Evaluation of relation among aneurysmal neck, parent artery, and daughter arteries in middle cerebral artery aneurysms, by three-dimensional digital subtraction angiography

Intracranial aneurysms usually occur at arterial bifurcations. However, in middle cerebral artery (MCA) aneurysms, we often find that the aneurysmal neck does not necessarily exist just on the arterial bifurcation. In this study, we have evaluated the relation among aneurysmal neck, parent artery, and daughter arteries in middle cerebral artery aneurysms, by three-dimensional digital subtraction angiography. Twenty consecutive patients (9 men and 11 women) with MCA aneurysms were examined. The total number of aneurysms was 22, of which 10 aneurysms were unruptured and 12 were ruptured. Aneurysmal sizes and angles between the parent artery and each of the two daughter arteries were measured. Furthermore, aneurysms were classified into two types based on neck location. Thus, when the neck was located on the extension of the midline of the parent artery, it was defined as a classical neck type aneurysm, and when it was not, it was defined as a deviating neck type aneurysm. There were 15 cases of deviating and 7 cases of classical neck type. Interestingly, in the deviating neck type, all the aneurysms existed on the side of the daughter arteries of which the angles between parent arteries were narrower, and in 93%, the sizes of the daughter arteries in which the neck existed were smaller compared with other daughter arteries.