{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T20:09:43Z","timestamp":1781294983212,"version":"3.54.1"},"reference-count":83,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2003,8]]},"abstract":"<jats:p content-type=\"fine-print\"><jats:italic>Object.<\/jats:italic> The goal of this study was to identify the origins of spontaneous fusiform middle cerebral artery (MCA) aneurysms.<\/jats:p>\n<jats:p content-type=\"fine-print\"><jats:italic>Methods.<\/jats:italic> One hundred two cases of spontaneous fusiform MCA aneurysms were reviewed, including 40 from the authors' institutions and 62 identified from the literature. The mean age at symptom onset was 38 years, and the male\/female ratio was 1.4:1. At presentation, the MCA lumen was stenosed or occluded in 12 patients, focally dilated in 57, and appeared \u201cserpentine\u201d in 33. Most lesions originated from the M<jats:sub>1<\/jats:sub> or M<jats:sub>2<\/jats:sub> segments, and most (80%) presented with nonhemorrhagic symptoms or were discovered incidentally.<\/jats:p>\n<jats:p content-type=\"fine-print\">The presenting clinical features correlated with morphological findings in the aneurysms, which could be observed to progress from a small focal dilation or vessel narrowing to a serpentine channel. Hemorrhage was the most common presentation in small lesions; the incidence of bleeding progressively diminished with larger lesions. Patients with stenoses or occluded vessels most often presented with ischemic symptoms, and occasionally with hemorrhage. Giant focal dilations or serpentine aneurysms were rarely associated with acute bleeding; clinical presentation was most often prompted by mass effect or thromboembolic stroke.<\/jats:p>\n<jats:p content-type=\"fine-print\"><jats:italic>Conclusions.<\/jats:italic> Analysis of results after various treatments indicates that for symptomatic lesions, therapies that reverse intraaneurysmal blood flow and augment distal cerebral perfusion are associated with better outcomes than other strategies, including conservative management. Based on the spectrum of clinical, pathological, neuroimaging, and intraoperative findings, dissection is proposed as the underlying cause of these lesions.<\/jats:p>","DOI":"10.3171\/jns.2003.99.2.0228","type":"journal-article","created":{"date-parts":[[2009,5,13]],"date-time":"2009-05-13T17:53:44Z","timestamp":1242237224000},"page":"228-240","source":"Crossref","is-referenced-by-count":120,"title":["Spontaneous fusiform middle cerebral artery aneurysms: characteristics and a proposed mechanism of formation"],"prefix":"10.3171","volume":"99","author":[{"given":"Arthur L.","family":"Day","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher G.","family":"Gaposchkin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun Jiang","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis J.","family":"Rivet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralph G.","family":"Dacey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Arch Neurol","first-page":"773","article-title":"Intracranial hemorrhage produced by spontaneous dissecting intracranial aneurysm.","volume":"39","author":"Adams","year":"1982"},{"key":"b2","series-title":"Br J Neurosurg","first-page":"572","article-title":"Giant fusiform aneurysm of the middle cerebral artery: successful Hunterian ligation without distal bypass.","volume":"12","author":"al-Yamany","year":"1998"},{"key":"b3","series-title":"Surg Neurol","first-page":"255","article-title":"Giant fusiform middle cerebral aneurysm: successful treatment utilizing microvascular bypass.","volume":"7","author":"Ammerman","year":"1977"},{"key":"b4","series-title":"Neurosurgery","first-page":"987","article-title":"Clinical analysis of a series of vertebral aneurysm cases.","volume":"31","author":"Andoh","year":"1992"},{"key":"b5","series-title":"Neurosurgery","first-page":"89","article-title":"Cervicocranial arterial dissection.","volume":"29","author":"Anson","year":"1991"},{"key":"b6","series-title":"J