Accessory Middle Cerebral Artery Research Articles

Triplicated middle cerebral arteries (duplicated and ipsilateral accessory) associated with triplicated anterior cerebral arteries (accessory) diagnosed by magnetic resonance angiography.

To describe a case of duplicated middle cerebral artery (MCA) combined with ipsilateral accessory MCA, forming a triplicated MCA, associated with the accessory anterior cerebral artery (ACA), forming a triplicated A2 segment of the ACA detected incidentally on magnetic resonance (MR) angiography. A 70-year-old woman with internal carotid artery (ICA) stenosis at the origin, which was detected by ultrasound, underwent cranial MR imaging and MR angiography of the intracranial region for an evaluation of brain and cerebral arterial lesions. The MR machine was a 3-Tesla scanner. MR angiography was performed using a standard 3-dimensional time-of-flight technique. Multiple ischemic white matter lesions are observed. No significant stenotic lesions were observed in intracranial arteries. The right duplicated MCA was originated from right distal ICA. And main MCA was originated from right ICA bifurcation. Right accessory MCA was arisen from the A2 segment of the right ACA. Thus, the right MCA was triplicated. There was also an accessory ACA forming a triplicated ACA at its A2 segment. These findings were clearly identified on partial volume-rendering (VR) images. We herein report a case of triplicated MCA associated with triplicated ACA. MCA variations are relatively rare, and this is the third case of triplicated MCA reported in relevant English-language literature. To identify multiple cerebral arterial variations, creating partial VR images using MR angiographic source images is useful.

Twig-like Middle Cerebral Artery: Case Series in a European Population

Twig-like middle cerebral artery (MCA) is a rare anomaly where the M1 MCA is partially or completely replaced by a plexiform network. It has been described in angiographic series from Asian and South-American cohorts, but has not yet been reported in a European population. The digital subtraction angiograms (DSA) of adult patients referred to a single neurovascular center for a diagnostic hypothesis of Moyamoya arteriopathy (MMA) from 2018 to 2023, were prospectively and retrospectively checked by experienced neuroradiologists for identifying patients with twig-like MCA. The angioarchitecture of twig-like MCA was systematically evaluated and described. 5/30 (16.7%) male patients (mean age 55.8 + 14.7 years) of European ancestry were identified as twig-like MCA. The clinical presentations were ischemic stroke (2/5), hemorrhagic stroke (1/5), and headache (2/5). All patients showed a unilateral involvement on DSA and in 1/5 (20%) an intracranial aneurysm was found. DSA was used to confirm the diagnosis of twig-like MCA and define the angioarchitecture and associated anomalies. An accessory MCA and recurrent artery of Heubner (RAH) were found in 3/5 (60%) cases, feeding the network together with the anterior choroidal artery (4/5, 80%). Twig-like MCA is a rare vascular anomaly, but it seems to be less rare than expected among adult European patients with suspected MMA on noninvasive neuroimaging studies. DSA is fundamental for a reliable differential diagnosis and should not be omitted in these patients.

Fenestrated Anterior Cerebral Artery, Anterior Communicating Artery, with Accessory Middle Cerebral Artery—A Conglomeration of Embryologically Different Entities in a Single Individual

Cerebral arterial fenestrations are anatomic variants of undetermined significance where there is a division of a single vessel into at least 2 channels, each having endothelial and muscular layers, that coalesce to a single lumen in the distal course of the vessel. The basilar artery is the most common site, followed by the anterior communicating artery. The accessory middle cerebral artery is defined as the anomalous origin of the vessel from the anterior cerebral artery and its further course along the sylvian fissure parallel to the middle cerebral artery. The embryologic basis of all these has been explained by studies on human embryological development by Padget et al. However, simultaneous existence of all 3 anomalies in a single individual has never been reported. Here we present a case of medial sphenoid wing meningioma with these incidental findings during workup and further delineation of anatomy following surgical resection of meningioma.

Variations in branching pattern of middle cerebral artery using CT angiography in South Indian population

Middle cerebral artery (MCA) variants are rare compared to that of the other two cerebral arteries. Incidence of variations like duplication, fenestration, accessory vessel and early branching ranges from 0.17 to 4%. However, the literature describing MCA variations using CT Angiography (CTA) is limited, so this study was planned to determine the incidence of MCA branching pattern in Indian population using CTA. Datasets of CTA of 578 MCA from 289 patients (180 males and 109 females), with average age of 49.29±16.16 years (range of 11 to 85 years), from a tertiary care hospital were systematically reviewed for variations in branching pattern. Cases involving aneurysms and infarcts were excluded from the study. Four branching patterns of MCA were seen. Pattern I: single trunk in 0.17% (1/578) cases, on left side. Pattern II: early bifurcation in 0.52% (2/578) cases, two cases on right and one on left side. Pattern III: bifurcation, in 97.75%, (565/578) cases, 46.15% (6/13) cases on right and 53.84% (7/13) on left side. Pattern IV: trifurcation, in 1% (6/578), two cases on right and four on left side. Duplicated MCA seen in 0.34% (2/578) cases, both on the right side. The fenestration of MCA seen in 0.17% (1/578), on the left side. No case of accessory MCA was seen. Awareness of these anatomical variations in the branching pattern of MCA is valuable for clinicians and surgeons handling cases of intracranial aneurysms and infarcts. Thus, data from this study would help surgeons minimize errors and provide the best possible outcome to the patients

