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Uchino A, Kobayashi S. Combined duplicate origin and early bifurcated middle cerebral artery diagnosed by magnetic resonance angiography. Surg Radiol Anat 2024; 46:1359-1361. [PMID: 38832952 DOI: 10.1007/s00276-024-03403-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 05/27/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE To describe a case of combined duplicate origin and early bifurcated middle cerebral artery (MCA) incidentally diagnosed using magnetic resonance (MR) angiography. METHODS A 51-year-old woman with an unruptured left MCA aneurysm underwent cranial MR angiography with a 3-Tesla scanner for presurgical evaluation. MR angiography was performed using a standard 3-dimensional time-of-flight technique. RESULTS An unruptured left MCA aneurysm at the M1-M2 junction was identified. The maximum aneurysm diameter was 9 mm. Two almost equally sized right MCAs arose from the terminal segment of the right internal carotid artery. These two channels soon anastomosed, and the temporal branch arose from the inferior channel. The aneurysm was successfully treated with coil embolization. CONCLUSION We herein report a case of a combined duplicate origin and early bifurcated MCA. This variation can also be regarded as anastomosis between the main MCA and the duplicated MCA. This variation has been previously reported as segmental duplication of the MCA. This is the third case of this rare MCA variation reported in the relevant English-language literature. The term "segmental duplication" may be confused with duplicate origin of the MCA, in which only one artery is located distal to the fusion.
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Affiliation(s)
- Akira Uchino
- Department of Radiology, Saitama Sekishinkai Hospital, 2-37-20 Irumagawa, Sayama, Saitama, 350-1305, Japan.
| | - Satoshi Kobayashi
- Department of Neuroendovascular Therapy, Saitama Sekishinkai Hospital, 2-37-20 Irumagawa, Sayama, Saitama, 350-1305, Japan
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2
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Uchino A, Tokushige K. Triplicated middle cerebral arteries (duplicated and ipsilateral accessory) associated with triplicated anterior cerebral arteries (accessory) diagnosed by magnetic resonance angiography. Surg Radiol Anat 2024; 46:959-962. [PMID: 38743145 DOI: 10.1007/s00276-024-03380-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 05/02/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Akira Uchino
- Department of Radiology, Saitama Sekishinkai Hospital, 2-37-20 Irumagawa, Sayama, Saitama, 350-1305, Japan.
| | - Kazuo Tokushige
- Department of Neurosurgery, Saitama Sekishinkai Hospital, 2-37-20 Irumagawa, Sayama, Saitama, 350-1305, Japan
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Kashtiara A, Beldé S, Schollaert J, Menovsky T. Anatomical Variations and Anomalies of the Middle Cerebral Artery. World Neurosurg 2024; 183:e187-e200. [PMID: 38101539 DOI: 10.1016/j.wneu.2023.12.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/09/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE Intracranial arteries have a high rate of variation, but a clear schematic overview is lacking. In this pictorial review we classify and depict all the variations and anomalies within the middle cerebral artery (MCA). METHODS PubMed was searched with the MeSH-term "Middle Cerebral Artery." Articles were selected based on their description of variants within the MCA. Cross-referencing was used to broaden the range of articles. The anatomical variants were then schematically drawn using the anteroposterior and lateral view during angiography of the internal carotid artery. RESULTS A total of 29 unique medical illustrations were made, depicting variation in number of vessels; variation in vessel origin; and variation in morphology. CONCLUSIONS The MCA provides vital blood supply to the frontal, parietal, temporal, and central brain structures. An overview of these variations is important to diagnose and treat patients with MCA-related pathology correctly and safely. They can aid in distinguishing pathology from normal anatomical variance; aid neurosurgeons during aneurysmal clipping or arteriovenous malformation resections; and aid interventional radiologists during thrombectomy or coiling. This article provides a summary regarding current knowledge of anatomical variations within the MCA, their prevalence and clinical relevance. A total of 29 unique illustrations were made, depicting currently known variants. We encourage all who diagnose, treat, and study the MCA to use this overview for a uniform and better understanding of its anatomy.
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Affiliation(s)
- Ardavan Kashtiara
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium; Faculty of Medicine and Health sciences, University of Antwerp, Antwerp, Belgium.
| | - Sarah Beldé
- Faculty of Medicine and Health sciences, University of Antwerp, Antwerp, Belgium
| | - Joris Schollaert
- Faculty of Medicine and Health sciences, University of Antwerp, Antwerp, Belgium
| | - Tomas Menovsky
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium; Faculty of Medicine and Health sciences, University of Antwerp, Antwerp, Belgium; Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Uchino A, Irie T. Accessory posterior cerebral artery (hyperplastic anterior choroidal artery) associated with contralateral accessory middle cerebral artery incidentally diagnosed by magnetic resonance angiography. Surg Radiol Anat 2024; 46:313-316. [PMID: 38319360 DOI: 10.1007/s00276-024-03298-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/03/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE To describe a case of accessory posterior cerebral artery (PCA) [hyperplastic anterior choroidal artery (AChA)] associated with contralateral accessory middle cerebral artery (MCA) incidentally diagnosed by magnetic resonance (MR) angiography. METHODS A 71-year-old man with paroxysmal atrial fibrillation underwent cranial MR imaging and MR angiography of the intracranial region using a 1.5-T scanner for the evaluation of brain and vascular lesions. RESULTS On MR angiography, two right PCAs of equal size arose from the internal carotid artery instead of the basilar artery. Additionally, a small left MCA branch arose from the proximal A2 segment of the anterior cerebral artery (ACA). CONCLUSION One of the branches of the PCA rarely arises from the AChA. This variation is referred to as a hyperplastic AChA or accessory PCA. The latter name was recently proposed and may be more appropriate than the former name. An MCA branch arising from the ACA is called an accessory MCA. It is a frontal branch of two types: proximal-origin and distal-origin. The distal-origin accessory MCA arises from the distal A1 segment, A1-A2 junction or proximal A2 segment. Distal-origin accessory MCAs are rare. Our patient had two rare variations: an accessory right PCA and a distal-origin accessory left MCA. To identify cerebral arterial variations, especially accessory MCA, volume-rendering images are more useful than maximum-intensity projection images on MR angiography.
