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

Brzegowy, Paweł; Polak, Jakub; Wnuk, Jakub; Łasocha, Bartłomiej; Walocha, Jerzy; Popiela, T

doi:10.5603/fm.a2017.0112

Cited by 30 publications

(26 citation statements)

References 19 publications

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“…In the current study, no association was found between the CW configuration and presence of aneurysms (p=0.567). These findings are similar to a retrospective cerebral CTA study by P. Brzegowy et al which showed no association between anatomic variations of the MCA and CW with aneurysms [40].…”

Section: Discussionsupporting

confidence: 91%

Proportion of Variant Anatomy of the Circle of Willis and Association with Vascular Anomalies on Cerebral CT Angiography

Machasio

Nyabanda

Mutala

2019

Radiology Research and Practice

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Background and Purpose. There is a wide variation in the anatomy of the CW in different individuals and population groups. The purpose of this study was to determine the proportion of variant anatomy of the circle of Willis (CW) and associated anomalies in patients with suspected cerebrovascular disease referred for cerebral computed tomography angiography (CTA) in two tertiary hospitals in Kenya. Methodology. This was a cross-sectional descriptive study conducted on 94 patients referred for cerebral CTA at the Kenyatta and Nairobi hospitals from August 2017 to February 2018. MIP and 3D reformatted images were analyzed by two senior radiologists to determine the final configuration of the CW and presence of vascular pathology. Vessels with diameters <0.8 mm were considered to be absent or hypoplastic. Chen et al. classification was used to determine the final configuration of CW. Results. Complete CW was seen in 37.2% (37.7% vs. 36.6% in males and females, respectively, p=0.909). Type A variant was the commonest anterior variant at 78.7%. Type E variant was the dominant posterior variant at 41.5%. Fetal PCA was demonstrated in 25.5%, unilateral > bilateral fetal PCA. Aneurysms were seen in 24.5% of patients. ACoA aneurysms were commonest at 43.6%. AVMs were seen in 8.5% of patients. Azygous ACA, fenestration, and duplication of vessels and persistent TA were not demonstrated. There is no significant association between aneurysms/AVMs and CW configuration. Conclusion. The findings in this study demonstrate slight differences in the CW configuration. A higher proportion of complete anterior CW was seen in female patients. Type A anterior and type E posterior circulation variants were the commonest in both males and females. No significant association was demonstrated between CW configuration and occurrence of aneurysms/AVMs in this study. Various methods of classification of CW configuration have been proposed with no standardized method to date, thus the need for consensus building between neuroanatomists, neurologists, neurosurgeons, and neuroradiologists for ease of comparison between similar future studies on the CW.

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Section: Discussionsupporting

confidence: 91%

Proportion of Variant Anatomy of the Circle of Willis and Association with Vascular Anomalies on Cerebral CT Angiography

Machasio

Nyabanda

Mutala

2019

Radiology Research and Practice

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“…Branches sprouting from the main artery had different termination patterns (Table 1) ; of these, bifurcation was the most common (72%), consistent with previous reports [19][20][21][22][23][24]. Early bifurcation, defined as occurring within 1 cm of the MCA origin [13], was observed in 3% (Figure 2(d) and Table 1) and should be distinguished from double MCA.…”

Section: Resultssupporting

confidence: 85%

Variable Anatomy of the Middle Cerebral Artery from Its Origin to the Edge of the Sylvian Fissure: A Direct Fresh Brain Study

Saw

et al. 2021

The Scientific World Journal

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The middle cerebral artery (MCA) is a major artery supplying blood to the brain and a common site of surgically treatable intracranial aneurysms. The MCA has anatomic variations that may have clinical significance. In order to investigate and document the extent of such variations, the MCA in 100 fresh brain hemispheres from 50 deceased patients, obtained from the Police Surgeon Office, Yangon General Hospital, Myanmar, was dissected and examined. Double MCA was observed in 2% of specimens. The termination patterns were bifurcation (72%), trifurcation (16%), and primary trunk (12%); early bifurcation was also observed (3%). The mean length of the main trunk (MT) was 20.6 ± 6.2 mm. The number of perforators ranged from 4 to 15 (mean = 9); most arose from the MT (96%), and the others originated at the bifurcation point (3%) and in postbifurcation divisions (1%). All of the perforators (100%) had a single branching pattern. The number of cortical branches ranged from 6 to 13 and included the orbitofrontal (98%), prefrontal (99%), precentral (95%), central (98%), temporopolar (87%), anterior temporal (89%), middle temporal (24%), posterior temporal (62%), temporo-occipital (69%), anterior parietal (88%), angular (83%), and posterior parietal (57%) arteries. Early cortical branches emerged from the MT in 52% of specimens. These data can help anatomists, radiologists, and neurosurgeons in preoperative assessment, surgical planning, and selection of surgical approach.

