{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:47:00Z","timestamp":1782262020654,"version":"3.54.5"},"reference-count":80,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"25","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"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":[[2026,6,22]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>The authors report a rare case of a complex wide-necked saccular middle cerebral artery (MCA) bifurcation aneurysm with atherosclerotic plaque at the neck, which mimicked a fusiform aneurysm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 68-year-old female presented with a 1-month history of dizziness. Angiography showed a fusiform aneurysm arising from the superior division of the left MCA. Contrast-enhanced black-blood MRI demonstrated marked aneurysmal wall and lumen enhancement, absent on noncontrast images. On surgical opening, a wide-necked saccular aneurysm was instead found. A calcified\/atheromatous plaque was present at the aneurysm neck, which explained the radiological findings of a fusiform-looking aneurysm. The surgical strategy consisted of complex clip reconstruction with distal revascularization via an extracranial-to-intracranial (EC-IC) bypass.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>In this case, preoperative angiography suggested a fusiform MCA aneurysm, but intraoperative examination revealed a wide-necked saccular aneurysm. The presence of atheromatous plaques at the aneurysm neck can distort its angiographic appearance and pose a challenge for clip reconstruction. Performing a preoperative vessel wall MR study may improve characterization of aneurysmal morphology and support tailored management of complex cases.<\/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\/CASE2684\">https:\/\/thejns.org\/doi\/10.3171\/CASE2684<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case2684","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:01:01Z","timestamp":1782259261000},"source":"Crossref","is-referenced-by-count":0,"title":["A wide-necked saccular aneurysm of the middle cerebral artery bifurcation with neck atherosclerosis mimicking a fusiform aneurysm: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8578-6056","authenticated-orcid":true,"given":"FeiFei","family":"Wu","sequence":"first","affiliation":[{"name":"Academic Neurosurgery, Department of Neuroscience, University of Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiqi","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai"},{"name":"National Center for Neurological Disorders, Shanghai"},{"name":"Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai"},{"name":"Neurosurgical Institute of Fudan University, Shanghai"},{"name":"Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai"},{"name":"National Center for Neurological Disorders, Shanghai"},{"name":"Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai"},{"name":"Neurosurgical Institute of Fudan University, Shanghai"},{"name":"Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7976-4446","authenticated-orcid":true,"given":"Feng","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai"},{"name":"National Center for Neurological Disorders, Shanghai"},{"name":"Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai"},{"name":"Neurosurgical Institute of Fudan University, Shanghai"},{"name":"Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"11","key":"bib1","series-title":"Lancet Neurol","first-page":"945","article-title":"Epidemiology, pathogenesis, and emerging concepts in unruptured intracranial aneurysms","volume":"24","author":"Etminan","year":"2025","unstructured":"Etminan NRuigrok YMHackenberg KAMVergouwen MDIKrings TRinkel GJE.Epidemiology, pathogenesis, and emerging concepts in unruptured intracranial aneurysms. 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