Anatomy Of Middle Cerebral Artery Research Articles

Microsurgical Anatomy of Middle Cerebral Artery in Northwest Indian Population: A Cadaveric Brain Dissection Study

AbstractThe introduction of cadaveric dissection of cerebral vasculature as a part of the neurosurgical training module would help the neurosurgical residents to understand the complex neuroanatomy of the brain vasculature and help gain confdence during the surgical procedure.To the best of our knowledge microsurgical anatomical studies of theMCA have not been done among the Northwest Indian population. Anatomical variations of MCA that have not been described before may come in as a surprise during any surgical intervention. Hence, we intend to record the anatomical variations of the MCA anatomy and its implications in contemporary vascular surgery and neurosurgical practice. The objective of this work was to study and compare the microsurgical anatomy and variations of MCA in Northwest Indian cadavers with the available literature.

Endovascular treatment of middle cerebral artery aneurysms: current status and future prospects.

Middle cerebral artery (MCA) aneurysms are complex and widely distributed throughout the course of the MCA. Various types of aneurysms can occur in the MCA. Ruptured as well as unruptured MCA aneurysms may require treatment to avoid bleeding or rebleeding. Currently, clipping is regarded as the first-line choice for the treatment of MCA aneurysms. However, endovascular treatment (EVT) is emerging as an alternative treatment in selected cases. EVT techniques vary. Therefore, it is necessary to review EVT for MCA aneurysms. In this review, the following issues were discussed: MCA anatomy and anomalies, classifications of MCA aneurysms, the natural history of MCA aneurysms, EVT status and principle, deployments of traditional coiling techniques and flow diverters (FDs), and deployments and prospects of intrasaccular flow disruptors and stent-like devices. According to the review and our experience, traditional coiling EVT is still the preferred therapy for most MCA aneurysms. FD deployment can be used in selective MCA aneurysms. Parent artery occlusion (PAO) can be used to treat distal MCA aneurysms. In addition, new devices can be used to treat MCA aneurysms, such as intrasaccular flow disruptors and stent-like devices. In general, EVT is gaining popularity as an alternative treatment option; however, there is still a lack of evidence regarding EVT, and longer-term data are not currently available for most EVT devices.

Study of Microsurgical Anatomy of Middle Cerebral Artery in Human Cadaveric Brain

ABSTRACT Background: Micro-dissection of cadaver specimens is the base, on which our knowledge of the intricate anatomy of the human brain. Microsurgical anatomy of middle cerebral artery (MCA) is of particulate interest to neurosurgeons as it is the largest and most complex arterial system of the brain. Although various studies have been done on MCA, no such study has been done taking into consideration large sample size of the Indian population. This study will be advantageous in improving knowledge of MCA and its variations. This will prove useful for neurosurgeons in performing microsurgeries. Objective: A study of the microsurgical anatomy of the MCA in human cadaveric brain; comparison of the findings with the existing studies and implication of these finding in micro-neurosurgical procedures. Materials and Methods: Sixteen formalin-fixed cadaveric brains, that is, 32 vessels from its origin from the internal cerebral artery to M1 segment with respect to diameter, length and branching pattern were studied under high magnification (operating microscope) and the data compared with literature. Results: The mean length of M1 was 24.1 ± 11 mm with the outer diameter of 3.1 ± 08 mm. An average number of perforators pre-bifurcation was 7 and post-bifurcation was 3. The pattern of branching of the main trunk was bifurcation (70%), trifurcation (20%) and tetrafurcation (10%), and amongst this, inferior trunk dominance was seen in 70%. An average number of early cortical branch was 3. Conclusion: The knowledge of anatomy of MCA and its variations is important for neurosurgical residents’ training and neurosurgeons dealing with MCA aneurysm management or bypass surgeries.

Microsurgical Anatomy of Middle Cerebral Artery in Northwest Indian Population: A Cadaveric Brain Dissection Study.

Background:Microsurgical anatomy of the Middle Cerebral Artery (MCA) of the Northwest Indian population has not been described to date. A study of cadaveric brains will add to the existing knowledge of brain vessels.Objective:To study and compare the microsurgical anatomy of MCA in Northwest Indian Population with that of the available literature.Methods and Material:15 Formalin Fixed Cadaveric brains, that is 30 vessels from its origin from Internal Cerebral Artery to M5 segment with respect to diameter, length and branching pattern were studied under high magnification (operating microscope) and the data compared with literature.Results:The main trunk of MCA was 16±3 mm long with no significant differences between both sides. Its outer diameter was 3±0.1 mm. Among the early branches 58% were destined to the temporal lobe. Distance between the origin of the early branch from MCA origin was 4±2mm on the right side and 4.5±2.5 mm on the left side. The most consistent perforating branch group was the intermediate group. The pattern of branching of the main trunk was bifurcation (73%), single trunk (10%) and trifurcation (10%). Within the bifurcation group, inferior trunk dominance was seen in 50%. Amongst the cortical branches diameter of the angular artery was largest and the temporo-polar was smallest. No significant difference in the data as compared to literature.Conclusions:The knowledge of anatomy of MCA and its variations are important for neurosurgical residents' training and neurosurgeons dealing with MCA aneurysm management or bypass surgeries.

