. Aplastic or twig-like middle cerebral artery harboring unruptured cerebral aneurysms treated by clipping and bypass surgery: illustrative case. J Neurosurg Case Lessons. 2021;2(9):CASE2136010.3171\/CASE21360"},{"key":"b27","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"e495","DOI":"10.1016\/j.wneu.2021.01.009","article-title":"Preventive effect of bypass surgery on rebleeding in patients with hemorrhagic twiglike middle cerebral artery","volume":"148","author":"Fuse Y","year":"2021","unstructured":"Fuse Y, Takasu S, Seki Y. Preventive effect of bypass surgery on rebleeding in patients with hemorrhagic twiglike middle cerebral artery. World Neurosurg. 2021;148:e495\u2013e501.10.1016\/j.wneu.2021.01.009"},{"issue":"8","key":"b28","series-title":"No Shinkei Geka","first-page":"727","article-title":"A case of spontaneous middle cerebral artery occlusion associated with a cerebral aneurysm angiographically disappearing after STA-MCA anastomosis. Article in Japanese","volume":"25","author":"Takahashi M","year":"1997","unstructured":"Takahashi M, Fujimoto T, Suzuki R, Asai J, Miyo T, Hokaku H. A case of spontaneous middle cerebral artery occlusion associated with a cerebral aneurysm angiographically disappearing after STA-MCA anastomosis. Article in Japanese. No Shinkei Geka. 1997;25(8):727\u2013732."},{"issue":"2","key":"b29","series-title":"No Shinkei Geka","first-page":"143","article-title":"A case of aplastic or twig-like middle cerebral artery presenting with an intracranial hemorrhage two years after a transient ischemic attack. Article in Japanese","volume":"44","author":"Uchiyama T","year":"2016","unstructured":"Uchiyama T, Okamoto H, Koguchi M, Tajima Y, Suzuyama K. A case of aplastic or twig-like middle cerebral artery presenting with an intracranial hemorrhage two years after a transient ischemic attack. Article in Japanese. No Shinkei Geka. 2016;44(2):143\u2013148."},{"issue":"4","key":"b30","series-title":"No Shinkei Geka Sokuho","first-page":"410","article-title":"Report of 3 cases of twig-like middle cerebral artery and review of the literature","volume":"28","author":"Hirai S","year":"2018","unstructured":"Hirai S, Ogawa Y, Takai Y,  Report of 3 cases of twig-like middle cerebral artery and review of the literature. No Shinkei Geka Sokuho. 2018;28(4):410\u2013416."},{"issue":"3","key":"b31","series-title":"Clin Neuroradiol","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1007\/s00062-017-0613-9","article-title":"Twig-like middle cerebral artery: a seldom vessel anomaly of important relevance","volume":"28","author":"Lutz T","year":"2018","unstructured":"Lutz T, M\u00f6nnings P, Ayzenberg I, Lukas C. Twig-like middle cerebral artery: a seldom vessel anomaly of important relevance. Clin Neuroradiol. 2018;28(3):441\u2013443.10.1007\/s00062-017-0613-9"},{"issue":"5","key":"b32","series-title":"J Stroke Cerebrovasc Dis","doi-asserted-by":"publisher","first-page":"e78","DOI":"10.1016\/j.jstrokecerebrovasdis.2017.12.004","article-title":"Revascularization for aplastic or twiglike middle cerebral artery: a case report","volume":"27","author":"Matsunaga Y","year":"2018","unstructured":"Matsunaga Y, Izumo T, Morofuji Y, Horie N, Hayashi K, Matsuo T. Revascularization for aplastic or twiglike middle cerebral artery: a case report. J Stroke Cerebrovasc Dis. 2018;27(5):e78\u2013e79.10.1016\/j.jstrokecerebrovasdis.2017.12.004"},{"issue":"2","key":"b33","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"453","DOI":"10.3171\/2018.2.JNS1832","article-title":"Rete middle cerebral artery anomalies: a unifying name, case series, and literature review","volume":"131","author":"Cho KC","year":"2018","unstructured":"Cho KC, Kim JJ, Jang CK, Hong CK, Joo JY, Kim YB. Rete middle cerebral artery anomalies: a unifying name, case series, and literature review. J Neurosurg. 2018;131(2):453\u2013461.10.3171\/2018.2.JNS1832"}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/3\/22\/article-CASE22121.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/3\/22\/article-CASE22121.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/3\/22\/article-CASE22121.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T14:41:52Z","timestamp":1770302512000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/3\/22\/article-CASE22121.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,30]]},"references-count":66,"journal-issue":{"issue":"22"},"URL":"https:\/\/doi.org\/10.3171\/case22121","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,30]]}}}