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

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  • 1 Department of Neurological Surgery, University of Florida, Gainesville, Florida
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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.

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  • 1.

    Abanou A, , Lasjaunias P, & Manelfe CJ, et al: The accessory middle cerebral artery (AMCA). Diagnostic and therapeutic consequences. Anat Clin 6:305309, 1984 Abanou A, Lasjaunias P, Manelfe CJ, et al: The accessory middle cerebral artery (AMCA). Diagnostic and therapeutic consequences. Anat Clin 6:305–309, 1984

    • Search Google Scholar
    • Export Citation
  • 2.

    Chyatte D, & Porterfield R: Nuances of middle cerebral artery aneurysm microneurosurgery. Neurosurgery 48:339346, 2001 Chyatte D, Porterfield R: Nuances of middle cerebral artery aneurysm microneurosurgery. Neurosurgery 48:339–346, 2001

    • Search Google Scholar
    • Export Citation
  • 3.

    Ciszek B, , Aleksandrowicz R, & Zabek M, et al: Classification, topography and morphometry of the early branches of the middle cerebral artery. Folia Morphol 55:229230, 1996 Ciszek B, Aleksandrowicz R, Zabek M, et al: Classification, topography and morphometry of the early branches of the middle cerebral artery. Folia Morphol 55:229–230, 1996

    • Search Google Scholar
    • Export Citation
  • 4.

    Crompton MR: The pathology of ruptured middle-cerebral aneurysms, with special reference to the differences between the sexes. Lancet 2:421425, 1962 Crompton MR: The pathology of ruptured middle-cerebral aneurysms, with special reference to the differences between the sexes. Lancet 2:421–425, 1962

    • Search Google Scholar
    • Export Citation
  • 5.

    Gibo H, , Carver CC, & Rhoton AL Jr, et al: Microsurgical anatomy of the middle cerebral artery. J Neurosurg 54:151169, 1981 Gibo H, Carver CC, Rhoton AL Jr, et al: Microsurgical anatomy of the middle cerebral artery. J Neurosurg 54:151–169, 1981

    • Search Google Scholar
    • Export Citation
  • 6.

    Grand W: Microsurgical anatomy of the proximal middle cerebral artery and the internal carotid artery bifurcation. Neurosurgery 7:215218, 1980 Grand W: Microsurgical anatomy of the proximal middle cerebral artery and the internal carotid artery bifurcation. Neurosurgery 7:215–218, 1980

    • Search Google Scholar
    • Export Citation
  • 7.

    Heros CR, & Fritsch MJ: Surgical management of middle cerebral artery aneurysms. Neurosurgery 48:780786, 2001 Heros CR, Fritsch MJ: Surgical management of middle cerebral artery aneurysms. Neurosurgery 48:780–786, 2001

    • Search Google Scholar
    • Export Citation
  • 8.

    Jain KK: Some observations on the anatomy of the middle cerebral artery. Can J Surg 7:134139, 1964 Jain KK: Some observations on the anatomy of the middle cerebral artery. Can J Surg 7:134–139, 1964

    • Search Google Scholar
    • Export Citation
  • 9.

    Komiyama M, , Nakajima H, & Nishikawa M, et al: Middle cerebral artery variations: duplicated and accessory arteries. AJNR 19:4549, 1998 Komiyama M, Nakajima H, Nishikawa M, et al: Middle cerebral artery variations: duplicated and accessory arteries. AJNR 19:45–49, 1998

    • Search Google Scholar
    • Export Citation
  • 10.

    Kwak R, , Kuwahara K, & Niizuma H, et al: [Anomalies of the cerebral artery with intracranial saccular aneurysms—duplication and fenestration.] No Shinkei Geka 7:691696, 1979 (Jpn) Kwak R, Kuwahara K, Niizuma H, et al: [Anomalies of the cerebral artery with intracranial saccular aneurysms—duplication and fenestration.] No Shinkei Geka 7:691–696, 1979 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 11.

    Marinkovic S, , Gibo H, & Milisavljevic M, et al: Anatomic and clinical correlations of the lenticulostriate arteries. Clin Anat 14:190195, 2001 Marinkovic S, Gibo H, Milisavljevic M, et al: Anatomic and clinical correlations of the lenticulostriate arteries. Clin Anat 14:190–195, 2001

    • Search Google Scholar
    • Export Citation
  • 12.