Feasibility and efficacy of coil embolization for middle cerebral artery aneurysms.

BackgroundThe anatomy of middle cerebral artery (MCA) aneurysms has been noted to be unfavorable for endovascular treatment. The purpose of this study was to assess the feasibility and efficacy of coiling for MCA aneurysms.MethodsFrom January 2004 to December 2015, 72 MCA aneurysms (38 unruptured and 34 ruptured) in 67 patients were treated with coils. Treatment-related complications, clinical outcomes, and immediate and follow-up angiographic outcomes were retrospectively analyzed. ResultsAneurysms were located at the MCA bifurcation (n=60), 1st segment (M1, n=8), and 2nd segment (M2, n=4). Sixty-nine aneurysms (95.8%) were treated by neck remodeling techniques using multi-catheter (n=44), balloon (n=14), stent (n=8), or combination of these (n=3). Only 3 aneurysms were treated by single-catheter technique. Angiographic results were 66 (91.7%) complete, 5 (6.9%) remnant neck, and 1 (1.4%) incomplete occlusion. Procedural complications included aneurysm rupture (n=1), asymptomatic coil migration to the distal vessel (n=1), and acute thromboembolism (n=10) consisting of 8 asymptomatic and 2 symptomatic events. Treatment-related permanent morbidity and mortality rates were 4.5% and 3.0%, respectively. There was no bleeding on clinical follow-up (mean, 29 months; range, 6-108 months). Follow-up angiographic results (mean, 26 months; range, 6-96 months) in patients included 1 major and 3 minor recanalizations.ConclusionCoiling of MCA aneurysms could be a technically feasible and clinically effective treatment strategy with acceptable angiographic and clinical outcomes. However, the safety and efficacy of this technique as compared to surgical clipping remains to be ascertained.

Relationship between middle cerebral parent artery asymmetry and middle cerebral artery aneurysm rupture risk factors.

The exact pathophysiological mechanisms underlying cerebral aneurysm formation remain unclear. Asymmetrical local vascular geometry may play a role in aneurysm formation and progression. The object of this study was to investigate the association between the geometric asymmetry of the middle cerebral artery (MCA) and the presence of MCA aneurysms and associated high-risk features. Using a retrospective case-control study design, the authors examined MCA anatomy in all patients who had been diagnosed with an MCA aneurysm in the period from 2008 to 2017 at the University Hospitals Cleveland Medical Center. Geometric features of the MCA ipsilateral to MCA aneurysms were compared with those of the unaffected contralateral side (secondary control group). Then, MCA geometry was compared between patients with MCA aneurysms and patients who had undergone CTA for suspected vascular pathology but were ultimately found to have normal intracranial vasculature (primary control group). Parent vessel and aneurysm morphological parameters were measured, calculated, and compared between case and control groups. Associations between geometric parameters and high-risk aneurysm features were identified. The authors included 247 patients (158 cases and 89 controls) in the study. The aneurysm study group consisted of significantly more women and smokers than the primary control group. Patients with MCA bifurcation aneurysms had lower parent artery inflow angles (p = 0.01), lower parent artery tortuosity (p < 0.01), longer parent artery total length (p = 0.03), and a significantly greater length difference between ipsilateral and contralateral prebifurcation MCAs (p < 0.01) than those in primary controls. Type 2 MCA aneurysms (n = 89) were more likely to be associated with dome irregularity or a daughter sac and were more likely to have a higher cumulative total of high-risk features than type 1 MCA aneurysms (n = 69). Data in this study demonstrated that a greater degree of parent artery asymmetry for MCA aneurysms is associated with high-risk features. The authors also found that the presence of a long and less tortuous parent artery upstream of an MCA aneurysm is a common phenotype that is associated with a higher risk profile. The aneurysm parameters are easily measurable and are novel radiographic biomarkers for aneurysm risk assessment.

Middle cerebral artery anatomical variations and aneurysms: a retrospective study based on computed tomography angiography findings.