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Affiliation(s)
- Akira Uchino
- Department of Radiology, Saitama Sekishinkai Hospital, 2-37-20 Irumagawa, Sayama, Saitama, 350-1305, Japan.
| | - Tadanobu Irie
- Department of Cardiology, Saitama Sekishinkai Hospital, 2-37-20 Irumagawa, Sayama, Saitama, 350-1305, Japan
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Hosokawa M, Maeoka R, Nakagawa I, Nakase H, Ohnishi H. Mechanical thrombectomy in acute stroke for superior limb of the fenestration of the middle cerebral artery. Radiol Case Rep 2022; 17:1483-1486. [PMID: 35265245 PMCID: PMC8899108 DOI: 10.1016/j.radcr.2022.01.081] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Makoto Hosokawa
- Department of Neurosurgery, Ohnishi Neurologic Center, Akashi, Japan
| | - Ryosuke Maeoka
- Department of Neurosurgery, Ohnishi Neurologic Center, Akashi, Japan
- Department of Neurosurgery, Nara Medical University, Nara, Japan
- Corresponding author
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Hideyuki Ohnishi
- Department of Neurosurgery, Ohnishi Neurologic Center, Akashi, Japan
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Multiple cerebral arterial variations incidentally detected by magnetic resonance angiography: a case report. Surg Radiol Anat 2022; 44:411-414. [PMID: 35075568 DOI: 10.1007/s00276-022-02891-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
Abstract
We herein report a case of multiple variations, including (1) anterior communicating artery duplication, (2) accessory anterior cerebral artery (ACA), (3) distal origin right accessory middle cerebral artery (MCA) with bifurcation, (4) proximal origin left accessory MCA with bifurcation, (5) right superior cerebellar artery (SCA) duplication, and (6) left SCA early bifurcation. These variations were found incidentally by magnetic resonance (MR) angiography. Volume-rendering images of MR angiography were more useful than maximum-intensity-projection images for identifying these variations, especially bilateral accessory MCAs, which were superimposed with the A1 segment of the ACAs and the M1 segment of the MCAs.
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Liu X, Zheng X, Wang Y, Liu J. Dysregulation Serum miR-19a-3p is a Diagnostic Biomarker for Asymptomatic Carotid Artery Stenosis and a Promising Predictor of Cerebral Ischemia Events. Clin Appl Thromb Hemost 2021; 27:10760296211039287. [PMID: 34558328 PMCID: PMC8495512 DOI: 10.1177/10760296211039287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
This study aims to identify the diagnostic potential of microRNA-19a-3p (miR-19a-3p) for asymptomatic carotid artery stenosis (CAS) and clinical predictive potential for cerebral ischemia events (CIEs). Serum samples from 101 asymptomatic CAS patients and 98 healthy controls were collected. And it was found that serum miR-19a-3p in asymptomatic CAS patients was generally elevated (P < .05). Increased miR-19a-3p in asymptomatic CAS was associated with severe CAS (odds ratio = 3.920, 95% confidence interval [CI] = 1.482-10.372, P < .01). The area under the receiver operating characteristic (ROC) curve (AUC) was 0.905, indicating that the level of miR-19a-3p was statistically significant for the diagnosis of asymptomatic CAS. Furthermore, the level of serum miR-19a-3p (hazard ratio [HR] = 8.507, 95% confidence interval [CI] = 2.239-32.328, P = .002) and degree of artery stenosis (HR = 3.695, 95% CI = 1.127-12.109, P = .031) were independent predictors of occurrence of CIE. Moreover, patients with elevated miR-19a-3p levels were more likely to experience CIE than patients with low levels. Upregulated miR-19a-3p can be used as a diagnostic biomarker for asymptomatic CAS patients and as an independent predictor of CIE.
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Affiliation(s)
- Xiaoliang Liu
- Department of Neurology, Baoji People's Hospital, Baoji, Shaanxi, China
| | - Xiaojun Zheng
- Department of Neurology, Baoji People's Hospital, Baoji, Shaanxi, China
| | - Ying Wang
- Department of Neurology, Baoji People's Hospital, Baoji, Shaanxi, China
| | - Juan Liu
- Department of Neurology, Baoji People's Hospital, Baoji, Shaanxi, China
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8
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Uchino A, Ishihara S. Type 4 persistent primitive olfactory artery associated with contralateral accessory middle cerebral artery arising from the fenestrated segment of the distal anterior cerebral artery. Surg Radiol Anat 2021; 43:1951-1953. [PMID: 34480592 DOI: 10.1007/s00276-021-02831-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 08/30/2021] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Akira Uchino
- Department of Radiology, Saitama Sekishinkai Hospital, 2-37-20 Irumagawa Sayama, Saitama, 350-1305, Japan.
| | - Shoichiro Ishihara
- Department of Neuroendovascular Therapy, Saitama Sekishinkai Hospital, Saitama, Japan
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Stojanović NN, Kostić A, Mitić R, Berilažić L. Correlation between multiple cerebral aneurysms and a rare type of segmental duplication of the middle cerebral artery. BMC Neurol 2020; 20:3. [PMID: 31901227 PMCID: PMC6942665 DOI: 10.1186/s12883-019-1588-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 12/24/2019] [Indexed: 12/02/2022] Open
Abstract
Background Connection between the duplication of the middle cerebral artery (DMCA) and the presence of multiple aneurysms has been described in a small number of cases. Case presentation The presence of a rare type of DMCA associated with cerebral aneurysms was diagnosed in 56 year old woman after a rupture of an aneurysm on the dorsal segment of the DMCA. .. The presence of equal diameters of branches of the DMCA and anterior cerebral artery (ACA) could be recorded as trifurcation of the carotid internal artery (ICA). However, due to the anastomosis of the DMCA branches in the area of the M2 segment, the recorded anatomical change represented a segmental duplication of MCA. Three aneurysms that were directly related to the segmental DMCA were diagnosed. Conclusions Anatomical variation by type of segmental DMCA is a rare subtype of DMCA. The presence of multiple aneurysms associated with this type of anatomical variation in MCA indicates their high hemodynamic instability.
