Perforating branches of the middle cerebral artery

1985 ◽  
Vol 63 (2) ◽  
pp. 266-271 ◽  
Author(s):  
Slobodan V. Marinković ◽  
Miroslav S. Kovačević ◽  
Jelena M. Marinković
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Carotid Bifurcation ◽  
Main Trunk ◽  
Content Type ◽  
Brain Hemispheres ◽  
Perforating Artery ◽  
Lateral Group ◽  
Medial Group ◽  
Perforating Arteries

✓ Perforating branches of the middle cerebral artery (MCA) were examined under magnification in 50 formalin-fixed brain hemispheres. Perforating vessels varied in number from three to 18, with an average of nine. The greater the number of vessels, the smaller was their diameter. In this study, the perforating arteries were divided into medial, middle, and lateral groupings. Those in the medial group usually arose directly from the MCA main trunk close to the carotid bifurcation. There were usually three vessels in the middle group, which originated not only from the MCA trunk, but also from the MCA collateral (cortical) branches. Common stems, when present, gave rise to individual perforating vessels and occasionally to thin olfactory and insular rami. Perforating arteries in the lateral group varied from one to nine in number. In addition to an origin from the MCA trunk, they also arose from cortical branches supplying the frontal and temporal lobes. The fact that lateral perforating vessels often originated from division sites and from terminal branches of the MCA is of clinical significance, because aneurysms are more commonly located at the MCA bifurcation. Anastomoses were not found among the perforating arteries. In two specimens, a fusion between a perforating artery and the MCA trunk was noted. Since the perforating vessels are obviously end arteries, injury to them must be avoided during operations for MCA aneurysms.

The perforating branches of the middle cerebral artery

1985 ◽  
Vol 62 (2) ◽  
pp. 261-268 ◽  
Author(s):  
Felix Umansky ◽  
Francisco B. Gomes ◽  
Manuel Dujovny ◽  
Fernando G. Diaz ◽  
James I. Ausman ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Interventional Neuroradiology ◽  
Great Majority ◽  
Outer Diameter ◽  
Main Trunk ◽  
Content Type ◽  
Brain Hemispheres ◽  
Medial Group ◽  
Fine Print

✓ The perforating branches (PFB's) of the middle cerebral artery (MCA) were studied in 34 unfixed brain hemispheres which were injected with a polyester resin and dissected under the operating microscope. Five hundred and eight vessels were identified and their site of origin, branching pattern, outer diameter (OD), and length recorded. Four hundred and two PFB's (79%) originated from the main trunk of the MCA before its division; the remaining 106 vessels (21%) had their origin from branches of the MCA as follows: superior trunk, 43 vessels (8.5%); inferior trunk, 30 vessels (6%); middle trunk, four vessels (0.8%); early temporal branch, 27 vessels (5.3%); and early frontal branch, two vessels (0.4%). The number of PFB's in each hemisphere varied from five to 29 (mean 14.9 ± 0.7 vessels). The great majority of PFB's (96%) originated along the proximal 17 mm of the MCA. The PFB's arising in the first 10 mm had a mean OD of 0.35 ± 0.01 mm and a mean length of 9.25 ± 0.19 mm, and those arising from the second 10 mm had a mean OD of 0.47 ± 0.02 mm and a mean length of 16.67 ± 1.4 mm. A clear distinction between a medial and lateral group of PFB's was present in only 14 hemispheres (41%). In nine hemispheres (26%), perforating vessels from the anterior cerebral artery (A1 segment) and from the recurrent artery of Heubner replaced the medial group of PFB's of the MCA. In one case this group originated in an accessory MCA. In three hemispheres (9%) a small anastomosis (OD 0.2 mm) was seen between a PFB of the recurrent artery of Heubner and one of the MCA. From a total of 508 PFB's, 255 vessels (50%) originated as single vessels, while 253 vessels (50%) originated as branches of common stems. The OD of the single vessels ranged from 0.1 mm to 1.1 mm (mean 0.39 ± 0.02 mm), and the length from 3 to 20 mm (mean 10.8 ± 0.2 mm). The common stems ranged in OD from 0.6 to 1.8 mm (mean 0.87 ± 0.04 mm), and in length from 1 to 15 mm (mean 4.1 ± 0.4 mm). The clinical application of these anatomical data to the management of aneurysms and arteriovenous malformations of the MCA, and in the field of interventional neuroradiology is described. The most frequent pathological entities involving the perforating vessels are also discussed.

