The branching pattern of the middle cerebral artery: is the intermediate trunk real or not? An anatomical study correlating with simple angiography

2012 ◽  
Vol 116 (5) ◽  
pp. 1024-1034 ◽  
Author(s):  
Gokmen Kahilogullari ◽  
Hasan Caglar Ugur ◽  
Ayhan Comert ◽  
Ibrahim Tekdemir ◽  
Yucel Kanpolat
Keyword(s):  
Motor Cortex ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Cerebral Angiography ◽  
Bifurcation Point ◽  
Point Group ◽  
3D Ct ◽  
Type Group ◽  
Group A ◽  
Group B

Object The branching structure of the middle cerebral artery (MCA) remains a debated issue. In this study the authors aimed to describe this branching structure in detail. Methods Twenty-seven fresh, human brains (54 hemispheres) obtained from routine autopsies were used. The cerebral arteries were first filled with colored latex and contrast agent, followed by fixation with formaldehyde. All dissections were done under a microscope. During examination, the trunk structures of the MCA and their relations with cortical branches were demonstrated. Lateral radiographs of the same hemispheres were then obtained and comparisons were made. Angles between the MCA trunks were measured on 3D CT cerebral angiography images in 25 patients (50 hemispheres), and their correlations with the angles obtained in the cadaver brains were evaluated. Results A new classification was made in relation to the terminology of the intermediate trunk, which is still a subject of debate. The intermediate trunk was present in 61% of cadavers and originated from a superior trunk in 55% and from an inferior trunk in 45%. Cortical branches supplying the motor cortex (precentral, central, and postcentral arteries) significantly originated from the intermediate trunk, and the diameter of the intermediate trunk significantly increased when it originated from the superior trunk. In measurements of the angles between the superior and intermediate trunks, it was found that the intermediate trunk had significant dominance in supplying the motor cortex as the angle increased. The intermediate trunk was classified into 3 types based on the angle values and the distance to the bifurcation point as Group A (pseudotrifurcation type), Group B (proximal type), and Group C (distal type). Group A trunks were seemingly closer to the trifurcation structure that has been reported on in the literature and was seen in 15%. Group B trunks were the most common type (55%), and Group C trunks were characterized as the farthest from the bifurcation point. Group C trunks also had the smallest diameter and fewest cortical branches. Similarities were found between the angles in cadaver specimens and on 3D CT cerebral angiography images. Beyond the separation point of the MCA, trunk structures always included the superior trunk and inferior trunk, and sometimes the intermediate trunk. Conclusions Interrelations of these vascular structures and their influences on the cortical branches originating from them are clinically important. The information presented in this study will ensure reliable diagnostic approaches and safer surgical interventions, particularly with MCA selective angiography.

scholarly journals Parasympathetic Denervation of Rat Pial Vessels Significantly Increases Infarction Volume following Middle Cerebral Artery Occlusion

1991 ◽  
Vol 11 (4) ◽  
pp. 628-637 ◽  
Author(s):  
Michihisa Kano ◽  
Michael A. Moskowitz ◽  
Masayuki Yokota
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Focal Cerebral Ischemia ◽  
Protective Role ◽  
Artery Occlusion ◽  
Nerve Fibers ◽  
Infarction Volume ◽  
Cortical Gray Matter ◽  
Group A ◽  
Group B

Studies were undertaken in Long Evans rats to examine the hypothesis that chronic unilateral sectioning of vasodilating nerve fibers (parasympathetic and/or sensory) innervating the circle of Willis increases infarction volume following unilateral branch occlusion of the middle cerebral artery (MCA) combined with temporary (45 min) bilateral common carotid occlusion. Infarct size was measured 24 h after surgical occlusion from seven coronal slices. Infarction volume (mean ± SD) in sham animals (group A) and surgically naive animals (group B) measured 153 ± 43 and 131 ± 38 mm3, respectively. After lesions of both sensory (nasociliary nerve) and parasympathetic efferents at the ethmoidal foramen (group C, combined lesion) or selective lesions of parasympathetic efferents (group D), infarction volume increased [214 ± 47 mm3 (p < 0.01) and 209 ± 46 mm3 (p < 0.05), respectively]. No increases were detected after cutting the nasociliary nerve alone (group E) or occluding the external ethmoidal artery (group F) [145 ± 39 mm3 (p > 0.05) and 124 ± 63 mm3 (p > 0.05), respectively]. The infarct was predominantly located within cortical gray matter and became enlarged on its superior and inferior aspects after parasympathectomy. Large infarcts were noted whether animals breathed spontaneously (all of the above) or were artificially respired or whether animals were anesthetized with xylazine and ketamine or chloral hydrate. Taken together, these studies suggest a previously unrecognized protective role for autonomic parasympathetic fibers in the pathophysiology of focal cerebral ischemia that is not shared by sensory fibers. The importance of autonomic vasodilating fibers to blood flow in ischemic brain merits further study.