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10
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Hou K, Xu K, Liu H, Li G, Yu J. The Clinical Characteristics and Treatment Considerations for Intracranial Aneurysms Associated With Middle Cerebral Artery Anomalies: A Systematic Review. Front Neurol 2020; 11:564797. [PMID: 33193002 PMCID: PMC7654337 DOI: 10.3389/fneur.2020.564797] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/10/2020] [Indexed: 11/17/2022] Open
Abstract
Background: As a result of their low incidence, most of the studies on intracranial aneurysms associated with middle cerebral artery (MCA) anomalies were presented as case reports or small case series. No systematic review on this specific entity has been conducted. Methods: A PubMed search of the published studies was performed on April 6th, 2019 for patients who had intracranial aneurysms associated with MCA anomalies. The languages included in this study were English, Chinese, and Japanese. Results: Finally, 58 articles reporting of 67 patients including 1 case in our center were included. The identified patients (37 females, 55.2%) aged from 4 to 81 (49.85 ± 15.22) years old. 50 (50/67, 74.6%) patients presented with hemorrhagic stroke either from the MCA anomalies associated aneurysms or other sources. 63 aneurysms (63/67, 94.0%) were saccular, 3 (4.5%) were dissecting or fusiform, and 1 (1.5%) was pseudoaneurysm. 32 (32/65, 49.2%) patients had other concurrent cerebrovascular anomalies. 56 (83.6%) patients underwent open surgeries, 8 (11.9%) patients underwent endovascular treatment, and 3 (4.5%) patients were conservatively managed. 56 (56/61, 91.8%) patients achieved a good recovery. Conclusions: The pathophysiological genesis of intracranial aneurysms associated with MCA anomalies is still obscure. The inflicted patients tend to have other concurrent cerebrovascular anomalies, which denotes that congenital defect in cerebrovascular development might play a role in this process. Most of the affected patients could experience a good recovery after treatment.
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Affiliation(s)
- Kun Hou
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Kan Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Hongping Liu
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Guichen Li
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
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11
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Liu Y, Liu G, Yang D, Xu B. Application of Linear Gradient Magnetic Field in Arterial Profile Scanning Imaging. SENSORS 2020; 20:s20164547. [PMID: 32823785 PMCID: PMC7472423 DOI: 10.3390/s20164547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Cardiovascular and cerebrovascular diseases caused by arterial stenosis and sclerosis are the main causes of human death. Although there are mature diagnostic techniques in clinical practice, they are not suitable for early disease prediction and monitoring due to their high cost and complex operation. The purpose of this paper is to study the coupling effect of arterial blood flow and linear gradient magnetic field, and to propose a method for the reconstruction of the arterial profile, which will lay a theoretical foundation for new electromagnetic artery scanning imaging technology. Methods and Models: A combination coil composed of gradient coils and drive coils is applied as a magnetic field excitation source. By controlling the excitation current, a linearly gradient magnetic field with a line-shaped zero magnetic field is generated, and the zero magnetic field is driven to scan in a specific direction. According to the magnetoelectric effect of blood flow, under the action of the external magnetic field, the voltage signals on the body surface can be detected by measuring electrodes. The location of the artery center line can be determined by the time–space relationship between voltage signals and zero magnetic field scanning. In addition, based on the reciprocity theorem integral equation, a numerical model between the amplitude of the voltage signal and the arterial radius is derived to reconstruct the arterial radius. The above physical process was simulated in the finite element analysis software COMSOL, and the voltage signals obtained from the simulation verified the arterial profile reconstruction. Results: Through finite element simulation verification, the imaging method based on a linear gradient magnetic field has a numerical accuracy of 90% and a spatial resolution of 1 mm. Moreover, under 100 Hz low-frequency alternating current excitation, the single scanning time is 0.005 s, which is far shorter than the arterial blood flow change cycle, meeting the requirements of real-time imaging. The results demonstrate the effectiveness and high theoretical feasibility of the proposed method in real-time arterial imaging. Conclusions: This study indicates the potential application of linear gradient magnetic fields in arterial profile imaging. Compared with traditional electromagnetic imaging methods, the proposed method has the advantages of fast imaging speed and high resolution, showing the certain application value in early real-time imaging of arterial disease. However, further studies are necessary to confirm its effectiveness in clinical practice by more medical data and real cases.
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Affiliation(s)
- Yanjun Liu
- College of Information Science and Engineering, Northeastern University, Shenyang 110819, China;
- Institute of Electrical Engineering Chinese Academy of Sciences, Beijing 100190, China
| | - Guoqiang Liu
- Institute of Electrical Engineering Chinese Academy of Sciences, Beijing 100190, China
- School of Electronics, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing 100190, China
- Correspondence: (G.L.); (D.Y.)
| | - Dan Yang
- College of Information Science and Engineering, Northeastern University, Shenyang 110819, China;
- Key Laboratory of Data Analytics and Optimization for Smart Industry MOE, Northeastern University, Shenyang 110819, China
- Liaoning Province Key Laboratory of Infrared Optoelectric Materials and Micro-Nano Devices, Northeastern University, Shenyang 110819, China
- Correspondence: (G.L.); (D.Y.)
| | - Bin Xu
- College of Computer Science and Engineering, Northeastern University, Shenyang 110819, China;
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12
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Imaging detection of cerebral artery fenestrations and their clinical correlation with cerebrovascular diseases. Clin Imaging 2020; 62:57-62. [DOI: 10.1016/j.clinimag.2020.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 11/23/2022]
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Deguchi I, Osada T, Kimura H, Saito N, Arai E, Kohyama S, Takao M. A case of acute cerebral infarction associated with an accessory middle cerebral artery in a patient who underwent thrombectomy. Acute Med Surg 2019; 7:e459. [PMID: 31988771 PMCID: PMC6971443 DOI: 10.1002/ams2.459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/30/2019] [Indexed: 11/09/2022] Open
Abstract
Background The accessory middle cerebral artery (AMCA) is a middle cerebral artery (MCA) anomaly originating from the anterior cerebral artery. We report our experience of a case in which thrombectomy was undertaken for a patient with hemodynamics that were specific to the AMCA. Case Presentation An 84‐year‐old man with a history of atrial fibrillation developed paralysis of the left upper and lower extremities. Imaging examinations suggested tandem occlusion of the right internal carotid artery and the origin (M2 segment) of the right MCA. An extremely narrow MCA was visualized. Because there was concern regarding development of frontal lobe infarction, thrombectomy was carried out to restore anterograde blood flow, but an AMCA was found. Recanalization of the main MCA in the infarction zone resulted in hemorrhagic infarction, and the patient died of cerebral herniation. Conclusion When a vascular variation like AMCA is suspected, a careful evaluation of hemodynamics is necessary before undertaking endovascular intervention.
