Microsurgical anatomy of the middle cerebral artery

Pai, S. Balaji; Varma, RG; Kulkarni, RN

doi:10.4103/0028-3886.16406

Cited by 54 publications

(60 citation statements)

References 3 publications

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“…Some of the cortical branches maybe absent and the adjacent branches may share the blood flow. [21] Our study of insular segment of middle cerebral artery differs from other studies mainly in the pattern of division of main trunk into secondary trunks and in variations in origin of cortical branches from secondary trunks. Though trifurcation and even tetrafurcation is reported earlier in many studies, not a single case of true trifurcation was found in our study.…”

Section: Branchcontrasting

confidence: 61%

A Study of Insular Segment of Middle Cerebral Artery in Northern India

Das¹,

Pankaj²,

Jahan³

2016

jemds

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The microsurgical anatomy of middle cerebral artery is of particular interest to the cerebrovascular surgeons as it supplies most of the superolateral surface of cerebral hemispheres and is the most commonly involved artery in stroke. The insular segment (M2 segment) begins at the limen insulae and runs on the surface of the insula in the sylvian insular cistern with a superoposterior direction. The M2 segment consists of two or three branches that arise from the bifurcation or trifurcation of the M1. After reaching the top of the insula, these branches turn inferolaterally and exit from the sylvian insular cistern forming the M3 segment. OBJECTIVECertain clinical conditions like aneurysms and glioma of the M2 segment aneurysms demands special attention due to vascular complexity of the insular area and peculiar clinical characteristics. The present study was carried out for a better understanding and to define further the microsurgical anatomy of the insular segment of middle cerebral artery hoping to find immediate application of our findings in the field of microsurgical cerebral revascularisation and better interpretation of radiological angiographic investigations performed in cases of young cerebral haemorrhages. The present study also elaborates the directly observed dissection findings rather than the other studies, which are mostly based on radiological findings. MATERIALS AND METHODSTotal 20 Middle Cerebral Arteries (MCA) were studied obtained from 10 brains. Meticulous dissection was done and middle cerebral artery and its branches were exposed and cleaned in lateral sulcus on the inferior surface of brain. Digital photographs were taken. The number of samples was based on the availability of cadavers in the mentioned institute during the time of study. RESULTIn all 20 MCAs, bifurcation was noted. In 15 out of 20 specimens, more than one major cortical branch was given by M1 segment before its division into secondary trunks at insula. No trifurcation was found. CONCLUSIONSome structural and statistical variations were noted in our study as in origin of major cortical branches before bifurcation in 75% of cases and this knowledge will be helpful to neurosurgeons operating in insular area. KEYWORDSMiddle Cerebral Artery, M1 Segment, M2 Segment, Cerebral Revascularisation. HOW TO CITE THIS ARTICLE:Das M, Pankaj P, Jahan S. A study of insular segment of middle cerebral artery in northern India.

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Section: Branchcontrasting

confidence: 61%

A Study of Insular Segment of Middle Cerebral Artery in Northern India

Das¹,

Pankaj²,

Jahan³

2016

jemds

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“…It can be considered the terminal branch of the ICA 7. During the first weeks of fetal life, when the embryo is 7–12 mm long, lateral striate arteries arise from its wall and provide blood supply to embryonic structures of the telencephalic vesicle that eventually become the MCA territory.…”

Section: Review Of Anatomy and Embryologymentioning

confidence: 99%

“…These perforators may arise as multiple single small vessels from the parent artery or from a common larger trunk or take over each other's territory. The MCA typically gives rise to the medial and lateral lenticulostriate artery groups 7 9. These groups can be interconnected and form a rete (the most prominent example of which is the fenestration of the M1).…”

Section: Review Of Anatomy and Embryologymentioning

confidence: 99%

What constitutes the M1 segment of the middle cerebral artery?

Goyal

Menon

Krings

et al. 2016

J NeuroIntervent Surg

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Intravenous tissue plasminogen activator has limited efficacy in fibrinolysis of large proximal intracranial thrombi. Thus, recent endovascular acute stroke trials restricted their selection criteria to patients with proximal occlusions in the anterior circulation. Although the terminal internal carotid artery occlusion is relatively easy to identify, there is often a debate as to what constitutes a proximal (involving the M1 segment) versus a distal (involving the M2 segment and beyond) middle cerebral artery occlusion. In light of overwhelming evidence demonstrating superiority of endovascular treatment in patients with proximal occlusion, this distinction has significant practical implications in patient selection. Here we present a brief review of the proximal (M1) segment of the middle cerebral artery anatomy and provide practical methods to recognize and separate the M1 and M2 segments. In keeping with the belief that CT angiography (CTA) (preferably multiphase CTA) is the ideal screening test for patients with emergent large vessel occlusion, we have provided tips for expeditious and accurate vascular imaging interpretation.

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“…Microanatomic studies showed that the variation in length of the M1 segment alone is between 12 and 20 mm and 3–11 lenticulostriate vessels arise along the course of the M1 segment, while the M2 segment is even longer 11. In the aforementioned trials, patients with an M1 and M2 occlusion were included.…”

Section: Introductionmentioning

confidence: 99%