• Ahmed Elsharkawy, Keisuke Ishii, Mika Niemelä, Riku Kivisaari, Hanna Lehto, and Juha Hernesniemi.
• Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland. Electronic address: ext-ahmed.elsharkawy@hus.fi.
• World Neurosurg. 2013 Dec 1;80(6):e313-8.

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.Copyright © 2013 Elsevier Inc. All rights reserved.

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