Neurosurg","first-page":"185","article-title":"Characteristics and surgical treatment of dolichoectatic and fusiform aneurysms.","volume":"84","author":"Anson","year":"1996"},{"key":"b7","series-title":"Stroke","first-page":"1201","article-title":"Internal carotid artery redundancy is significantly associated with dissection.","volume":"25","author":"Barbour","year":"1994"},{"key":"b8","series-title":"J Neurosurg","first-page":"863","article-title":"Anastomosis of the anterior temporal artery to a secondary trunk of the middle cerebral artery for treatment of a giant M1 segment aneurysm. Case report.","volume":"76","author":"Bederson","year":"1992"},{"key":"b9","series-title":"Surg Neurol","first-page":"210","article-title":"Tumor-simulating giant serpentine aneurysm of the posterior cerebral artery.","volume":"29","author":"Belec","year":"1988"},{"key":"b10","series-title":"Neurosurgery","first-page":"360","article-title":"Thrombosis of a giant aneurysm after extracranial-intracranial bypass.","volume":"31","author":"Benashvili","year":"1992"},{"key":"b11","series-title":"J Neurosurg","first-page":"882","article-title":"Intracranial dissecting aneurysms of the posterior circulation. Report of six cases and review of the literature.","volume":"61","author":"Berger","year":"1984"},{"key":"b12","series-title":"Acta Neurochir","first-page":"184","article-title":"Giant fusiform aneurysm in middle cerebral artery branches: a report of two cases and a review of the literature.","volume":"125","author":"Borzone","year":"1993"},{"key":"b13","series-title":"Br J Radiol","first-page":"317","article-title":"A large middle cerebral aneurysm presenting as a bizarre vascular malformation.","volume":"39","author":"Cantu","year":"1966"},{"key":"b14","series-title":"Childs Nerv Syst","first-page":"59","article-title":"Giant middle cerebral aneurysm presenting as hemiathetosis in a child and its spontaneous thrombosis.","volume":"7","author":"Choudhury","year":"1991"},{"key":"b15","series-title":"Stroke","first-page":"158","article-title":"Embolization from a fusiform middle cerebral artery aneurysm.","volume":"11","author":"Cohen","year":"1980"},{"key":"b16","series-title":"Angiology","first-page":"161","article-title":"Atherosclerosic dissection of the cervical internal carotid artery\u2014a case report.","volume":"41","author":"De Baets","year":"1990"},{"key":"b17","series-title":"J Neurosurg","first-page":"272","article-title":"Treatment of fusiform aneurysms of the peripheral cerebral arteries. Report of two cases.","volume":"49","author":"Dolenc","year":"1978"},{"key":"b18","series-title":"J Neurosurg","first-page":"141","article-title":"Giant fusiform intracranial aneurysms: review of 120 patients treated surgically from 1965 to 1992.","volume":"87","author":"Drake","year":"1997"},{"key":"b19","series-title":"J Neurovasc Dis","first-page":"32","article-title":"Guglielmi detachable coil treatment of a serpentine middle cerebral aneurysm.","volume":"1","author":"Duong","year":"1996"},{"key":"b20","series-title":"Neurosurgery","first-page":"732","article-title":"A pathological study of intracranial posterior circulation dissecting aneurysms with sub-arachnoid hemorrhage: report of three autopsied cases and review of the literature.","volume":"33","author":"Endo","year":"1993"},{"key":"b21","series-title":"J Neurosurg","first-page":"903","article-title":"Giant serpentine intracranial aneurysm after carotid ligation. Case report.","volume":"49","author":"Fodstad","year":"1978"},{"key":"b22","series-title":"Surg Neurol","first-page":"366","article-title":"Microsurgical procedures for management of giant middle cerebral aneurysm causing increased intracranial pressure.","volume":"32","author":"Fujii","year":"1989"},{"key":"b23","series-title":"J Neurosurg","first-page":"151","article-title":"Microsurgical anatomy of the middle cerebral artery.","volume":"54","author":"Gibo","year":"1981"},{"key":"b24","series-title":"J