{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:06:47Z","timestamp":1776096407271,"version":"3.50.1"},"reference-count":64,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"14","license":[{"start":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T00:00:00Z","timestamp":1775433600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,4,6]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Twig-like middle cerebral artery (T-MCA) is an uncommon configuration in which the M1 segment is replaced by a plexiform network reconstituting the distal middle cerebral artery (MCA). It is often labeled congenital, yet adult de novo cases suggest acquired formation after focal M1 disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>\n                      A male neonate underwent angiography at 6 days of life for a suspected right brain arteriovenous malformation (AVM); the contralateral left M1 segment was normal. After staged AVM treatment, follow-up angiography at approximately 1 year showed a new left M1 irregularity and narrowing consistent with dissection, without ischemic lesions on serial MRI. Over the ensuing 2\u20133 years, serial angiography documented progression to left M1 occlusion with replacement of the M1 trunk by a plexiform collateral network that reconstituted the distal MCA, forming a classic T-MCA configuration by 4.5 years. The child remained neurologically intact. Molecular analysis of AVM tissue identified a likely pathogenic somatic\n                      <jats:italic>KRAS<\/jats:italic>\n                      in-frame duplication.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>\n                      This pediatric case shows that T-MCA can form postnatally after focal M1 injury and may be misclassified as congenital on a single late angiogram. The coexisting\n                      <jats:italic>KRAS<\/jats:italic>\n                      -mutated AVM raises a testable role for somatic vascular genetics in remodeling responses beyond\n                      <jats:italic>RNF213<\/jats:italic>\n                      -focused testing.\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE2611\">https:\/\/thejns.org\/doi\/10.3171\/CASE2611<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case2611","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T10:04:53Z","timestamp":1775642693000},"source":"Crossref","is-referenced-by-count":0,"title":["De novo twig-like middle cerebral artery after suspected M1 dissection in early childhood with coexisting KRAS-mutated brain arteriovenous malformation: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0434-5466","authenticated-orcid":true,"given":"Pablo","family":"Albi\u00f1a-Palmarola","sequence":"first","affiliation":[{"name":"Neuroradiologische Klinik, Kopf- und Neurozentrum, Klinikum Stuttgart, Stuttgart"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9482-0151","authenticated-orcid":true,"given":"Ali","family":"Khanafer","sequence":"additional","affiliation":[{"name":"Neuroradiologische Klinik, Kopf- und Neurozentrum, Klinikum Stuttgart, Stuttgart"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1618-9269","authenticated-orcid":true,"given":"Martin","family":"Zenker","sequence":"additional","affiliation":[{"name":"Institut f\u00fcr Humangenetik, Universit\u00e4tsklinikum, Otto-von-Guericke-Universit\u00e4t Magdeburg, Magdeburg"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4520-4897","authenticated-orcid":true,"given":"Philipp","family":"von Gottberg","sequence":"additional","affiliation":[{"name":"Neuroradiologische Klinik, Kopf- und Neurozentrum, Klinikum Stuttgart, Stuttgart"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6794-1900","authenticated-orcid":true,"given":"Oliver","family":"Ganslandt","sequence":"additional","affiliation":[{"name":"Neurochirurgische Klinik, Klinikum Stuttgart, Stuttgart"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6534-036X","authenticated-orcid":true,"given":"Hans","family":"Henkes","sequence":"additional","affiliation":[{"name":"Neuroradiologische Klinik, Kopf- und Neurozentrum, Klinikum Stuttgart, Stuttgart"},{"name":"Medizinische Fakult\u00e4t, Universit\u00e4t Duisburg-Essen, Essen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"3","key":"bib1","series-title":"Interv Neuroradiol","first-page":"361","article-title":"Current state and confusion of twig-like middle cerebral artery","volume":"30","author":"Yu","year":"2024","unstructured":"Yu J.Current state and confusion of twig-like middle cerebral artery. 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