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Affiliation(s)
- Ichiro Deguchi
- Department of Neurology Saitama Medical University International Medical Center Saitama Japan
| | - Takashi Osada
- Department of Neurology Saitama Medical University International Medical Center Saitama Japan
| | - Hiroaki Kimura
- Department of Neurology Saitama Medical University International Medical Center Saitama Japan
| | - Naoko Saito
- Department of Diagnostic Radiology Saitama Medical University International Medical Center Saitama Japan
| | - Eiichi Arai
- Department of Pathology Saitama Medical University International Medical Center Saitama Japan
| | - Shinya Kohyama
- Department of Endovascular Neurosurgery Saitama Medical University International Medical Center Saitama Japan
| | - Masaki Takao
- Department of Neurology Saitama Medical University International Medical Center Saitama Japan
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14
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Cooke J, Maingard J, Chandra RV, Slater LA, Brooks M, Asadi H. Acute middle cerebral artery stroke in a patient with a patent middle cerebral artery. Neurol Clin Pract 2019; 9:250-255. [PMID: 31341713 DOI: 10.1212/cpj.0000000000000605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 12/17/2018] [Indexed: 11/15/2022]
Abstract
Purpose of review 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. Recent findings 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. Summary 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.
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Affiliation(s)
- Jamie Cooke
- Anatomy and Neuroscience (JC), School of Biomedical Sciences, University of Melbourne, Parkville; Department of Surgery (JC), Alfred Hospital, Melbourne, Victoria; Interventional Radiology Service (JM, MB, HA), Department of Radiology, Austin Hospital, Melbourne; School of Medicine (JM, MB, HA), Faculty of Health, Deakin University, Waurn Ponds; Stroke Division (JM, MB, HA), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria; Interventional Neuroradiology Service (HA), Department of Radiology, St Vincent's Hospital; Interventional Neuroradiology Unit (RVC, L-AS, HA), Monash Imaging, Monash Health; and Faculty of Medicine (RVC, HA), Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Julian Maingard
- Anatomy and Neuroscience (JC), School of Biomedical Sciences, University of Melbourne, Parkville; Department of Surgery (JC), Alfred Hospital, Melbourne, Victoria; Interventional Radiology Service (JM, MB, HA), Department of Radiology, Austin Hospital, Melbourne; School of Medicine (JM, MB, HA), Faculty of Health, Deakin University, Waurn Ponds; Stroke Division (JM, MB, HA), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria; Interventional Neuroradiology Service (HA), Department of Radiology, St Vincent's Hospital; Interventional Neuroradiology Unit (RVC, L-AS, HA), Monash Imaging, Monash Health; and Faculty of Medicine (RVC, HA), Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Ronil V Chandra
- Anatomy and Neuroscience (JC), School of Biomedical Sciences, University of Melbourne, Parkville; Department of Surgery (JC), Alfred Hospital, Melbourne, Victoria; Interventional Radiology Service (JM, MB, HA), Department of Radiology, Austin Hospital, Melbourne; School of Medicine (JM, MB, HA), Faculty of Health, Deakin University, Waurn Ponds; Stroke Division (JM, MB, HA), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria; Interventional Neuroradiology Service (HA), Department of Radiology, St Vincent's Hospital; Interventional Neuroradiology Unit (RVC, L-AS, HA), Monash Imaging, Monash Health; and Faculty of Medicine (RVC, HA), Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Lee-Anne Slater
- Anatomy and Neuroscience (JC), School of Biomedical Sciences, University of Melbourne, Parkville; Department of Surgery (JC), Alfred Hospital, Melbourne, Victoria; Interventional Radiology Service (JM, MB, HA), Department of Radiology, Austin Hospital, Melbourne; School of Medicine (JM, MB, HA), Faculty of Health, Deakin University, Waurn Ponds; Stroke Division (JM, MB, HA), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria; Interventional Neuroradiology Service (HA), Department of Radiology, St Vincent's Hospital; Interventional Neuroradiology Unit (RVC, L-AS, HA), Monash Imaging, Monash Health; and Faculty of Medicine (RVC, HA), Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Mark Brooks
- Anatomy and Neuroscience (JC), School of Biomedical Sciences, University of Melbourne, Parkville; Department of Surgery (JC), Alfred Hospital, Melbourne, Victoria; Interventional Radiology Service (JM, MB, HA), Department of Radiology, Austin Hospital, Melbourne; School of Medicine (JM, MB, HA), Faculty of Health, Deakin University, Waurn Ponds; Stroke Division (JM, MB, HA), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria; Interventional Neuroradiology Service (HA), Department of Radiology, St Vincent's Hospital; Interventional Neuroradiology Unit (RVC, L-AS, HA), Monash Imaging, Monash Health; and Faculty of Medicine (RVC, HA), Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Hamed Asadi
- Anatomy and Neuroscience (JC), School of Biomedical Sciences, University of Melbourne, Parkville; Department of Surgery (JC), Alfred Hospital, Melbourne, Victoria; Interventional Radiology Service (JM, MB, HA), Department of Radiology, Austin Hospital, Melbourne; School of Medicine (JM, MB, HA), Faculty of Health, Deakin University, Waurn Ponds; Stroke Division (JM, MB, HA), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria; Interventional Neuroradiology Service (HA), Department of Radiology, St Vincent's Hospital; Interventional Neuroradiology Unit (RVC, L-AS, HA), Monash Imaging, Monash Health; and Faculty of Medicine (RVC, HA), Nursing and Health Sciences, Monash University, Melbourne, Australia
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15
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Gunnal SA, Farooqui MS, Wabale RN. Study of Middle Cerebral Artery in Human Cadaveric Brain. Ann Indian Acad Neurol 2019; 22:187-194. [PMID: 31007431 PMCID: PMC6472224 DOI: 10.4103/0972-2327.144289] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Middle cerebral artery (MCA) is the larger terminal branch of the internal carotid artery. It travels through the Sylvian fissure on the insula. Objective: MCA supplies a large area of distribution than the other two cerebral arteries. Though it is so, there are very few articles in the literature describing MCA. Aim of the present work is to study the MCA regarding its origin, course, termination, branching pattern, morphometry and symmetry. Materials and Methods: 340 MCAs from 170 formalin preserved brains were dissected. Morphology, morphometry and symmetry of MCAs, were studied in detail and well photographed. The data collected in the study was analyzed. Results: Accessory MCA was found in seven specimens (2.05%). Duplicated MCA was seen in three specimens (0.88%). Aneurysm was found in three specimens (0.88%). MCA with bifurcated, trifurcated, quadrifurcated and single trunk termination was seen in 220 (64.70%), 42 (12.35%), 8 (2.35%), and in 70 (20.58%) specimens respectively. Bifurcated pattern as upper prominent trunk (type A), lower prominent trunk (type B) and both equal prominent trunks (type C) were seen in 63 (28.63%), 129 (58.63%), and 28 (12.72%) specimens respectively. Asymmetry was seen in 102 specimens (60%). Mean length and diameter of the MCA was 25.5-27.8 mm and 3 mm respectively. Conclusion: Awareness of these anatomical variations in branching patterns is important in neurovascular procedures. As very few Anatomical studies on MCA are there in the literature, this type of research work should be done by a number of scientists from a different region of the world in large scale.