Neurosurg","first-page":"974","article-title":"Giant serpentine middle cerebral artery aneurysm treated by extracranial-intracranial bypass. Case report.","volume":"78","author":"Greene","year":"1993"},{"key":"b25","series-title":"Stroke","first-page":"1400","article-title":"Intracerebral hemorrhage caused by transmural dissection of the anterior cerebral artery.","volume":"24","author":"Guridi","year":"1993"},{"key":"b26","series-title":"Neurosurgery","first-page":"92","article-title":"Cerebral giant serpentine aneurysm: case report and review of the literature.","volume":"23","author":"Haddad","year":"1988"},{"key":"b27","series-title":"Neurol Clin","first-page":"155","article-title":"Dissections of cervical and cerebral arteries.","volume":"1","author":"Hart","year":"1983"},{"key":"b28","series-title":"J Neurosurg","first-page":"944","article-title":"Intravascular stent and endovascular coil placement for a ruptured fusiform aneurysm of the basilar artery. Case report and review of the literature.","volume":"87","author":"Higashida","year":"1997"},{"key":"b29","series-title":"Surg Neurol","first-page":"221","article-title":"Management of a giant middle cerebral artery fusiform serpentine aneurysm with distal clip application and retrograde thrombosis: case report and review of the literature.","volume":"41","author":"Horowitz","year":"1994"},{"key":"b30","series-title":"Neurol Med Chir","first-page":"30","article-title":"Giant fusiform aneurysm at the horizontal portion of the middle cerebral artery in a child\u2014case report.","volume":"34","author":"Ikeda","year":"1994"},{"key":"b31","series-title":"Neurosurgery","first-page":"1072","article-title":"Serpentine aneurysm: regrowth after a superficial temporal artery-middle cerebral artery bypass and internal carotid artery ligation: case report.","volume":"34","author":"Isla","year":"1994"},{"key":"b32","series-title":"Surg Neurol","first-page":"49","article-title":"Dissecting aneurysm of intracranial arteries.","volume":"7","author":"Johnson","year":"1977"},{"key":"b33","series-title":"Neurosurgery","first-page":"620","article-title":"Intracranial vertebral artery dissections: clinical, radiological features, and surgical considerations.","volume":"34","author":"Kitanaka","year":"1994"},{"key":"b34","series-title":"Surg Neurol","first-page":"386","article-title":"Infantile cerebral aneurysm.","volume":"16","author":"Kitano","year":"1981"},{"key":"b35","series-title":"Neurosurgery","first-page":"1027","article-title":"Two cases of giant serpentine aneurysm.","volume":"26","author":"Kumabe","year":"1990"},{"key":"b36","series-title":"Neuroradiology","first-page":"201","article-title":"Angiographic demonstration of a dissecting aneurysm of the middle cerebral artery.","volume":"2","author":"Kunze","year":"1971"},{"key":"b37","series-title":"Neurosurgery","first-page":"81","article-title":"Giant pediatric aneurysm treated with ligation of the middle cerebral artery with the Drake tourniquet and extracranial-intracranial bypass.","volume":"25","author":"Lansen","year":"1989"},{"key":"b38","series-title":"J Neurosurg","first-page":"178","article-title":"Treatment of aneurysms by excision or trapping with arterial reimplantation or interpositional grafting. Report of three cases.","volume":"85","author":"Lee","year":"1996"},{"key":"b39","series-title":"Chin Med J","first-page":"55","article-title":"Giant serpentine intracranial aneurysm. A case report.","volume":"101","author":"Li","year":"1988"},{"key":"b40","series-title":"J Neurosurg","first-page":"922","article-title":"Report on the cooperative study of intracranial aneurysms and subarachnoid hemorrhage. Section II. General survey of cases in the central registry and characteristics of the sample population.","volume":"24","author":"Locksley","year":"1966"},{"key":"b41","series-title":"Neuroradiology","first-page":"125","article-title":"Thrombosed giant middle cerebral aneurysms.","volume":"10","author":"Lukin","year":"1975"},{"key":"b42","series-title":"Surg