Anatomical variations of the middle cerebral artery (MCA) are an important clinical issue, due to high prevalence of intracranial aneurysms. Anatomical variations of vessels can lead to higher shear stress, which is thought to be the main factor leading to aneurysm formation and consequently to higher prevalence of aneurysms. The aim of this study was to evaluate anatomy of the MCA; to classify MCA aneurysms using computed tomography angiography and to correlate anatomical variations of MCA and circle of Willis with prevalence of MCA aneurysms. Two hundred and fifty patients without MCA aneurysms and 100 patients with unruptured MCA aneurysms were qualified for the study, with exclusion of patients after MCA clipping. Four aspects of MCA anatomy were evaluated: division point, its relation to the genu, distance to M1 division and the genu and domination of post-division trunks. Middle cerebral artery bifurcation was found in 86.2% and trifurcation in 13.8% of the cases. 78.4% of MCAs divided before the genu, 19.2% in the genu and 2.4% after the genu. Upper branch domination was seen in 26%, lower branch in 25.4%, middle branch in 4% and no domination in 44.6% of the cases. In the study group 116 aneurysms were found. 86.2% of the aneurysms were located in M1 division point, 6.9% in M2 segment, 3.4% near lenticulostriatae arteries and 3.4% near early cortical branches. The only anatomical variation, which had significantly higher prevalence in patients with left MCA aneurysms, was domination of upper post-division trunk of MCA. No other statistically significant differences in circle of Willis and MCA variations were found between patients with aneurysms and without them. The most common configuration of MCA is bifurcation before the genu with no dominating post-division trunk. Incidence of MCA aneurysms is not correlated with anatomical variations of MCA and the circle of Willis.

Anatomy of the Middle Cerebral Artery: Cortical Branches, Branching Pattern and Anomalies.

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.

The pREset Stent Retriever for Endovascular Treatment of Stroke Caused by MCA Occlusion: Safety and Clinical Outcome.

PurposeThe purpose of this study was to analyze the safety and efficacy of the pREset device, a stent retriever system, for endovascular mechanical thrombectomy (MT) in acute ischemic stroke (AIS) after middle cerebral artery (MCA) occlusion.MethodsRetrospectively, 48 consecutive patients (mean age ± standard deviation, 71.0 ± 11.9 years; 24 women) treated for acute MCA occlusion using pREset solely or in combination with other MT devices were identified. Recanalization success was evaluated using the modified thrombolysis in cerebral infarction score (TICI), and complications were detected by 24-h follow-up computed tomography or magnetic resonance imaging. MCA anatomy was assessed in angiograms. Clinical outcome was evaluated with National Institutes of Health Stroke Scale (NIHSS) score at admission and discharge, and modified Rankin scale (mRS) score at discharge and follow-up.ResultsSuccessful recanalization (TICI 2b/3) was achieved in 39 patients (81.3 %). Rate of procedure-related complications was 8.3 %. In four patients, a subarachnoid hemorrhage occurred (8.3 %), and parenchymal hematoma was detected in four patients (8.3 %). None of those events was associated with clinical deterioration. MCA curvature significantly influenced recanalization success (P < 0.005).Successful recanalization correlated significantly with lower NIHSS scores and favorable clinical outcome (mRS score 0–2) at discharge (P < 0.05). Mortality within 90 days was significantly lower in patients with TICI 2b/3 (P < 0.005).ConclusionsHigh recanalization rates, low complication rates, and a significantly improved outcome after successful recanalization strongly suggest that MT with pREset is an adequate therapy for AIS after MCA occlusion. Vessel curvature is a significant determining factor for recanalization success.

Differences between middle cerebral artery bifurcations with normal anatomy and those with aneurysms

The objectives of this study were to elucidate the normal anatomy of middle cerebral artery (MCA) bifurcations and to analyze the differences in patients with MCA aneurysms. In the present study, 62 patients underwent three-dimensional magnetic resonance angiography, and no intracranial lesions were noted. The widths of M1 and the superior and inferior M2 branches, as well as their respective lateral angles, were measured. These values were used to calculate the daughter artery ratio (DA ratio; width of larger M2/width of smaller M2) and the lateral angle ratio (LA ratio; lateral angle between M1 and larger M2/lateral angle between M1 and smaller M2). The DA and LA ratios of 54 MCA aneurysm patients (34 with ruptured aneurysms, 20 with unruptured aneurysms) were also calculated, using three-dimensional digital subtraction angiography, and compared with the normal values. In normal patients, the widths of M1 and the branches of M2, the lateral angles, and the LA and DA ratios were not significantly different between the right and left sides. The bilateral superior and inferior lateral angles of normal MCAs were significantly wider than those of MCAs with aneurysms. The DA ratio was 1.5 ± 0.4 in normal MCAs and 1.7 ± 0.7 in MCAs with aneurysms; this difference was significant (p < 0.05). The LA ratio was 1.3 ± 0.4 in normal MCAs and 2.1 ± 1.4 in MCAs with aneurysms; these values were also significantly different (p < 0.01). Normal cerebral artery bifurcations show close to symmetric structure in the M2 branches and the lateral angles, whereas aneurysmal MCAs do not show this symmetry.

