Atilla Erdem, Hasan Çağlar Uğur and Bariş Diren
Gokmen Kahilogullari, Hasan Caglar Ugur, Ayhan Comert, Ibrahim Tekdemir and Yucel Kanpolat
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.
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.
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.
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.
Hasan Caglar Ugur, Gokmen Kahilogullari, Ali Firat Esmer, Ayhan Comert, Aysun B. Odabasi, Ibrahim Tekdemir, Alaittin Elhan and Yucel Kanpolat
The vascularization pattern of the anatomy of the distal anterior cerebral artery (ACA) remains a subject of debate. The authors provide detailed information about the distal ACA and shed light on issues concerning it that have not previously been adequately discussed.
Fifty adult human brains (100 hemispheres) were obtained during routine autopsies. Cerebral arteries were separately cannulated and injected with latex. The vascularization patterns of the cortical branches and the variations of the arteries were investigated. The authors found that the distal ACA supplied all the inner surfaces of the frontal and parietal lobes and a median of one third of the outer surfaces. The origin of the arteries from the main trunk and their exit angles affected the vascularization patterns of the hemispheres. The authors redefine controversial terminology regarding the callosomarginal artery.
In each hemisphere, the vascularization pattern of the distal ACA is different to a greater or lesser extent. An awareness of this fact will contribute significantly to surgical interventions.
Simel Kendir, Halil Ibrahim Acar, Ayhan Comert, Mevci Ozdemir, Gokmen Kahilogullari, Alaittin Elhan and Hasan Caglar Ugur
Knowledge of the cranium projections of the gyral structures is essential to reduce the surgical complications and to perform minimally invasive interventions in daily neurosurgical practice. Thus, in this study the authors aimed to provide detailed information on cranial projections of the eloquent cortical areas.
Ten formalin-fixed adult human skulls were obtained. Using sutures and craniometrical points, the crania were divided into 8 windows: superior frontal, inferior frontal, superior parietal, inferior parietal, sphenoidal, temporal, superior occipital, and inferior occipital. The projections of the precentral gyrus, postcentral gyrus, inferior frontal gyrus, superior temporal gyrus, transverse temporal gyri, Heschl gyrus, genu and splenium of the corpus callosum, supramarginal gyrus, angular gyrus, calcarine sulcus, and sylvian fissure to cranial vault were evaluated.
Three-fourths of the precentral gyrus and postcentral gyrus were in the superior parietal window. The inferior frontal gyrus extended to the inferior parietal window in 80%. The 3 important parts of this gyrus were located below the superior temporal line in all hemispheres. The orbital and triangular parts were in the inferior frontal window, and the opercular part was in the inferior parietal window. The superior temporal gyrus was usually located in the inferior parietal and temporal windows, whereas the supramarginal gyrus and angular gyrus were usually located in the superior and inferior parietal windows. The farthest anterior point of the Heschl gyrus was usually located in the inferior parietal window. The mean positions of arachnoid granulations were measured as 3.9 ± 0.39 cm anterior and 7.3 ± 0.51 cm posterior to the bregma.
Given that recognition of the gyral patterns underlying the craniotomies is not always easy, awareness of the coordinates and projections of certain gyri according to the craniometric points may considerably contribute to surgical interventions.