Neurol","first-page":"89","article-title":"Delayed thrombus propagation after parent artery clipping for giant fusiform aneurysms of the circle of Willis.","volume":"51","author":"Miyamoto","year":"1999"},{"key":"b43","series-title":"J Neurosurg","first-page":"571","article-title":"Cerebral dissecting aneurysm and intimal fibroelastic thickening of cerebral arteries. Case report.","volume":"56","author":"Mizutani","year":"1982"},{"key":"b44","series-title":"Eur Neurol","first-page":"255","article-title":"Regression of a conservatively treated gigantic fusiform aneurysm of the middle cerebral artery.","volume":"37","author":"Mull","year":"1997"},{"key":"b45","series-title":"Stroke","first-page":"896","article-title":"Clinicopathological study of intracranial fusiform and dolichoectatic aneurysms: insight on the mechanism of growth.","volume":"31","author":"Nakatomi","year":"2000"},{"key":"b46","series-title":"J Pathol Bacteriol","first-page":"580","article-title":"Dissecting aneurysm of the middle cerebral artery as a cause of acute infantile hemiplegia.","volume":"73","author":"Norman","year":"1957"},{"key":"b47","series-title":"Surg Neurol","first-page":"402","article-title":"Giant serpentine intracranial aneurysm.","volume":"16","author":"Patel","year":"1981"},{"key":"b48","series-title":"J Neurosurg","first-page":"909","article-title":"Intracranial dissection of the distal middle cerebral artery as an uncommon cause of distal cerebral artery aneurysm. Case report.","volume":"80","author":"Piepgras","year":"1994"},{"key":"b49","series-title":"Stroke","first-page":"393","article-title":"Fibromuscular dysplasia and multiple dissecting aneurysms of intracranial arteries. A further cause of Moyamoya syndrome.","volume":"7","author":"Pilz","year":"1976"},{"key":"b50","series-title":"Radiology","first-page":"85","article-title":"Correlation of computed tomographic, angiographic, and neuropathological changes in giant cerebral aneurysms.","volume":"132","author":"Pinto","year":"1979"},{"key":"b51","series-title":"J Neurosurg","first-page":"75","article-title":"Specific treatment of intracranial aneurysms. Experiences with 143 surgically treated patients.","volume":"8","author":"Poppen","year":"1951"},{"key":"b52","series-title":"Surg Neurol","first-page":"119","article-title":"Dissecting aneurysms of the vertebrobasilar system: study of 16 cases.","volume":"41","author":"Pozzati","year":"1994"},{"key":"b53","series-title":"Neurosurgery","first-page":"327","article-title":"Arterial graft reconstruction in an aneurysm of the middle cerebral artery.","volume":"26","author":"Ramina","year":"1990"},{"key":"b54","series-title":"Clin Neurosurg","first-page":"289","article-title":"Anatomic foundations of aneurysm surgery (honored guest lecture).","volume":"41","author":"Rhoton","year":"1994"},{"key":"b55","series-title":"Clin Neurosurg","first-page":"248","article-title":"Microsurgical anatomy of common aneurysm sites.","volume":"26","author":"Rhoton","year":"1979"},{"key":"b56","series-title":"J Neurosurg","first-page":"413","article-title":"Dissecting aneurysm of middle cerebral artery. Case report.","volume":"21","author":"Robert","year":"1964"},{"key":"b57","series-title":"J Neurosurg","first-page":"177","article-title":"Giant aneurysm of middle cerebral artery. A case report.","volume":"22","author":"Sadik","year":"1965"},{"key":"b58","series-title":"Surg Neurol","first-page":"300","article-title":"Surgical treatment and radiological consideration of supergiant cerebral aneurysms.","volume":"31","author":"Sakaguchi","year":"1989"},{"key":"b59","series-title":"Surg Neurol","first-page":"49","article-title":"Serial angiography in a spontaneous dissecting anterior cerebral artery aneurysm.","volume":"36","author":"Sasaki","year":"1991"},{"key":"b60","series-title":"J Neurosurg","first-page":"504","article-title":"Subarachnoid hemorrhage from a dissecting aneurysm of the middle cerebral artery. Case