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Elnahry AG, Elnahry GA. Oculomotor Nerve Palsy Associated with Duplication of Middle Cerebral Artery, Anterior Communicating Artery Aneurysm, and Parietal Meningioma. Neuroophthalmology 2019; 43:53-55. [PMID: 30723526 DOI: 10.1080/01658107.2018.1451902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 03/09/2018] [Indexed: 10/17/2022] Open
Abstract
A 61-year-old male presents with diplopia of acute onset and progressive course. He has a history of previous intracranial haemorrhage that was surgically evacuated 7 years ago and was also associated with diplopia. Examination revealed left complete oculomotor nerve paralysis with a fixed and dilated left pupil. Computed tomography (CT) revealed encephalomalacia, evidence of previous craniotomy, and an incidental left parietal convexity meningioma. CT angiography of the brain revealed a left tortuous duplicate middle cerebral artery with fenestration of its proximal part, an anterior communicating artery aneurysm, and a characteristic capillary blush of the meningioma. Possible mechanisms of oculomotor nerve involvement are discussed.
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Affiliation(s)
- Ayman G Elnahry
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Gehad A Elnahry
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
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17
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Abstract
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.
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18
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Uchino A, Saito N, Kozawa E, Masutani S. Multiple variations of the cerebral arteries associated with tetralogy of Fallot: a case report. Surg Radiol Anat 2017; 39:1161-1164. [PMID: 28396981 DOI: 10.1007/s00276-017-1848-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 03/10/2017] [Indexed: 10/19/2022]
Abstract
Tetralogy of Fallot (TOF) can be associated with vascular malformations or variations, especially of the aortic arch or supracardiac major venous systems. We report its association with an extremely rare combination of three such variations of the cerebral arteries-a right persistent hypoglossal artery, an extremely rare left carotid-right anterior cerebral artery (ACA) anastomosis, and a left accessory middle cerebral artery arising from the A1-A2 junction of the left ACA-which were diagnosed by magnetic resonance angiography in a 9-year-old girl during evaluation of multiple acute cerebral infarctions.
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Affiliation(s)
- Akira Uchino
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, Saitama, Japan.
| | - Naoko Saito
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Eito Kozawa
- Department of Radiology, Saitama Medical University Hospital, Saitama, Japan
| | - Satoshi Masutani
- Department of Pediatrics and Pediatric Cardiology, Saitama Medical University Saitama Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
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19
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Chandra A, Li WA, Stone CR, Geng X, Ding Y. The cerebral circulation and cerebrovascular disease I: Anatomy. Brain Circ 2017; 3:45-56. [PMID: 30276305 PMCID: PMC6126264 DOI: 10.4103/bc.bc_10_17] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/28/2017] [Accepted: 06/07/2017] [Indexed: 11/28/2022] Open
Abstract
In this paper, which is the first in a three-part series that reviews cerebrovascular anatomy, pathogenesis, and stroke, we lay the anatomical foundation for the rest of the series. Beginning with its origin in the branches of the aorta, we start by describing the arterial system. This system is partitioned into two major divisions (anterior and posterior circulations) that differ significantly in features and pathogenic potential. The systems, and the major branches that comprise them, are described. Description of the arterial system proceeds to the point of the fulfillment of its function. This function, the exchange of gases and nutrients with the cerebral parenchyma, is the subject of a subsequent section on the microcirculation and blood-brain barrier. Finally, the cerebral venous system, which is composed of cerebral veins and dural venous sinuses, is described. Thus, an anatomical context is supplied for the discussion of cerebrovascular disease pathogenesis provided by our second paper.
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Affiliation(s)
- Ankush Chandra
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - William A Li
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Christopher R Stone
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xiaokun Geng
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
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20
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Takahashi M, Uchino A, Suzuki C. Anastomosis between accessory middle cerebral artery and middle cerebral artery diagnosed by magnetic resonance angiography. Surg Radiol Anat 2016; 39:685-687. [PMID: 27771760 DOI: 10.1007/s00276-016-1763-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 10/13/2016] [Indexed: 11/26/2022]
Abstract
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 3 T are useful to identify such rare vascular variation.
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Affiliation(s)
- Masao Takahashi
- Department of Diagnostic Radiology, Saitama Medial University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Akira Uchino
- Department of Diagnostic Radiology, Saitama Medial University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan.
| | - Chihiro Suzuki
- Neuroscience Center, Suzuki Neurosurgical Clinic, Kawagoe, Japan
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21
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Uchino A, Ito S, Kurita H, Tanaka M. Duplicated middle cerebral artery arising from the origin of the hyperplastic anterior choroidal artery that mimicked aneurysm on routine MR angiography. Neuroradiol J 2016; 29:106-9. [PMID: 26915899 DOI: 10.1177/1971400916633711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report a case of duplicated right middle cerebral artery that arose from the origin of the right hyperplastic anterior choroidal artery diagnosed by magnetic resonance angiography. To our knowledge, this is the first case of such a variation reported with magnetic resonance angiographic images. The internal carotid artery-hyperplastic anterior choroidal artery-duplicated middle cerebral artery junction was dilated and mimicking aneurysm. Partial maximum intensity projection images and volume-rendering images showed that it was not a saccular aneurysm but an infundibular dilatation. Careful observation of magnetic resonance angiographic images including its source images is important for detecting rare arterial variations. To identify an anomalous artery on magnetic resonance angiography, creation of partial maximum intensity projection images and volume-rendering images is valuable.