scholarly journals Variable Anatomy of the Middle Cerebral Artery from Its Origin to the Edge of the Sylvian Fissure: A Direct Fresh Brain Study

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Eve M. Oo ◽  
Khin E. E. Saw ◽  
Hnin N. Oo ◽  
Thida Than ◽  
Khin Thida
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Preoperative Assessment ◽  
Main Trunk ◽  
Brain Hemispheres ◽  
Posterior Parietal ◽  
The Mean ◽  
The Brain ◽  
Brain Study ◽  
Selection Of

The middle cerebral artery (MCA) is a major artery supplying blood to the brain and a common site of surgically treatable intracranial aneurysms. The MCA has anatomic variations that may have clinical significance. In order to investigate and document the extent of such variations, the MCA in 100 fresh brain hemispheres from 50 deceased patients, obtained from the Police Surgeon Office, Yangon General Hospital, Myanmar, was dissected and examined. Double MCA was observed in 2% of specimens. The termination patterns were bifurcation (72%), trifurcation (16%), and primary trunk (12%); early bifurcation was also observed (3%). The mean length of the main trunk (MT) was 20.6 ± 6.2 mm. The number of perforators ranged from 4 to 15 (mean = 9); most arose from the MT (96%), and the others originated at the bifurcation point (3%) and in postbifurcation divisions (1%). All of the perforators (100%) had a single branching pattern. The number of cortical branches ranged from 6 to 13 and included the orbitofrontal (98%), prefrontal (99%), precentral (95%), central (98%), temporopolar (87%), anterior temporal (89%), middle temporal (24%), posterior temporal (62%), temporo-occipital (69%), anterior parietal (88%), angular (83%), and posterior parietal (57%) arteries. Early cortical branches emerged from the MT in 52% of specimens. These data can help anatomists, radiologists, and neurosurgeons in preoperative assessment, surgical planning, and selection of surgical approach.

Accessory middle cerebral artery

1974 ◽  
Vol 41 (2) ◽  
pp. 248-251 ◽  
Author(s):  
Tohru Watanabe ◽  
Makoto Togo
Keyword(s):  
Central Nervous System ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Content Type ◽  
Accessory Middle Cerebral Artery ◽  
The Central Nervous System ◽  
Horizontal Portion ◽  
Perforating Arteries ◽  
Fine Print

✓ An accessory middle cerebral artery was demonstrated in the carotid angiograms of four patients; it originated from the horizontal portion of the anterior cerebral artery, and in two, gave rise to perforating arteries. None of the accessory arteries was associated with an intracranial aneurysm or anomaly of the central nervous system.

Indications for surgical intervention in middle cerebral artery obstruction

1984 ◽  
Vol 60 (2) ◽  
pp. 296-304 ◽  
Author(s):  
Arthur L. Day
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Surgical Intervention ◽  
Carotid Bifurcation ◽  
High Grade ◽  
Content Type ◽  
High Incidence ◽  
Collateral Vessels ◽  
Artery Obstruction ◽  
Fine Print

✓ The clinical, angiographic, and surgical characteristics of 31 patients with high-grade middle cerebral artery (MCA) stenosis or occlusion (jointly termed “MCA obstructions”) referred for cerebral revascularization by extracranial-intracranial (EC-IC) bypass are reviewed. Overall, 12 (66%) of the 18 patients with stenosis and all 13 (100%) of those with complete occlusion experienced clinically evident infarctions. Twenty-five of these patients underwent arteriography at least twice during their clinical course. Eleven (44%) demonstrated significant improvement in flow or complete resolution of obstruction on their second study. Ten of these 11 were patients in whom the initial arteriography was done within 2 weeks of symptom onset. Five other patients with stenosis exhibited obstruction that was worse on serial arteriography without surgical intervention. The high incidence of resolution of MCA obstructions indicates that surgery should not be contemplated in most instances until delayed arteriography has been performed, at least 6 weeks after the onset of symptoms. Proximal embolic sources, such as the cervical carotid bifurcation, should receive carotid endarterectomy and repeat arteriography in appropriate patients prior to consideration of EC-IC bypass. Persistent high-grade MCA obstructions are thereafter potential candidates for EC-IC bypass, since leptomeningeal collateral vessels are marginal in their protective ability. Overall, of 15 patients who underwent an EC-IC bypass procedure, 14 were either stable or improved postoperatively, and 13 have been free of any further ischemic events without the use of major anticoagulant agents.

