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

Abstract

The middle cerebral artery (MCA) is the largest and most complex of cerebral arteries because the cerebral neocortex is significantly developed in humans [1,2]. The MCA covers a large part of the cerebral hemispheres; therefore, it is exposed during surgical intervention in that area. Aspects of the cerebral branches tend to vary, and different branching patterns can be described. In the past, surgical interest in the MCA has been directed at avoiding damage to its branches during surgery performed within its territory. Microsurgical techniques have made reconstruction and bypass to the MCA, surgical approaches to MCA aneurysms and resection of arteriovenous malformations (AVMs) related to MCA branches common procedures in vascular neurosurgery. The vascular territory of the MCA includes some of the most eloquent cortical areas for motor and sensory functions. That territory encompasses the receptive and expressive components of language, abstract thought and other faculties of higher cognitive functioning. Moreover, the perforating branches of the proximal MCA supply the basal ganglia and important descending and corticospinal tracts. Anatomical variations of the MCA have to be recognised when planning interventions in order to avoid damage or occlusion of the perforating vessels that arise from the MCA and to assess their contribution to the perfusion of the deep MCA territory. Descriptions of the origins and possible common trunks of the MCA branches are still lacking in the literature. While bifurcation and trifurcation types of MCA branching are usually described, most studies fail to mention the different subtypes. Moreover, there is still some confusion about the criteria used to determine the different branching subtypes. Thus, the present study aimed to review the neuroangiography patterns of the MCA.