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Affiliation(s)
- Akira Uchino
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, Japan Social Medical Corporation KAN-ETSU, KAN-ETSU Hospital, Japan
| | - Sayaka Ito
- Department of Neurosurgery, Saitama Medical University International Medical Center, Japan
| | - Hiroki Kurita
- Department of Neurosurgery, Saitama Medical University International Medical Center, Japan
| | - Masahiko Tanaka
- Social Medical Corporation KAN-ETSU, KAN-ETSU Hospital, Japan
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22
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Sharifi G, Bakhtevari MH, Sabouri S, Rezaei O. An aneurysm at the site of the fenestration of the middle cerebral artery in a patient with multiple aneurysms: A case report. Surg Neurol Int 2015; 6:S414-7. [PMID: 26539312 PMCID: PMC4597291 DOI: 10.4103/2152-7806.166177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 06/28/2015] [Indexed: 11/29/2022] Open
Abstract
Background: Middle cerebral artery (MCA) fenestration is a very rare anatomical variant of the MCA, incidentally found during magnetic resonance or computed tomography angiography. It has an incidence of 0.6%. Unlike fenestration of the posterior cerebral arterial circulation, fenestration of the anterior cerebral arterial circulation has not been well described. Methods: We present the rare case of a patient who was admitted for a ruptured aneurysm of the MCA arising at the site of the fenestration of the MCA and also an unruptured fusiform aneurysm of the right posterior communicating artery and a distal anterior cerebral artery (ACA) aneurysm. Results: The patient underwent craniotomy with microsurgical aneurysm clipping and the previously undiagnosed ruptured aneurysm, at the site of the fenestration of the MCA, arose immediately. Postoperatively, the patient awoke without a deficit. After treatment of postoperative bacterial meningitis, he was discharged on the 26th postoperative day in good condition without any neurologic deficit. Six months after the first surgery, he was operated for the distal azygos ACA aneurysm. Conclusion: Anomalies of the intracranial vasculature are common, and we describe a rare case of left MCA fenestration with an associated ruptured aneurysm at the site of the fenestration. In the literature, cases of fenestration of the MCA are sporadically reported and are only incidental findings.
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Affiliation(s)
- Guive Sharifi
- Department of Neurosurgery, Loghman e Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Sofia Sabouri
- Department of Neuroradiology, Tooska Medical Imaging Center, Tehran, Iran
| | - Omidvar Rezaei
- Department of Neurosurgery, Loghman e Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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23
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Unfused or twig-like middle cerebral artery. Eur J Radiol 2015; 84:2013-8. [DOI: 10.1016/j.ejrad.2015.06.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 06/10/2015] [Accepted: 06/15/2015] [Indexed: 11/23/2022]
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24
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Tabuchi S, Yoshioka H. Ruptured aneurysm at the fenestration of the middle cerebral artery detected by magnetic resonance angiography in a patient with systemic lupus erythematosus and renal failure: a case report. J Med Case Rep 2014; 8:30. [PMID: 24467808 PMCID: PMC3917415 DOI: 10.1186/1752-1947-8-30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 11/22/2013] [Indexed: 11/21/2022] Open
Abstract
Introduction A cerebral aneurysm arising at the fenestration of the middle cerebral artery is extremely rare, with one report describing subarachnoid hemorrhage due to this type of lesion. There have been no reports of this type of lesion occurring in a patient with systemic lupus erythematosus. Case presentation A 47-year-old Japanese woman with 23 years’ history of systemic lupus erythematosus and chronic renal failure had sudden onset of subarachnoid hemorrhage. We avoided using contrast medium due to her chronic renal failure. Magnetic resonance angiography showed her ruptured aneurysm arising at the site of fenestration of her middle cerebral artery. Successful clipping, perioperative management avoiding the cerebral vasospasm, renal dialysis initiated after the acute phase and placement of a ventriculoperitoneal shunt were performed, and she was discharged home with no complications. Conclusions This is the first report of ruptured aneurysm associated with middle cerebral artery fenestration in a patient with systemic lupus erythematosus as detected by magnetic resonance angiography. The presence and anatomical relationship of fenestration accompanied by aneurysm could be noninvasively and accurately evaluated preoperatively using three-dimensional time-of-flight magnetic resonance angiography with the volume rendering method in a case in which contrast medium was contraindicated.
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Affiliation(s)
- Sadaharu Tabuchi
- Department of Neurosurgery, Tottori Prefectural Central Hospital, 730 Ezu, Tottori 680-0901, Japan.
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25
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Abstract
Successful open and endovascular carotid artery intervention depends on a thorough foundational knowledge of cervical and intracranial vascular anatomy. It is essential for the carotid interventionist to be familiar with the common and rare variants of the cervical and intracranial vasculature, and to understand the implications of these variants for the performance of carotid intervention with protection of the distal circulation. This article provides interventionists with a basic description of the normal and relevant variant vascular anatomy from the aortic arch to the circle of Willis, and outlines the potential difficulties that specific variants may present for endovascular therapy.
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Affiliation(s)
- Peter C Thurlow
- Department of Radiology, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212, USA
| | - Jason M Andrus
- Department of Radiology, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212, USA
| | - Mark H Wholey
- Department of Radiology, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212, USA; Center for Vascular and Neurovascular Interventions, Cardiovascular Institute, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212, USA; Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA 15213, USA.
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26
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Duplicate origin and fenestration of the middle cerebral artery on MR angiography. Surg Radiol Anat 2012; 34:401-4. [PMID: 22271164 DOI: 10.1007/s00276-012-0936-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 01/12/2012] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Duplicate origin of the middle cerebral artery (MCA) is rare and has been misdiagnosed or confused as fenestration of the proximal M1 segment of the MCA. The condition is not a true fenestration and occurs when two MCA branches arise separately from the terminal segment of the internal carotid artery, and fuse to form an arterial ring. We researched our institutional records to determine the prevalence of such cases and investigated its characteristic features on magnetic resonance (MR) angiography. METHODS To isolate these cases, we retrospectively reviewed cranial MR angiographic images of 3,491 patients obtained on either of two 1.5-tesla scanners at our institution from April 1, 2007 through December 31, 2009. RESULTS We found four cases of duplicate origin of the MCA, two cases each on the right and the left (3 men, one woman), representing a prevalence of 0.11%. All four arterial rings were small and mimicked fenestration of the proximal M1 segment. During the same period, we found three MCA fenestrations, two at the proximal M1 segment and one at the middle M1 segment. Total prevalence of duplicate origin and fenestration was 0.20%. CONCLUSIONS In our institution, we observed 0.11% prevalence of duplicate origin of the MCA on MR angiography, and all were small and mimicked fenestration. Clinically, an important difference between duplicate origin and fenestration of the MCA is the potential collateral circulation available from the inferior branch in the case of saddle embolism occlusion of only the superior branch when there is duplicate origin of the MCA.