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“…Theo P.T.Hà [7], ĐKTB của ICA trái là 4,71±0,62mm; phải là 4,68±0,56mm; theo J.Krejza [15] Theo bảng 3.4: khi nghiên cứu về MCA, R.Jeyakumar [17] có cách phân chia M1, thân trên (M2 trên), thân dưới (M2 dưới) tương tự như nhóm nghiên cứu của chúng tôi, tuy nhiên các tác giả chỉ đánh giá số đo M1, các đoạn khác chưa được nghiên cứu đến. P.Brzegowy [18] đưa ra kết quả đường kính của M1 T là 17mm; M1 P là 16,9; V.Rohan [19] đưa ra kết quả đường kính chung của đoạn M1 là 15,4mm. Theo kết quả nêu trên, đoạn M1 trong nghiên cứu của chúng tôi có giá trị cao hơn các tác giả khác có thể do phương tiện nghiên cứu, cỡ mẫu và chủng tộc khác nhau.…”

Section: Phương Pháp Nghiên Cứuunclassified

“…Theo kết quả nêu trên, đoạn M1 trong nghiên cứu của chúng tôi có giá trị cao hơn các tác giả khác có thể do phương tiện nghiên cứu, cỡ mẫu và chủng tộc khác nhau. P.Brzegowy [18] áp dụng MSCT đánh giá kích thước MCA và các biến đổi trên 250 bệnh nhân người châu Âu có phình mạch não và đưa ra khoảng cách MCA từ nguyên ủy đến vị trí gối (the distance from ICA division to MCA genu) là 24.2 mm (95% CI 23.9-24.5). V.Rohan [19], ứng dụng MSCT đánh giá 80 bệnh nhân châu Âu bị nhồi máu não, R.Jeyakumar [17] Theo bảng 3.6: Về mặt giải phẫu học, xét cả tiêu chí ĐKTB và CDTB, ICA đoạn trong sọ ngoài màng cứng của nhóm tuổi > 60 lớn hơn nhóm ≤60 (p<0,05).…”