scholarly journals Simultaneous Combined Intravenous Recombinant Tissue Plasminogen Activator and Endovascular Therapy for Hyperacute Middle Cerebral Artery M1 Occlusion

2011 ◽  
Vol 17 (1) ◽  
pp. 115-122 ◽  
Author(s):  
S. Toyota ◽  
S. Sugiura ◽  
K. Iwaisako
Keyword(s):  
Middle Cerebral Artery ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Cerebral Artery ◽  
Endovascular Therapy ◽  
Recombinant Tissue Plasminogen Activator ◽  
Simultaneous Treatment ◽  
Tissue Plasminogen ◽  
Group A ◽  
Group B

We investigated the efficacy and safety of combined intravenous (IV) recombinant tissue plasminogen activator (rtPA) and simultaneous endovascular therapy (ET) for hyperacute middle cerebral artery (MCA) M1 occlusion. Between October 2005 and April 2007, in the combined group, 22 patients eligible for IV rtPA, who were diagnosed as having MCA M1 occlusion, were treated with IV rtPA and simultaneous ET was initiated as soon as possible. The other patients were treated with IV rtPA alone (IV group A: n = 11). Between May 2007 and November 2008, all patients eligible for IV rtPA, who were diagnosed as having MCA M1 occlusion, underwent thrombolysis by IV rtPA alone (IV group B: n = 24). The improvement of the National Institutes of Health Stroke Scale score at 24 hours was highest in the combined group (10 ± 4.1). In contrast, it was 5.1 ± 4.7 in the IV group A (P = 0.017) and 5.6 ± 5.6 in IV group B (P = 0.006). In the combined group, successful recanalization was observed in 18 of 22 patients with one symptomatic intracranial hemorrhage. The rate of mRS0–2 at three months was highest in the combined group, 36% in the IV group A and 33% in the IV group B (P = 0.008). Simultaneous treatment with IV rtPA and ET improved the clinical outcome of MCA M1 occlusion without a significant increase of adverse effects in our study.

scholarly journals Study of fetal doppler velocimetry versus non stress test as predictors of adverse perinatal outcome in high risk pregnancies

2020 ◽  
Vol 9 (2) ◽  
pp. 729
Author(s):  
Hymavathi K. ◽  
Prasuna P. ◽  
Davuluru Sandhya Rani
Keyword(s):  
High Risk ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Perinatal Outcome ◽  
Stress Test ◽  
Doppler Velocimetry ◽  
Group A ◽  
Group B ◽  
Group D ◽  
Fetal Compromise

Background: Pregnancy is a unique, physiologically normal event in a women’s life. Objective of this study was to compare the efficacy of the doppler velocimetry versus non stress test in relation to perinatal outcome in high risk pregnancies.Methods: This is a prospective study conducted in the department of obstetrics and gynaecology, Narayana Medical College and Hospital. 100 women with high risk pregnancy were recruited. All were examined systematically, and Doppler velocimetry and non-stress test were done.Results: All cases were divided into four groups based on NST and doppler velocimetry of umbilical artery and middle cerebral artery. 10% of women had abnormal doppler. Middle cerebral artery doppler abnormality was noted in 3% and CPR abnormality in 3% of women in the study group. 15% had abnormal NST. In Group A, out of 88 patients 9 had fetal compromise. In Group B, out of 5 patients all had fetal compromise. In Group C, out of 4 patients none had fetal compromise. In Group D, all 3 patients had fetal compromise. In Group D, all 3 had neonatal deaths. Average birth weights in Group A was 2.7 kg, in Group B was 2 kg, in Group C was 2.5 kg, in Group D was 1.4 kg. Two (2.2%) newborn in Group A, 4 (80%) newborns in Group B, 3 (100%) in Group had Apgar < 7 at 5 minutes. 4 (4.5%) babies in Group A, 5 (100%) babies in Group B, 3 (100%) babies in Group D were admitted in NICU. Umbilical artery doppler was found to have sensitivity 46.6%, specificity - 94%, PPV - 93%, NPV - 54%. Middle cerebral artery doppler was found to have sensitivity 73.3%, specificity - 90%, PPV - 91.6%, NPV- 69.3%.Conclusions: In present study, highest percentage of perinatal complications and perinatal deaths were seen in groups with abnormal tests of NST and velocimetry. Group D had the worst perinatal outcome.