    Marinkovic SV, , Kovacevic MS, & Marinkovic JM: Perforating branches of the middle cerebral artery. Microsurgical anatomy of their extracerebral segments. J Neurosurg 63:266271, 1985 Marinkovic SV, Kovacevic MS, Marinkovic JM: Perforating branches of the middle cerebral artery. Microsurgical anatomy of their extracerebral segments. J Neurosurg 63:266–271, 1985

    • Search Google Scholar
    • Export Citation
  • 13.

    Michotey P, , Moscow NP, & Salamon G: Anatomy of the cortical branches of the middle cerebral artery, in Newton TH, & Potts DG (eds): Radiology of the Skull and Brain: Angiography. St. Louis: CV Mosby, 1974, Vol 2, Book 2, pp 14711478 Michotey P, Moscow NP, Salamon G: Anatomy of the cortical branches of the middle cerebral artery, in Newton TH, Potts DG (eds): Radiology of the Skull and Brain: Angiography. St. Louis: CV Mosby, 1974, Vol 2, Book 2, pp 1471–1478

    • Search Google Scholar
    • Export Citation
  • 14.

    Rhoton AL Jr: Anatomy of saccular aneurysms. Surg Neurol 14:5966, 1980 Rhoton AL Jr: Anatomy of saccular aneurysms. Surg Neurol 14:59–66, 1980

    • Search Google Scholar
    • Export Citation
  • 15.

    Rhoton AL Jr: Aneurysms. Neurosurgery 51 (Suppl 4):121158, 2002 Rhoton AL Jr: Aneurysms. Neurosurgery 51 (Suppl 4):121–158, 2002

  • 16.

    Rhoton AL Jr: The supratentorial arteries. Neurosurgery 51 (Suppl 4):53120, 2002 Rhoton AL Jr: The supratentorial arteries. Neurosurgery 51 (Suppl 4):53–120, 2002

    • Search Google Scholar
    • Export Citation
  • 17.

    Ring BA: Middle cerebral artery: anatomical and radiographic study. Acta Radiol 57:289300, 1962 Ring BA: Middle cerebral artery: anatomical and radiographic study. Acta Radiol 57:289–300, 1962

    • Search Google Scholar
    • Export Citation
  • 18.

    Ring BA, & Waddington MM: Intraluminal diameters of the intracranial arteries. Vasc Surg 1:137151, 1967 Ring BA, Waddington MM: Intraluminal diameters of the intracranial arteries. Vasc Surg 1:137–151, 1967

    • Search Google Scholar
    • Export Citation
  • 19.

    Rosner SS, , Rhoton LA Jr, & Ono M, et al: Microsurgical anatomy of the anterior perforating arteries. J Neurosurg 61:468485, 1984 Rosner SS, Rhoton LA Jr, Ono M, et al: Microsurgical anatomy of the anterior perforating arteries. J Neurosurg 61:468–485, 1984

    • Search Google Scholar
    • Export Citation
  • 20.

    Takahashi S, , Hoshino F, & Uemura K, et al: Accessory middle cerebral artery: is it a variant form of the recurrent artery of Heubner? AJNR 10:563568, 1989 Takahashi S, Hoshino F, Uemura K, et al: Accessory middle cerebral artery: is it a variant form of the recurrent artery of Heubner? AJNR 10:563–568, 1989

    • Search Google Scholar
    • Export Citation
  • 21.

    Teal JS, , Rumbaugh CL, & Bergeron RT, et al: Anomalies of the middle cerebral artery: accessory artery, duplication, and early bifurcation. AJR 118:567575, 1973 Teal JS, Rumbaugh CL, Bergeron RT, et al: Anomalies of the middle cerebral artery: accessory artery, duplication, and early bifurcation. AJR 118:567–575, 1973

    • Search Google Scholar
    • Export Citation
  • 22.

    Türe U, , Yaşargil MG, & Al-Mefty O, et al: Arteries of the insula. J Neurosurg 92:676687, 2000 Türe U, Yaşargil MG, Al-Mefty O, et al: Arteries of the insula. J Neurosurg 92:676–687, 2000

    • Search Google Scholar
    • Export Citation
  • 23.

