Management of Aneurysms at the Origin of Duplicated Middle Cerebral Artery: Series of Four Patients with Review of the Literature

ObjectiveTo review the management of aneurysms arising at the origin of a duplicated middle cerebral artery (DMCA), which is an extremely rare entity.MethodsFour patients with internal carotid artery–DMCA aneurysms are presented, and 24 previously published cases are reviewed.ResultsOf the 28 internal carotid artery-DMCA aneurysms, 17 were ruptured, and 11 were unruptured. The aneurysms were equally distributed on the right and left sides and were small in size (≤6 mm) except for two that were of medium size. All aneurysms were treated surgically except for two very small aneurysms, which have been managed conservatively and followed for 9 years.ConclusionsAlthough all previously published clinical cases of internal carotid artery–DMCA aneurysms were treated surgically, conservative management with follow-up is a viable option in very small unruptured aneurysms.