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27
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LaBorde DV, Mason AM, Riley J, Dion JE, Barrow DL. Aneurysm of a duplicate middle cerebral artery. World Neurosurg 2011; 77:201.e1-4. [PMID: 22405396 DOI: 10.1016/j.wneu.2011.03.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 09/16/2010] [Accepted: 03/29/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Anatomic middle cerebral artery (MCA) anomalies are rare, but each of the described variants (eg, duplicate, fenestrated, accessory) can be of clinical significance. CASE DESCRIPTION A 34-year-old man with a history of left hemispheric stroke was found to have an aberrant, early-arising duplicate left M1 segment of the MCA with an associated asymptomatic fusiform aneurysm. The patient was treated with a superficial temporal artery (STA) to distal MCA bypass followed by surgical trapping of the aneurysm. RESULTS Intraoperative and follow-up angiography performed postoperatively at 3 months showed complete isolation of the aneurysm from the circulation and patency of the bypass graft. The postoperative course was uneventful with the exception of a craniotomy flap infection, which was effectively managed with intravenous antibiotics, flap removal, and subsequent use of a fabricated replacement. CONCLUSIONS This rare case is presented and used as a framework for a brief discussion of the literature regarding both variant MCA anatomy and treatment considerations for these anomalies when associated with an aneurysm.
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Affiliation(s)
- David V LaBorde
- Department of Neurosurgery, Division of Interventional Neuroradiology, Emory University School of Medicine, Atlanta, Georgia, USA
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28
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Sim KB, Lee CS, Park JC, Huh JS. Cerebral aneurysm in the long fenestration at the middle portion of m1 segment. J Korean Neurosurg Soc 2011; 48:434-7. [PMID: 21286481 DOI: 10.3340/jkns.2010.48.5.434] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 03/22/2010] [Accepted: 11/22/2010] [Indexed: 11/27/2022] Open
Abstract
We report a unique case of bilateral mirror image M1 aneurysms, one of which was an unruptured aneurysm arising from the proximal end of right middle cerebral artery fenestration with long loop and the other ruptured aneurysm from the contralateral side. We clipped ruptured aneurysm first and unruptured one in three months after the first operation. The difficulties of identifying this unusual vascular anomaly and possible problems during the surgery of an aneurysm at the site of fenestration are discussed with a review of the literature.
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Affiliation(s)
- Ki-Bum Sim
- Department of Neurosurgery, Jeju National University College of Medicine, Jeju, Korea
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29
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Zurada A, Gielecki J, Tubbs RS, Loukas M, Maksymowicz W, Cohen-Gadol AA, Michalak M, Chlebiej M, Zurada-Zielińska A. Three-dimensional morphometrical analysis of the M1 segment of the middle cerebral artery: potential clinical and neurosurgical implications. Clin Anat 2010; 24:34-46. [PMID: 20949492 DOI: 10.1002/ca.21051] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
With an increase in the understanding of the formation and treatment of cerebral aneurysms and an improvement in imaging technology, actual standardized measurement values for the cerebral arteries are necessary. Therefore, the aim of this study was to provide a detailed assessment of the three-dimension (3D) morphology (vessel's curvature and trajectory) and 3D-morphometry of the M1 segment of the middle cerebral artery using computer tomography angiography (CTA) images. The DICOM files from CTA of 40 male and 75 female individuals with a mean age of 50.1 years were analyzed using an interactive postprocessing 3D volume-rendering algorithm. Specifically, the M1 segment was evaluated. Calculations included the length, internal diameter, volume, deviation (DI) and tortuosity indices (TI). The M1 segment had a mean internal diameter of 2.23 mm and was greater in men. M1 asymmetry was identified in 23.4% of the individuals and was more common in women. The mean length was 15.62 mm and the left M1 segments were a little longer. The mean volume of the M1 segments was 63.92 mm(3) , and this was typically greater in men and on the left sides. The mean TI and DI for the M1 segment were 0.91 and 2.17 mm, respectively. Therefore, the M1 segments are only slightly curved or straight in their course. In addition, the longest vascular M1 segments are more deviated (curved) and more tortuous. Such standardized data as presented herein may be useful in the preprocedural evaluation of patients with intracranial vascular pathology of the M1 segment.
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Affiliation(s)
- Anna Zurada
- Medical Faculty, Department of Anatomy, University of Varmia and Masuria, Olsztyn, Poland.
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30
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Otani N, Nawashiro H, Tsuzuki N, Osada H, Suzuki T, Shima K, Nakai K. A ruptured internal carotid artery aneurysm located at the origin of the duplicated middle cerebral artery associated with accessory middle cerebral artery and middle cerebral artery aplasia. Surg Neurol Int 2010; 1:51. [PMID: 20975967 PMCID: PMC2958321 DOI: 10.4103/2152-7806.69378] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 08/20/2010] [Indexed: 12/04/2022] Open
Abstract
Background: Intracranial vascular anomalies involving the middle cerebral artery (MCA) are relatively rare, as such knowledge will be helpful for planning the optimal surgical procedures. Case Description: We herein present the first case of a ruptured internal carotid artery aneurysm arising at the origin of the hypoplastic duplicated MCA associated with accessory MCA and main MCA aplasia, which was revealed by angiograms and intraoperative findings. Conclusion: In practice, this case highlights the urgent need to preoperatively recognize such vascular anomalies as well as understand the collateral blood supply in cerebral ischemia associated with these MCA anomalies.
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Affiliation(s)
- Naoki Otani
- Department of Neurosurgery, National Defense Medical College, Saitama, Japan
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31
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Lee IH, Jeon P, Kim KH, Byun HS, Kim HJ, Kim ST, Kim JS. Endovascular treatment of a ruptured accessory middle cerebral artery aneurysm. J Clin Neurosci 2010; 17:383-4. [PMID: 20074969 DOI: 10.1016/j.jocn.2009.02.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Revised: 02/14/2009] [Accepted: 02/17/2009] [Indexed: 11/18/2022]
Abstract
A 51-year-old female presented with bilateral accessory middle cerebral arteries (MCA) with associated ruptured aneurysm manifesting as a subarachnoid hemorrhage. Angiography demonstrated the bilateral accessory MCA and associated ruptured aneurysm at the junction of the left anterior cerebral artery and left accessory MCA. This was successfully treated by coil embolization. Magnetic resonance angiography obtained 6 months later revealed no evidence of residual or recurring aneurysm.
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Affiliation(s)
- In Ho Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-dong, Gangnam-gu, Seoul 135-710, Korea
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32
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Dimmick SJ, Faulder KC. Normal Variants of the Cerebral Circulation at Multidetector CT Angiography. Radiographics 2009; 29:1027-43. [DOI: 10.1148/rg.294085730] [Citation(s) in RCA: 175] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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33
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Tutar NU, Töre HG, Kirbaş I, Tarhan NC, Coşkun M. Various origins of the duplicated middle cerebral artery. J Neuroimaging 2008; 18:448-50. [PMID: 18494777 DOI: 10.1111/j.1552-6569.2008.00254.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We describe the features of a duplicated middle cerebral artery identified by computed tomographic angiography that originates from a previously undefined origin, ie, from the petrous portion of the internal carotid artery. Recognition of this anomaly is important in patients with a possible aneurysm, which was not present in our patient.