Anomalous origin of a middle cerebral artery from anterior cerebral artery with no association to an accessory or duplicated middle cerebral artery

The middle cerebral artery (MCA) is one of the major paired intracranial arteries involved in the formation of the circle of Willis. MCA is the most complex of the intracranial arteries mainly because it supplies the cerebral neocortex, which has been significantly developed in humans. The MCA is a recent phylogenetic acquisition and can be considered as a collateral branch of the anterior cerebral artery (ACA). Anomalies of the middle cerebral artery are less commonly reported than other intracranial arteries. Previously, described anomalies include accessory MCA, duplicated MCA, fenestration of MCA and variations of the branching patterns. Recently, several reports have been published describing unfused or twig-like MCA, in which the single MCA trunk is substituted by a collateral plexiform arterial network. This manuscript would like to report our unique case of an anomalous MCA origin from the anterior cerebral artery unassociated with duplication or accessory MCA.

A Case of Hemichorea-Hemiballism Following a Cortical Stroke from Occlusion of an Anomalous Accessory Middle Cerebral Artery (P3-10.003)

A Case of Hemichorea-Hemiballism Following a Cortical Stroke from Occlusion of an Anomalous Accessory Middle Cerebral Artery (P3-10.003)

Accessory Middle Cerebral Artery Originating from the Posterior Circulation, Presenting with an Occult Ruptured Cerebral Aneurysm: a Case Report—Management of Atypical Subarachnoid Haemorrhage Cases with Rare Vascular Variations

Accessory Middle Cerebral Artery Originating from the Posterior Circulation, Presenting with an Occult Ruptured Cerebral Aneurysm: a Case Report—Management of Atypical Subarachnoid Haemorrhage Cases with Rare Vascular Variations

Unruptured aneurysm arising from fenestrated anterior cerebral artery, associated with accessory anterior cerebral artery and accessory middle cerebral artery, with a quasi-moyamoya disease of neurofibromatosis type 1: case report

Unruptured aneurysm arising from fenestrated anterior cerebral artery, associated with accessory anterior cerebral artery and accessory middle cerebral artery, with a quasi-moyamoya disease of neurofibromatosis type 1: case report

Type 4 persistent primitive olfactory artery associated with contralateral accessory middle cerebral artery arising from the fenestrated segment of the distal anterior cerebral artery

Persistent primitive olfactory artery (PPOA) is a rare variation of the proximal anterior cerebral artery (ACA) that generally follows an extreme anteroinferior course and takes a hairpin turn before continuing to the A2 segment of the ACA (type 1). There are four other types of extremely rare variations. The type 4 variation continues to the accessory middle cerebral artery (MCA) instead of the ACA. Only a few cases have been reported. We herein report a case of type 4 PPOA in which the contralateral side of the accessory MCA arose from the fenestrated segment of the distal ACA. No similar cases were found in the relevant English-language literature. For the identification of these variations on MR angiography, volume-rendering images were superior to maximum-intensity-projection images.

Embryology and variations of the recurrent artery of Heubner.

The recurrent artery of Heubner (RAH) is a very fascinating artery for various reasons. The first one is its early development in the embryologic and phylogenic life. The second one is the discrepancy between its diameter and its functional importance and the last but not least reason is the many variations of origin and course of this artery. For more than a century, numerous studies furnished important information about variations in origin, course, and parenchymal territory of the RAH. The most important anomaly concerning the RAH is the accessory middle cerebral artery and well-illustrates the complexity of its embryologic development. For these reasons, authors provide a review of anatomical variations of this artery that could be encountered with a particular attention given to the history and embryological knowledge.

Acute middle cerebral artery stroke in a patient with a patent middle cerebral artery.

Knowledge of cerebrovascular anatomical variants is vital for clinicians working with patients presenting with signs and symptoms of cerebral infarction, particularly in the era of endovascular clot retrieval. We provide an overview of a cerebrovascular anatomical variation and detail a patient presenting with cerebral infarction secondary to occlusion of their anomalous vessel who underwent successful endovascular clot retrieval with excellent functional outcome. We also include technical descriptions. Given the clinical importance of the areas supplied by the accessory middle cerebral artery, knowledge of this vessel is not only important for diagnosis but also for neurosurgical or endovascular management of patients with this variant.

Hybrid surgery for an arteriovenous malformation fed by an accessory middle cerebral artery and drained by a developmental venous anomaly: A case report and literature review.