Morphological Parameters Associated With Middle Cerebral Artery Aneurysms

Neurosurgery ◽  
2015 ◽  
Vol 76 (6) ◽  
pp. 721-727 ◽  
Author(s):  
Anil Can ◽  
Allen L. Ho ◽  
Ruben Dammers ◽  
Clemens M.F. Dirven ◽  
Rose Du
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Vascular Malformations ◽  
Statistical Significance ◽  
Source Image ◽  
Parent Artery ◽  
Morphological Parameters ◽  
Daughter Branch ◽  
Group A ◽  
Group B

Abstract BACKGROUND: Morphological factors contribute to the hemodynamics of the middle cerebral artery (MCA). OBJECTIVE: To identify image-based morphological parameters that correlated with the presence of MCA aneurysms. METHODS: Image-based anatomic parameters obtained from 110 patients with and without MCA bifurcation aneurysms were evaluated with Slicer, an open-source image analysis software, to generate 3-dimensional models of the aneurysms and surrounding vascular architecture. We examined segment lengths, diameters, and vessel-to-vessel angles of the parent and daughter vessels at the MCA bifurcation. In order to reduce confounding by genetic and clinical risk factors, 2 control groups were selected: group A (the unaffected contralateral side of patients with unilateral MCA bifurcation aneurysms) and group B (patients without intracranial aneurysms or other vascular malformations). Univariate and multivariate analyses were performed to determine statistical significance. RESULTS: One hundred ten patients who were evaluated from 2007 to 2014 were analyzed (73 patients with MCA aneurysms and 37 control patients). Multivariate analysis revealed that a smaller parent artery diameter (group A: odds ratio [OR] 0.20, P &lt; .01, group B: OR 0.23, P &lt; .01) and a larger daughter-to-daughter branch angle (group A: OR 1.01, P = .04, group B: OR 1.02, P = .04) were most strongly associated with MCA aneurysm presence after adjusting for other morphological factors. CONCLUSION: Smaller parent artery diameter and larger daughter-to-daughter branch angles are associated with the presence of MCA bifurcation aneurysms. These easily measurable parameters may provide objective metrics to assess aneurysm formation and growth risk stratification in high-risk patients.

scholarly journals Correlation between angiographic transit times and neurological status on admission in patients with aneurysmal subarachnoid hemorrhage

2016 ◽  
Vol 124 (4) ◽  
pp. 1093-1099 ◽  
Author(s):  
Alexander Ivanov ◽  
Andreas Linninger ◽  
Chih-Yang Hsu ◽  
Sepideh Amin-Hanjani ◽  
Victor A. Aletich ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Artery ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Clinical Information ◽  
Control Group ◽  
Angiography Suite ◽  
Transit Times ◽  
Significant Difference ◽  
Group A ◽  
Group B

OBJECT The use of digital subtraction angiography (DSA) for semiquantitative cerebral blood flow(CBF) assessment is a new technique. The aim of this study was to determine whether patients with aneurysmal subarachnoid hemorrhage (aSAH) with higher Hunt and Hess grades also had higher angiographic contrast transit times (TTs) than patients with lower grades. METHODS A cohort of 30 patients with aSAH and 10 patients without aSAH was included. Relevant clinical information was collected. A method to measure DSA TTs by color-coding reconstructions from DSA contrast-intensity images was applied. Regions of interest (ROIs) were chosen over major cerebral vessels. The estimated TTs included time-to-peak from 0% to 100% (TTP0–100), TTP from 25% to 100% (TTP25–100), and TT from 100% to 10% (TT100–10) contrast intensities. Statistical analysis was used to compare TTs between Group A (Hunt and Hess Grade I-II), Group B (Hunt and Hess Grade III-IV), and the control group. The correlation coefficient was calculated between different ROIs in aSAH groups. RESULTS There was no difference in demographic factors between Group A (n = 10), Group B (n = 20), and the control group (n = 10). There was a strong correlation in all TTs between ROIs in the middle cerebral artery (M1, M2) and anterior cerebral artery (A1, A2). There was a statistically significant difference between Groups A and B in all TT parameters for ROIs. TT100–10 values in the control group were significantly lower than the values in Group B. CONCLUSIONS The DSA TTs showed significant correlation with Hunt and Hess grades. TT delays appear to be independent of increased intracranial pressure and may be an indicator of decreased CBF in patients with a higher Hunt and Hess grade. This method may serve as an indirect technique to assess relative CBF in the angiography suite.