report.","volume":"74","author":"Sasaki","year":"1991"},{"key":"b61","series-title":"Stroke","first-page":"1426","article-title":"Familial association of intracranial aneurysms and cervical artery dissections.","volume":"22","author":"Schievink","year":"1991"},{"key":"b62","series-title":"Neurology","first-page":"1607","article-title":"Spontaneous dissections of cervicocephalic arteries in childhood and adolescence.","volume":"44","author":"Schievink","year":"1994"},{"key":"b63","series-title":"Lancet","first-page":"452","article-title":"Alpha 1-antitrypsin deficiency in intracranial aneurysms and cervical artery dissection.","volume":"343","author":"Schievink","year":"1994"},{"key":"b64","series-title":"J Neurosurg","first-page":"503","article-title":"Giant intracranial aneurysm and fibromuscular dysplasia in an adolescent with alpha 1-antitrypsin deficiency.","volume":"85","author":"Schievink","year":"1996"},{"key":"b65","series-title":"Childs Nerv Syst","first-page":"110","article-title":"Demonstration of giant MCA aneurysm by transcranial duplex sonography and color Doppler imaging.","volume":"9","author":"Schoning","year":"1993"},{"key":"b66","series-title":"Neurology","first-page":"22","article-title":"Dissecting aneurysms of intracranial arteries.","volume":"10","author":"Scott","year":"1960"},{"key":"b67","series-title":"J Neurosurg","first-page":"115","article-title":"Giant serpentine aneurysm. Report of two cases.","volume":"46","author":"Segal","year":"1977"},{"key":"b68","series-title":"Neurol Med Chir","first-page":"1047","article-title":"Ruptured intracranial aneurysm in a 19-day-old infant\u2014case report.","volume":"29","author":"Shimauchi","year":"1989"},{"key":"b69","series-title":"J Neurosurg","first-page":"1038","article-title":"Dissecting aneurysm of the vertebral artery. Report of seven cases and angiographic findings.","volume":"61","author":"Shimoji","year":"1984"},{"key":"b70","series-title":"Am J Pathol","first-page":"1083","article-title":"Dissecting aneurysm of the middle cerebral artery associated with migraine syndrome.","volume":"29","author":"Sinclair","year":"1953"},{"key":"b71","series-title":"Surgical Techniques for Saccular and Giant Intracranial Aneurysms.","first-page":"198","author":"Sundt","year":"1990"},{"key":"b72","series-title":"Acta Neurochir","first-page":"23","article-title":"Management of giant serpentine aneurysms of the middle cerebral artery\u2014review of literature and report of a case successfully treated by STA-MCA anastomosis only.","volume":"117","author":"Suzuki","year":"1992"},{"key":"b73","series-title":"J Neurosurg","first-page":"352","article-title":"Giant aneurysm of the middle cerebral artery containing an important blood channel. Case report.","volume":"37","author":"Terao","year":"1972"},{"key":"b74","series-title":"Surg Neurol","first-page":"33","article-title":"Giant fusiform aneurysm of the middle cerebral artery treated with extracranial-intracranial arterial bypass and Drake tourniquet.","volume":"22","author":"Tognetti","year":"1984"},{"key":"b75","series-title":"Surg Neurol","first-page":"429","article-title":"Giant serpentine aneurysms: a separate entity.","volume":"12","author":"Tomasello","year":"1979"},{"key":"b76","series-title":"J Neurosurg","first-page":"261","article-title":"The perforating branches of the middle cerebral artery. A microanatomical study.","volume":"62","author":"Umansky","year":"1985"},{"key":"b77","series-title":"Stroke","first-page":"1068","article-title":"Basilar artery occlusion caused by thrombosis of atherosclerotic fusiform aneurysm of the basilar artery.","volume":"25","author":"Watanabe","year":"1994"},{"key":"b78","series-title":"Mayo Clin Proc","first-page":"437","article-title":"Giant fusiform aneurysm presenting as fatal basilar artery occlusion.","volume":"72","author":"Wijdicks","year":"1997"},{"key":"b79","series-title":"J Neurosurg","first-page":"120","article-title":"Cerebral dissecting aneurysms in patients with moyamoya disease. 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