The microdissection of middie cerebral artery and insula

Objective To have a intimate knowledge of the anatomy of middle cerebral artery(MCA)and insula,to explore the relationship between insular glioma and MCA surgery.Method Dissection and relative measurement were performed in the insular region of 10 adult cadaveric heads(20 hemispheres).Results The MCA's M2 looked like ablood vessel wall,overlaying on the insula.The timinal short performing arteries arose from the M2 segments supplied only the insula,however,the long perforating arteries on the posterior part of the insula,coursed towards the post angle of the insula,and entered the corona radiate.The most lateral lenticulostriate artery(LSAs),an important landmark in insular surgery,arose 15.68 mm from the apex of the insala and penetrated the anterior perforated substance 15.42 mm medial to the limen insulae.Conclusions To have a intimate knowledge of the anatomy of the MCA,make for the resection of the insular glioma,and reduce the complication caused by the injury of arteries. Key words: Middle cerebral artery; Insula; Glioma; Dissection

Middle cerebral artery anatomy and characteristics of embolic signals: a dual gate computer simulation study

In terms of microembolic signal (MES) detection, the anatomy of the middle cerebral artery (MCA) mainstem has only scarcely been considered. The vessel itself, however, could be at least partly responsible for the enormous variation when calculating the essential time difference (Δt) values of MES using the dual-gate technique. Therefore, we studied the time characteristics of MES in a computer simulation applying an anatomically realistic vessel and a dual-gate TCD approach. Three different MCA anatomies and two MES to blood intensities were simulated as well as two different sample volume settings. The MES length (proximal sample volume t 1; distal sample volume t 2) and Δt were calculated for different angles of insonation and sample volume depths. The calculations of the time characteristics of MES showed extreme variation, with only modest changes of the insonation angle (t 1 4–34 ms; Δt 9–27 ms) or the sample volume depth (t 1 7–27 ms; Δt 6–32 ms). The variation could be considerably reduced with modified TCD settings i.e., a shorter gate separation combined with a shorter receiver gate time in the distal sample volume (Δt with changing insonation angles 6–19 ms; Δt with changing insonation depths 13–17 ms). These results not only urge us to a cautious interpretation of the properties of single MES, but also contribute to an understanding of the marked Δt variation using the dual-gate technique.

Surgical Treatment of Middle Cerebral Artery Aneurysms

Middle cerebral artery (MCA) aneurysms account for approximately 20% of aneurysmal subarachnoid hemorrhage (SAH). An understanding of MCA anatomy and variations is the key to successful treatment of MCA aneurysms, which may occur on the M1 segment, at the division of the main trunk or on distal branches. Patients may present with SAH, mass effect, epilepsy, or ischemia. MCA aneurysms associated with large temporal hematomas may be approached through the superior temporal gyrus. Other aneurysms are best approached with a medial or lateral transSylvian approach.

Anatomic variation of the middle cerebral artery in the Sprague-Dawley rat.

The aim of this study was to record and analyze the anatomy of the middle cerebral artery in the rat in an attempt to identify a potential source of variation of quantitative infarct measurements in commonly used models of focal cerebral ischemia. Over a period of 22 months, as part of ongoing studies, we routinely induced focal cerebral ischemia in 263 Sprague-Dawley rats. This was achieved by permanent occlusion of a length of the right middle cerebral artery approximately 1 to 5 mm distal to the point at which it traverses the rhinal fissure combined with 60 minutes of bilateral common carotid occlusion. The branching pattern of the middle cerebral artery was recorded for each animal by drawing and photography before occlusion and at the time of death. Six distinct branching patterns were observed. The majority (82.9%) of middle cerebral arteries studied conformed to the typical bifurcating vessel commonly referred to in the literature. However, the remaining 17.1% were far more variable with major, atypical branching, introducing, we believe, unnecessary and avoidable variation into quantitative measurements of ischemia in this and similar models. Middle cerebral artery anatomy should be routinely recorded in models of focal cerebral ischemia in which this artery is occluded distal to the olfactory tract, thus allowing improved analysis of data.