Numerical taxonomy of certain genera of Fungi Imperfecti and Ascomycotina

1978 ◽  
Vol 56 (17) ◽  
pp. 2031-2049 ◽  
Author(s):  
Patrick E. Dabinett ◽  
Angela M. Wellman
Keyword(s):  
Numerical Taxonomy ◽  
Species Group ◽  
Numerical Classification ◽  
Type Group ◽  
Ordination Techniques ◽  
Group A ◽  
Group B ◽  
New Evidence ◽  
Group D ◽  
Fungi Imperfecti

Various clustering and ordination techniques are used on data collected from 88 cultures of Fungi Imperfecti and imperfect states of Ascomycotina to produce classifications. The data consist of 98 characters representing the morphology, conidium ontogeny, and physiology of the cultures. Although 23 genera are represented, emphasis is placed on Graphium sensu lato and Ceratocystis to which half the cultures belong. Seven groups which cluster consistently in all the techniques used are recognized, groups A to G. Group A contains species which have the annellidic type of conidiation, namely Trichurus. Scopulariopsis, Doratomyces, and Microascus. Group B contains the phialidic Chalara-type Ceratocystis species. Group C is characterized by the sympodial type of conidiation of the Sporothrix type and contains species from Petriella and Sporocybe. Group D contains an assortment of species which display the typical phialidic conidiogeny. Group E contains species from Ceratocystis and Graphium sensu lato which have holoblastic conidia with conidiogenous cells of the ramoconidium type. Group F is a loose cluster of species characterized by sympodial conidiation and contains species from Graphium sensu lato, Ceratocystis, and Verticicladiella. Group G contains species of Periconia which produce large conidia polyblastically. This numerical classification provides new evidence to support the classifications based on conidium ontogeny.

Combined Encephaloduroarteriosynangiosis and Bifrontal Encephalogaleo(periosteal)synangiosis in Pediatric Moyamoya Disease

Neurosurgery ◽  
2002 ◽  
Vol 50 (1) ◽  
pp. 88-96 ◽  
Author(s):  
Seung-Ki Kim ◽  
Kyu-Chang Wang ◽  
In-One Kim ◽  
Dong Soo Lee ◽  
Byung-Kyu Cho
Keyword(s):  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Single Photon ◽  
Photon Emission ◽  
Single Photon Emission ◽  
Computed Tomographic ◽  
Group A ◽  
Single Photon Emission Computed ◽  
Group B

ABSTRACT OBJECTIVE We compared the surgical results of simple encephaloduroarteriosynangiosis (EDAS) and EDAS with bifrontal encephalogaleo(periosteal)synangiosis for the treatment of pediatric moyamoya disease. METHODS Data for 159 children (up to 15 yr of age, 76 boys and 83 girls) who underwent indirect revascularization procedures for the treatment of moyamoya disease between 1987 and 1998 were retrospectively reviewed. Group A patients underwent simple EDAS (n = 67). Group B patients underwent EDAS with bifrontal encephalogaleo(periosteal)synangiosis (n = 92). The surgical results for each group were compared, in terms of clinical outcomes, neuroimaging changes, extent of revascularization evident on angiograms, and hemodynamic changes evident on single-photon emission computed tomographic scans. The average follow-up periods were 45 months for Group A and 22 months for Group B. RESULTS The overall clinical outcomes and neuroimaging changes tended to be better for Group B. In terms of single-photon emission computed tomographic changes of the whole brain after surgery, Group B patients exhibited more favorable outcomes than did Group A patients (62 versus 36%, P = 0.003). The surgical results for the anterior cerebral artery territory were significantly better for Group B than for Group A, with respect to outcomes of anterior cerebral artery symptoms (81 versus 40%, P = 0.015), revascularization on angiograms (79 versus 16%, P &lt; 0.001), and hemodynamic changes on single-photon emission computed tomographic scans (70 versus 52%, P = 0.002). The incidences of postoperative infarctions were not significantly different between the two groups. CONCLUSION EDAS with bifrontal encephalogaleo(periosteal)synangiosis is a more effective surgical modality for the treatment of pediatric moyamoya disease, compared with simple EDAS, because it covers both the middle cerebral artery and anterior cerebral artery territories of the brain.