    Uchino A, , Kato A, & Takase Y, et al: Middle cerebral artery variations detected by magnetic resonance angiography. Eur Radiol 10:560563, 2000 Uchino A, Kato A, Takase Y, et al: Middle cerebral artery variations detected by magnetic resonance angiography. Eur Radiol 10:560–563, 2000

    • Search Google Scholar
    • Export Citation
  • 24.

    Umansky F, , Dujovny M, & Ausman JI, et al: Anomalies and variations of the middle cerebral artery: a microanatomical study. Neurosurgery 22:10231027, 1988 Umansky F, Dujovny M, Ausman JI, et al: Anomalies and variations of the middle cerebral artery: a microanatomical study. Neurosurgery 22:1023–1027, 1988

    • Search Google Scholar
    • Export Citation
  • 25.

    Umansky F, , Gomes FB, & Dujovny M, et al: The perforating branches of the middle cerebral artery. A microanatomical study. J Neurosurg 62:261268, 1985 Umansky F, Gomes FB, Dujovny M, et al: The perforating branches of the middle cerebral artery. A microanatomical study. J Neurosurg 62:261–268, 1985

    • Search Google Scholar
    • Export Citation
  • 26.

    Umansky F, , Juarez SM, & Dujovny M, et al: Microsurgical anatomy of the proximal segments of the middle cerebral artery. J Neurosurg 61:458467, 1984 Umansky F, Juarez SM, Dujovny M, et al: Microsurgical anatomy of the proximal segments of the middle cerebral artery. J Neurosurg 61:458–467, 1984

    • Search Google Scholar
    • Export Citation
  • 27.

    Waddington MM (ed): Atlas of Cerebral Angiography With Anatomic Correlation. Boston: Little, Brown & Co, 1974 Waddington MM (ed): Atlas of Cerebral Angiography With Anatomic Correlation. Boston: Little, Brown & Co, 1974

    • Search Google Scholar
    • Export Citation
  • 28.

    Waddington MM: Intraluminal diameters of middle cerebral branches for microanastomoses. Neurol Res 1:6576, 1979 Waddington MM: Intraluminal diameters of middle cerebral branches for microanastomoses. Neurol Res 1:65–76, 1979

    • Search Google Scholar
    • Export Citation
  • 29.

    Warwick R, & Williams PL (eds): Gray's Anatomy, ed 35. Philadelphia: WB Saunders, 1973 Warwick R, Williams PL (eds): Gray's Anatomy, ed 35. Philadelphia: WB Saunders, 1973

    • Search Google Scholar
    • Export Citation
  • 30.

    Wen HT, , Rhoton AL Jr, & de Oliveira E, et al: Microsurgical anatomy of the temporal lobe: part 1: mesial temporal lobe anatomy and its vascular relationships as applied to amygdalohippocampectomy. Neurosurgery 45:549592, 1999 Wen HT, Rhoton AL Jr, de Oliveira E, et al: Microsurgical anatomy of the temporal lobe: part 1: mesial temporal lobe anatomy and its vascular relationships as applied to amygdalohippocampectomy. Neurosurgery 45:549–592, 1999

    • Search Google Scholar
    • Export Citation
  • 31.

    Williams PL: Gray's Anatomy, ed 38. London: Chuchill Livingstone, 1995 Williams PL: Gray's Anatomy, ed 38. London: Chuchill Livingstone, 1995

    • Search Google Scholar
    • Export Citation
  • 32.

    Yaşargil MG: Microneurosurgery: In 4 Volumes. Stuttgart: Georg Thieme Verlag, 1984, Vol I Yaşargil MG: Microneurosurgery: In 4 Volumes. Stuttgart: Georg Thieme Verlag, 1984, Vol I

    • Search Google Scholar
    • Export Citation
  • 33.

    Yaşargil MG: Microneurosurgery: In 4 Volumes. Stuttgart: Georg Thieme Verlag, 1984, Vol II Yaşargil MG: Microneurosurgery: In 4 Volumes. Stuttgart: Georg Thieme Verlag, 1984, Vol II

    • Search Google Scholar
    • Export Citation

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