An accessory middle cerebral artery (AMCA), which mainly acts in the collateral circulation of the middle cerebral artery (MCA), is a rare anatomic malformation. Similar to other intracranial vessels, cerebrovascular disease can occur in the AMCA. However, the development of an arteriovenous malformation (AVM) in the AMCA is very rare, especially in conjuction with developmental venous anomalies (DVAs). Here, a rare case of an AMCA combined with an AVM and a DVA was reported. The patient was a 47-year-old female with intracranial hemorrhage at symptom onset. CT and MRI showed lesions in the left Sylvian fissure and insula accompanied by hemorrhage. DSA suggested a left AMCA; an AVM of the AMCA was located in the deep Sylvian fissure. The AVM was diffusely developed and drained into the DVA. The operation was performed in a hybrid operating room. The major feeding artery of the AVM, which was derived from the AMCA, was clipped, then the AVM and DVA were subsequently removed. Intraoperative DSA showed that the AVM and DVA were radically removed. A pathological examination confirmed the presence of an AVM. The patient recovered well and was discharged. Therefore, as highlighted in this case report, rare AVMs can be found in AMCAs and can even occur simultaneously with a DVA. Hybrid surgical treatment can be used to remove AVMs and can lead to an improved prognosis.

Duplicated middle cerebral artery origin with an aneurysm

Rationale:Middle cerebral artery (MCA) anomalies are relatively rare and often related to aneurysms. Familiarity with these anomalies is important in resolving problems that arise in the complex angioarchitecture. Reports often describe that aneurysms that are related to accessory or duplicated MCA are often located at its origin.Patient concerns:A 59-year-old man presented with a headache for 10 days, without nausea and vomiting. The physical examination was negative.Diagnosis:A computed tomography (CT) scan revealed an intracerebral hematoma in the deep right frontal lobe, near the caudate nucleus. Digital subtraction angiography (DSA) revealed an anomalous duplicated origin of the right MCA, with occlusion of the main MCA trunk as well as twisting and dilation of the accessory MCA trunk. A wide-necked aneurysm was located at a sharp curve of the tortuous accessory MCA trunk. A ruptured aneurysm related to a duplicated MCA origin was diagnosed.Interventions:Open surgery was rejected by the patient; hence, palliative endovascular coil embolization of the larger daughter sac was performed.Outcomes:The postoperative course was uneventful. There was no rebleeding at 8-months follow-up.Lessons:MCA anomalies are relatively rare and often related to aneurysms. It is important to be familiar with these anomalies as related lesions often manifest within a complex angioarchitecture. Aneurysms at the trunk of an anomalous MCA are a rare entity and open surgery may be recommended.

Accessory middle cerebral artery: An uncommon finding.

Accessory middle cerebral artery: An uncommon finding.

Anomalies of the Middle Cerebral Artery

There are several anomalies of the middle cerebral artery (MCA) in humans, such as accessory MCA, duplicated MCA, fenestration of MCA, and duplicated origin of MCA. Recently, unfused or twig-like MCA, which indicates MCA trunk occlusion with collateral plexiform arterial network, have been reported. During the embryonic stage, MCA is thought to generate from plexiform arterial twigs arising from the anterior cerebral artery, and these twigs form the definitive MCA by fusion and regression at the end of the development stage. Any interruption during the fusion of the arterial twigs may result in MCA anomalies, and the unfused or twig-like MCA, especially, is hypothesized to be the persistent primitive arterial twigs. Clinically, it is challenging to differentiate the unfused or twig-like MCA from unilateral moyamoya disease, in which stenotic change begins at the MCA. The knowledge of the anomalies of the MCA is important to perform a safe surgical or endovascular intervention.

Anastomosis between accessory middle cerebral artery and middle cerebral artery diagnosed by magnetic resonance angiography.

The accessory middle cerebral artery (MCA) is a common variation of the MCA that arises from the anterior cerebral artery. We report a patient with anastomosis of the accessory MCA with the main MCA, an extremely rare variant that we diagnosed by magnetic resonance (MR) angiography. Both partial maximum-intensity-projection and partial volume-rendering MR angiographic images obtained at 3T are useful to identify such rare vascular variation.

前大脳動脈A1 部窓形成及び副中大脳動脈に関連した破裂脳動脈瘤に対してコイル塞栓術を施行した1 例

前大脳動脈A1 部窓形成及び副中大脳動脈に関連した破裂脳動脈瘤に対してコイル塞栓術を施行した1 例

Aneurysm Associated with an Accessory Middle Cerebral Artery

Aneurysm Associated with an Accessory Middle Cerebral Artery

副中大脳動脈を伴い診断に苦慮した脳梗塞の1例

副中大脳動脈を伴い診断に苦慮した脳梗塞の1例

副中大脳動脈起始部動脈瘤を合併したもやもや病の1 例

副中大脳動脈起始部動脈瘤を合併したもやもや病の1 例