scholarly journals Complications of Cerebral Angiography Performed at a University Hospital

2018 ◽  
Vol 24 (3) ◽  
pp. 194-200
Author(s):  
Márcio Francisco Lehmann ◽  
Paulo Henrique Pires De Aguiar ◽  
Johnathan De Sousa Parreira ◽  
Adriano Torres Antonucci ◽  
Natally Santiago ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Cerebral Angiography ◽  
Focus Of Attention ◽  
University Hospital ◽  
Southern Brazil ◽  
Reduced Risk

Objective: The risk of complication of cerebral angiography has always been the focus of attention. The aim of this study was to evaluate the outcome of cerebral angiography performed in the first 30 months of operational training in the endovascular neurosurgery service of a university hospital. Methods: A retrospective study evaluated 129 digital cerebral angiography examinations in 91 patients at a univeristy hospital from Southern Brazil. Results: The rate of complication was 2/129 (1.55%); of them, one (0.77%) presented a transient complication (hematoma puncture), and one (0.77%) a permanent complication with death of the patient because of an association between clotting in the middle cerebral artery and complications from the initial trauma. Conclusion: The rate of cerebral angiography complication obtained was low (1.75%) and underscores its reduced risk when performed in a neurological service even with professional in training. 

scholarly journals Anatomical study of Gerdy’s tubercle, its shape, texture and clinical application.

2020 ◽  
Vol 27 (05) ◽  
pp. 957-962
Author(s):  
Anwaar Hussain ◽  
Irfan Ahmed Mughal ◽  
Muhammad Hanif
Keyword(s):  
Anatomical Study ◽  
Common Peroneal Nerve ◽  
Left Tibia ◽  
Type Group ◽  
Safe Area ◽  
Group A ◽  
Group B ◽  
Gerdy’S Tubercle ◽  
Group D ◽  
Triangular Group

Objectives: The objective of this study is to lay emphasis on Gerdy’s tubercle, its morphology and clinical significance of Gerdy’s safe area in upper lateral part of tibia for any surgical intervention to avoid injury to neighboring common peroneal nerve. Study Design: Comparative anatomical study. Setting: Anatomy Department Faisalabad Medical University Faisalabad. Period: From 1st September 2018 to 20th Feb 2019. Material & Methods: Total 72 dried Pakistani tibia irrespective of sex (38 right and 34 left) were taken from the bone bank of Anatomy Department FMU. The upper end of tibia was studied with respect to the shape and texture of Gerdy’s tubercle. The shape is divided in to Group A having triangular, Group B oval, Group C irregular and group D unidentified in both right and left bones and their % age was calculated. Similarly the texture Of GT was divided in to Group A facet (smooth), Group B tubercle (rough) and Group C unidentified in both right and left tibia and then % age was calculated. Results: Total 72 dried human tibia were examined out of which 38 were of right side and rest 34 were of left side all showed presence of Gerdry’s tubercle. Regarding shape of GT Right tibia showed 12(31.5%) triangular (group A), Oval shape was 20 (52.6%) (Group B), number of irregular was 6 (15.9%) (Group C) and none unidentified (0%) (Group D). Regarding texture GT Right Tibia showed facet type Group A 16(42%), Group B 57% were of tubercle type (22) and non unidentified (Group D) Zero %. Total 34 left tibia Shape of GT was examined and found triangular (group A) in 18 tibia (52%) and oval shaped 6(17.6%) in group B. Whereas in group C 10 (29.4%). were irregular. The texture of left tibia 41.1% (14) were of facet Type Group A and 58.82% (20) were of tubercle type (group B). Total Number of Tibia (N=72) GT showed 41.6% triangular, 36.1% oval and 22.2% irregular. While 41.6% were facet and 58.3% tubercle in texture. Conclusion: This study concluded that the morphological study of Gerdy’s tubercle is mandatory to approach the lateral compartment of the knee joint for any surgical intervention. The calculation of safe area is so important to avoid injury to common peroneal nerve.

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