Microsurgical anatomy of the middle cerebral artery

1981 ◽  
Vol 54 (2) ◽  
pp. 151-169 ◽  
Author(s):  
Hirohiko Gibo ◽  
Christopher C. Carver ◽  
Albert L. Rhoton ◽  
Carla Lenkey ◽  
Robert J. Mitchell
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Sylvian Fissure ◽  
Microsurgical Anatomy ◽  
Main Trunk ◽  
Content Type ◽  
Posterior Parietal ◽  
Relationship Of ◽  
The Relationship ◽  
Temporal Middle

✓ The microsurgical anatomy of the middle cerebral artery (MCA) was defined in 50 cerebral hemispheres. The MCA was divided into four segments: the M1 (sphenoidal) segment coursed posterior and parallel to the sphenoid ridge; the M2 (insular) segment lay on the insula; the M3 (opercular) segment coursed over the frontoparietal and temporal opercula; and the M4 (cortical) segment spread over the cortical surface. The Sylvian fissure was divided into a sphenoidal and an operculoinsular compartment. The M1 segment coursed in the sphenoidal compartment, and the M2 and M3 segments coursed in the operculoinsular compartment. The main trunk of the MCA divided in one of three ways: bifurcation (78% of hemispheres), trifurcation (12%), or division into multiple trunks (10%). The MCA's that bifurcated were divided into three groups: equal bifurcation (18%), inferior trunk dominant (32%), or superior trunk dominant (28%). The MCA territory was divided into 12 areas: orbitofrontal, prefrontal, precentral, central, anterior parietal, posterior parietal, angular, temporo-occipital, posterior temporal, middle temporal, anterior temporal, and temporopolar. The smallest cortical arteries arose at the anterior end and the largest one at the posterior end of the Sylvian fissure. The largest cortical arteries supplied the temporo-occipital and angular areas. The relationship of each of the cortical arteries to a number of external landmarks was reviewed in detail.

Anomalies and Variations of the Middle Cerebral Artery : A Micro anatomical Study

Neurosurgery ◽  
1988 ◽  
Vol 22 (6P1-P2) ◽  
pp. 1023-1027 ◽  
Author(s):  
Felix Umansky ◽  
Manuel Dujovny ◽  
James I. Ausman ◽  
Fernando G. Diaz ◽  
Haresh G. Mirchandani
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Polyester Resin ◽  
Anterior Cerebral Artery ◽  
Anatomical Study ◽  
Clinical Implications ◽  
Main Trunk ◽  
Brain Hemispheres ◽  
Accessory Middle Cerebral Artery

Abstract The microvascular anatomy of the main trunk and divisions of the middle cerebral artery was studied in 104 unfixed brain hemispheres injected with polyester resin and dissected under the operating microscope. The following anomalies and variations of the middle cerebral artery were found: fenestration (1 case; 1%), located on the first 4 mm of the main trunk of the middle cerebral artery; duplication (1 case; 1%). with vessels arising from the internal carotid artery; accessory middle cerebral artery (2 cases; 2%). originating on the A, segment of the anterior cerebral artery; single-trunk type of middle cerebral artery (4 cases; 4%), with no division of its main trunk; quadrifurcation (4 cases; 4%), in which the main trunk of the middle cerebral artery divided into four secondary trunks. The clinical implications of these anatomical findings are discussed, and photographs of representative specimens illustrate the anomalies.