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Affiliation(s)
- Nihal Uslu Tutar
- Baskent University Faculty of Medicine, Department of Radiology, Ankara, Turkey.
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Uchino A, Takase Y, Nomiyama K, Egashira R, Kudo S. Fenestration of the Middle Cerebral Artery Detected by MR Angiography. Magn Reson Med Sci 2006; 5:51-5. [PMID: 16785728 DOI: 10.2463/mrms.5.51] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Unlike fenestration of the posterior cerebral arterial circulation, fenestration of the anterior cerebral arterial circulation has not been well described. We investigated the location and configuration of fenestration of the middle cerebral artery (MCA) detected by magnetic resonance (MR) angiography. We found 6 fenestrations of the MCA among cranial MR angiography images obtained from about 2,000 patients during the past 9 years at our institution using either of two 1.5T imagers. All images were obtained by the three-dimensional time-of-flight technique. Maximum-intensity projection images in the horizontal rotation view were displayed stereoscopically. All 6 fenestrations had small slit-like configurations, five located at the proximal M1 segment, the other, at the middle M1 segment. No associated aneurysm was found. Although MCA fenestration is extremely rare and cerebral artery fenestration usually has no clinical significance, an aneurysm can arise at the proximal end of the fenestration. Thus, recognizing MCA fenestration is important when interpreting cranial MR angiograms.
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Affiliation(s)
- Akira Uchino
- Department of Radiology, Saga Medical School, Nabeshima, Saga, Japan.
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Liu HM, Lai DM, Tu YK, Wang YH. Aneurysms in Twig-Like Middle Cerebral Artery. Cerebrovasc Dis 2005; 20:1-5. [PMID: 15925875 DOI: 10.1159/000086119] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2004] [Accepted: 02/23/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We report a vascular abnormality of the middle cerebral artery (MCA) that has not been described in the literature before. METHODS Two patients (1 male and 1 female; age 44 and 67 years, respectively) were found to have a vascular abnormality in which the main trunk of the MCA had a twig-like form. Both patients presented with intracranial hemorrhage. RESULTS In these 2 patients, the abnormality was seen before the genu of the MCA. They had an intracranial hemorrhage due to an associated aneurysm inside the twigs. The twig appeared to be a network between the bifurcation of internal carotid artery and insular segment of MCA, and it was different from the collateral circulation due to acquired occlusion or moyamoya disease. CONCLUSION This new type of vascular lesion of the MCA is not benign. It appears to be associated with the occurrence of an aneurysm, an important clinical aspect.
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Affiliation(s)
- Hon-Man Liu
- Department of Radiology, Division of Neurosurgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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Parmar H, Sitoh YY, Hui F. Normal variants of the intracranial circulation demonstrated by MR angiography at 3T. Eur J Radiol 2005; 56:220-8. [PMID: 15950421 DOI: 10.1016/j.ejrad.2005.05.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2005] [Revised: 05/09/2005] [Accepted: 05/11/2005] [Indexed: 10/25/2022]
Abstract
Magnetic resonance angiography (MRA) at 3T offers increased signal to noise ratio with better background suppression, leading to exquisite depiction of the intracranial circulation. We present a pictorial review of the normal variations and anomalies of the intracranial circulation detected on MRA performed on a high field 3T clinical scanner using parallel imaging techniques. The salient imaging features of these anomalies and normal variations are discussed with relevance to clinical practice.
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Affiliation(s)
- H Parmar
- National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.
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Uchino A, Sawada A, Takase Y, Kudo S. MR Angiography of Anomalous Branches of the Internal Carotid Artery. AJR Am J Roentgenol 2003; 181:1409-14. [PMID: 14573446 DOI: 10.2214/ajr.181.5.1811409] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Akira Uchino
- Department of Radiology, Saga Medical School, 5-1-1 Nabeshima, Saga 849-8501, Japan.
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Tanriover N, Kawashima M, Rhoton AL, Ulm AJ, Mericle RA. Microsurgical anatomy of the early branches of the middle cerebral artery: morphometric analysis and classification with angiographic correlation. J Neurosurg 2003; 98:1277-90. [PMID: 12816276 DOI: 10.3171/jns.2003.98.6.1277] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The cortical arteries arising from the main trunk of the middle cerebral artery, proximal to its bifurcation or trifurcation, are called "early branches." The purpose of this study was to characterize these early branches. METHODS The early branches were characterized according to their sites and patterns of origin, diameters, and relative proximity to the internal carotid artery bifurcation, as well as the course and area of supply of their cortical branches based on an examination of 50 hemispheres. Special attention was directed to the perforating arteries that arose from the early branches and entered the anterior perforated substance. The anatomical findings were compared with data obtained from 109 angiograms. CONCLUSIONS Early branches directed to the temporal and frontal lobes were found in 90 and 32% of the hemispheres, respectively. The early branches that arose more proximally from the M1 segment were larger than those arising distally. Lenticulostriate arteries arose from 81% of the early frontal branches (EFBs) and from 48% of the early temporal branches (ETBs). An average of two cortical arteries arose from the EFBs and 1.3 from the ETBs, the most common of which supplied the temporopolar and orbitofrontal areas. Although the microsurgical anatomy of the early branches demonstrates abundant diversity, they can be classified into clearly defined patterns based on anatomical features. These patterns can prove helpful in evaluating angiographic data and in planning an operative procedure.
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Affiliation(s)
- Necmettin Tanriover
- Department of Neurological Surgery, University of Florida, Gainesville, Florida 32610-0265, USA
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Uchino A, Sawada A, Takase Y, Kan Y, Matsuo M, Kudo S. Supraclinoid carotid dissection in a pediatric patient. Clin Imaging 2001; 25:385-7. [PMID: 11733149 DOI: 10.1016/s0899-7071(01)00341-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors present the case of a 13-year-old boy with a left temporal lobe infarction that developed during a 400-m run. Magnetic resonance (MR) angiography showed segmental narrowing of the left supraclinoid internal carotid artery (ICA) and a duplicated left middle cerebral artery (MCA). MR angiographic source images revealed a crescent-shaped left carotid lumen, indicative of a supraclinoid carotid dissection.
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Affiliation(s)
- A Uchino
- Department of Radiology, Saga Medical School, 5-1-1, Nabeshima, 849-8501, Saga, Japan.
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