There are just four reported cases of spontaneous dissecting aneurysms of the M3 segment of the middle cerebral artery or more distal locations 1) , and only one case of saccular aneurysm has been reported in the literature 2).
Yılmaz et al. describes a rare case of a distal middle cerebral artery (dMCA) aneurysm, that developed a right intracerebral haematoma and subarachnoid haemorrhage. It was treated by surgical exploration and clipping via pterional approach 3).
A 65-year-old woman presented with a ruptured dissecting aneurysm of the M3 segment of the middle cerebral artery (MCA) manifesting as disturbance of consciousness and motor aphasia. Computed tomography revealed subarachnoid hemorrhage. Emergent angiography demonstrated segmental aneurysmal dilatation of the M3 portion of the left MCA. Infectious aneurysm was excluded. Surgery was performed to prevent repeated hemorrhage from the aneurysm. The lesion was excised and flow to the distal MCA was preserved with an anastomosis of the superficial temporal artery to the MCA. Histological examination confirmed that the aneurysmal dilatation was due to arterial dissection caused by disruption of the internal elastic lamina. Distal dissecting aneurysm may occur in the absence of infectious disease. Such ruptured distal dissecting aneurysm should preferably be treated surgically in the acute stage, immediately after detection of the aneurysm. The parent artery of the proximal and distal sides of the aneurysm should be trapped because of the probable weakness of the arterial wall, and bypass surgery performed to preserve the distal circulation 4).