Microsurgical anatomy of the early branches of the middle cerebral artery: morphometric analysis and classification with angiographic correlation

2003 ◽  
Vol 98 (6) ◽  
pp. 1277-1290 ◽  
Author(s):  
Necmettin Tanriover ◽  
Masatou Kawashima ◽  
Albert L. Rhoton ◽  
Arthur J. Ulm ◽  
Robert A. Mericle
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Operative Procedure ◽  
Microsurgical Anatomy ◽  
Main Trunk ◽  
Content Type ◽  
Anatomical Features ◽  
Relative Proximity ◽  
Angiographic Data ◽  
Fine Print

Object. The cortical arteries arising from the main trunk of the middle cerebral artery, proximal to its bifurcation or trifurcation, are called “early branches.” The purpose of this study was to characterize these early branches. Methods. The early branches were characterized according to their sites and patterns of origin, diameters, and relative proximity to the internal carotid artery bifurcation, as well as the course and area of supply of their cortical branches based on an examination of 50 hemispheres. Special attention was directed to the perforating arteries that arose from the early branches and entered the anterior perforated substance. The anatomical findings were compared with data obtained from 109 angiograms. Conclusions. Early branches directed to the temporal and frontal lobes were found in 90 and 32% of the hemispheres, respectively. The early branches that arose more proximally from the M1 segment were larger than those arising distally. Lenticulostriate arteries arose from 81% of the early frontal branches (EFBs) and from 48% of the early temporal branches (ETBs). An average of two cortical arteries arose from the EFBs and 1.3 from the ETBs, the most common of which supplied the temporopolar and orbitofrontal areas. Although the microsurgical anatomy of the early branches demonstrates abundant diversity, they can be classified into clearly defined patterns based on anatomical features. These patterns can prove helpful in evaluating angiographic data and in planning an operative procedure.

Middle meningeal to middle cerebral arterial bypass for cerebral revascularization

1979 ◽  
Vol 50 (6) ◽  
pp. 802-804 ◽  
Author(s):  
Clinton F. Miller ◽  
Robert F. Spetzler ◽  
Dennis J. Kopaniky
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Middle Meningeal Artery ◽  
Cerebral Revascularization ◽  
Content Type ◽  
Arterial Bypass ◽  
Meningeal Artery ◽  
Fine Print

✓ A case is reported of successful anastomosis of the middle meningeal artery to a cortical branch of the middle cerebral artery. Based on the analyses of 50 random angiograms, the authors discuss the circumstances in which such an anastomosis might be practical and indicated.

Posttraumatic bilateral middle cerebral artery occlusion

1975 ◽  
Vol 42 (2) ◽  
pp. 217-221 ◽  
Author(s):  
Skip Jacques ◽  
C. Hunter Shelden ◽  
D. Thomas Rogers ◽  
Anthony C. Trippi
Keyword(s):  
Middle Cerebral Artery ◽  
Middle Cerebral Artery Occlusion ◽  
Cerebral Artery ◽  
Artery Occlusion ◽  
Content Type ◽  
Pathophysiological Mechanisms ◽  
Cerebral Artery Occlusion ◽  
Fine Print

✓ The authors report a case of bilateral posttraumatic middle cerebral artery occlusion. Previously reported unilateral cases are reviewed and possible pathophysiological mechanisms disscussed.

Multiple middle cerebral artery aneurysms in an infant

1990 ◽  
Vol 72 (5) ◽  
pp. 806-809 ◽  
Author(s):  
Cornelia Cedzich ◽  
J. Schramm ◽  
G. Röckelein
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Systemic Disease ◽  
Intracerebral Hematoma ◽  
Left Middle Cerebral Artery ◽  
Content Type ◽  
Middle Cerebral Artery Aneurysms ◽  
Subarachnoid Blood ◽  
Left Middle ◽  
Control Angiography

✓ An 11-month-old boy was admitted for evaluation of drowsiness, vomiting, and convulsions. Computerized tomography showed subarachnoid blood in the left sylvian fissure and a small intracerebral hematoma in the temporal lobe. Angiography revealed several aneurysms of the left middle cerebral artery (MCA). During surgery, 13 aneurysms were found arising from one main branch of the left MCA, and this segment of the MCA was trapped. Somatosensory evoked potentials did not show any change during surgery. The diseased arterial segment was examined histologically and the pathogenetic aspects of the case are discussed. Control angiography 6 months later excluded systemic disease or other aneurysms. The rarity of such lesions in childhood and their successful surgical treatment are discussed briefly.

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