Section: Phương Pháp Nghiên Cứuunclassified

Anatomy of the Middle Cerebral Artery and some related arteries on 256 MSCT

Son¹,

Khoa²,

Dũng³

et al. 2019

MPS

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Abstracts: Introduction: studying the percentage of display and dimensions of the middle cerebral artery and some related arteries on on 256 MSCT data. Methods: A cross-sectional study, with sample size of 261. Results: The percentage of display of middle cerebral artery is 100%; the posterior artery is 76.4; Internal Carotid Artery is 100%. The average diameter, average length are (mm) M1T respectively: 3.25 ± 0.43 and 19.98 ± 6.10; M1 P: 3.26 ± 0.46 and 19.68 ± 6.28; M2T left 2.10 ± 0.48 and 22.85 ± 13.18; M2T right 2.09 ± 0.49 and 23.42 ± 11.89; M2D left 2.48 ± 0.49 and 31.73-16.36; M2D right 2.55 ± 0.49 and 29.11 ± 15.31. PCoA T 1.29 ± 0.63 and 11.87 ± 4.87; PCoA P 1.26 ± 0.66 and 14.02 ± 9.13; Conclusions: The size of the middle cerebral artery and some related arteries were accurately evaluated in the study, the image of vascular anatomy was display clearly. Keywords Middle cerebral artery, cerebral angiography, multi-slices computed tomography ... References [1] H.V. Cúc. To the study of arterial blood supply vessels for Vietnamese adults, Ministry of Health research project, Hanoi Medical University, Hanoi, Vietnam (2000) (in Vietnamese).[2] H.M.Tú. To the study of cerebral artery anatomy on MSCT 64 image, Master's thesis in Medicine, Hanoi Medical University, Hanoi, Vietnam (2011) (in Vietnamese).[3] Ogeng'o, J.A. Geometric features of Vertebrobasilar arterial system in adult Black Kenyans, Int. J. Morphol, 36(2) (2018) 544 - 50. [4] KrzyżewsKi, R.M.. Variation of the anterior communicating artery complex and occurrence of anterior communicating artery aneurysm: A2 segment consideration, Folia medica cracoviensia, LIV (1) (2014) 13 - 20.[5] Jiménez-Sosa, M.S. Anatomical variants of Anterior cerebral arterial circle. A study by Multidetector computerized 3D tomographic angiography, Int J. Morphol 35(3) 1121 – 28.[6] Hamidi, C. (2013). Display with 64-detector MDCT angiography of cerebral vascular variations, Surg Radiol Anat 35 (2017) 729 – 36.[7] Dimmick, S.J., et al. Normal variations of the cerebral circulation at multidetector CT angiography, Radiographics 29(4) (2009) 1027 – 43.[8] P.T.Hà. To the study of Willis polygonal anatomy on MSCT 128 image of patients with cerebral aneurysm, Specialish level 2 thesis in Hanoi Medical University, Hanoi, Vietnam.[9] Saha, A. (2013). Variation of posterior communicating artery in human brain: a morphological study, Gomal Journal of Medical Sciences 11(1) (2018). 42 – 6.[10] Gullari, G. K. The branching pattern of the middle cerebral artery: is the intermediate trunk real or not? An anatomical study correlating with simple angiography, J.Neurosurg, 116 (2012) 1024 - 34.[11] Canaz, H., el al Morphometric analysis of the arteries of Willis Polygon, Romanian Neurosurgery, XXXII (1) (2018) 56 - 64.[12] Pedroza, A. (1987). Microanatomy of the Posterior Communicating Artery, Neurosurgery 20(2) (2018) 229 – 35.[13] Keeranghat, P. P., et al. Evaluation of normal variants of circle of Willis at MRI, Int.J. Res Med Sci, 6(5) (2018) 1617 - 22.[14] Tao, X., Yu, et al. Microsurgical anatomy of the anterior communicating artery complex in adult Chinese heads, Surgical Neurology 65 (2006) 155 – 61.[15] Krejza, J., et al. Carotid artery diameter in Men and Women and the relation to body and neck size, Stroke, 37 (2006) 1103 - 5.[16] Masatoukawashima. Microsurgical anatomy of cerebral revascularization. Part I: Anterior circulation, J.Neurosurg, 102 (2005) 116 – 31.[17] Jeyakumar.R., et al, Study of Anatomical Variations in Middle Cerebral Artery, Int.J.Sci Stud 5(12) (2018) 5-10. [18] Brzegowy, P, et al Middle cerebral artery anatomical variations and aneurysms: a retrospective study based on computed tomography angiography findings, Folia Morphol, 77(3) (2018) 434 – 40.[19] Rohan, V., et al, Length of Occlusion predicts recanalization and outcome after intravenous thrombolysis in middle cerebral artery stroke, Stroke, 45 (2014) 2010 - 17.[20] Vijaywargiya, M., et al. Anatomical study of petrous and cavernous parts of internal carotid artery, Anat Cell Biol, 50 (2017) 163 - 70.[21] Bouthillier, et al Segments of the internal carotid artery: a new classification, Neurosurgery, 38(3), (1996) 425 - 32.

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

Abstract: 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.

Cited by 30 publications

References 19 publications

Proportion of Variant Anatomy of the Circle of Willis and Association with Vascular Anomalies on Cerebral CT Angiography

Proportion of Variant Anatomy of the Circle of Willis and Association with Vascular Anomalies on Cerebral CT Angiography

Variable Anatomy of the Middle Cerebral Artery from Its Origin to the Edge of the Sylvian Fissure: A Direct Fresh Brain Study

Anatomy of the Middle Cerebral Artery and some related arteries on 256 MSCT

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