Review on the anatomy of the middle cerebral artery; cortical branches, branching pattern and anomalies

Abstract

The middle cerebral artery (MCA) covers a large part of the cerebral hemispheres and is therefore exposed during surgical intervention in this area. Aspects of cerebral branches tend to vary, different branching patterns can be described, and several anomalies can be observed. Knowledge of these variations and anomalies is important and can be helpful to neurosurgeons and clinicians. The aim of this manuscript was to review the available literature on the cortical branches, branching pattern and anomalies of the MCA, to identify the gaps in the literature, and to fill these gaps by including the results of a pilot study. Twenty hemispheres were perfused with colored silicone and the MCA was dissected. For the cortical branches, the diameter, length, presence, duplication and origins were noted. Most commonly duplicated was the anterior parietal artery in 30.0%, and most commonly absent was the common temporal artery in 65.0%. A detailed description on the origins is given. Criteria were described for the bifurcation subtypes and medial bifurcation (50.0%) was most commonly observed. No anomalies were observed. Aspects previously neglected of the MCA cortical branches were reported in the pilot study. The branching subtypes were identified and criteria are given. Illustrations of the different branching subtypes and anomalies are provided. Certain aspects of the MCA anatomy have been neglected, and future studies should give adequate descriptions of the MCA cortical branches, MCA branching pattern, and any anomalies observed.

Neuroangiography patterns of the middle cerebral artery: Study of 554 cerebral angiography results

“…This result is also similar to the findings reported by Harrigan et al, which stated that the average M1 segment is 16 mm long [8]. Grellier et al reported that the main trunk could be short (3-12 mm), medium (13-22 mm) or long (23-40 mm) [6]. To the best of our knowledge, the percentages associated with this classification have never been published.…”

“…The MCAs were grouped into 11 branching patterns: (1) monofurcation, (2) tetrafurcation, (3) pseudotetrafurcation, (4) medial bifurcation, (5) lateral bifurcation, (6) medial pesudobifurcation, (7) lateral pseudobifurcation, (8) true trifurcation, (9) pseudotrifurcation, (10) proximal trifurcation and (11) distal trifurcation ( Fig. 1) [6].…”

Anatomical variations of anterior circulation in the brains of patients with and without intracranial aneurysm

“…However, we found no relationship between the presence of aneurysm and accessory MCA. The second most common variation of MCA was duplicated MCA which was present in 0.3% to 7.1% of cases in the literature (15). In our study, 3% of all subjects had duplicated MCA and this variation did not differ between groups with and without aneurysm.…”

“…Vascular variations are more frequently seen in other cerebral arteries than in the MCA, including duplicated MCA, accessory MCA, early branching of middle cerebral arteries and fenestrations (15). The accessory MCA arises from the A1 segment of the ACA (15,16).…”

“…The accessory MCA arises from the A1 segment of the ACA (15,16). The duplicated MCA usually supplies the temporal lobe (15,17).…”