Middle Cerebral Artery Anomalies Detected by Conventional Angiography and Magnetic Resonance Angiography

  • Kim, Myoung-Soo (Department of Neurosurgery, Seoul Paik Hospital, Inje University College of Medicine) ;
  • Hur, Jin-Woo (Department of Neurosurgery, Cheongju Saint Mary's Hospital) ;
  • Lee, Jong-Won (Department of Neurosurgery, Cheongju Saint Mary's Hospital) ;
  • Lee, Hyun-Koo (Department of Neurosurgery, Cheongju Saint Mary's Hospital)
  • Published : 2005.04.30

Abstract

Objective: Middle cerebral artery(MCA) anomalies are found incidentally on conventional cerebral angiography and magnetic resonance angiography(MRA). Our goal is to examine the incidence and types of MCA anomalies. Methods: Cerebral angiography was performed in 448 patients and MRA in 743; the patients had or were suspected to have cerebrovascular disease. The images were retrospectively evaluated for arterial anatomic anomalies. We use Teal's classification for definition of accessory and duplicated MCAs. Results: On cerebral angiography, the following anomalies of the MCA were found in seven patients: fenestration (n = 2, incidence = 0.45%); duplication (n = 2, incidence = 0.45%); accessory MCA (n = 2, incidence = 0.45%); aplasia (n = 1, incidence = 0.22%). On MRA, eight patients had anomalous MCAs : fenestration (n = 1, incidence = 0.14%); duplication (n= 6, incidence = 0.81%); accessory (n = 1, incidence = 0.14%). Conclusion: Although the clinical significance is not great, we find a relatively high incidence of anomalous MCAs. Knowledge and recognition of these MCA anomalies are useful and important in the interpretation of cerebral images and during neurosurgical procedures.

Keywords

References

  1. Amagasaki K, Yagishita T, Kawataki T, Kase M, Nukui H : Middle cerebral artery aplasia associated with an aneurysm of the proximal anterior cerebral artery. Acta Neurochir (Wien) 140 : 1313-1314, 1998 https://doi.org/10.1007/s007010050256
  2. Deruty R, Pelissou-Guyotat I, Mottolese C, Bognar L, Laharotte JC, Turjman F : Fenestration of the middle cerebral artery and aneurysm at the site of the fenestration. Neurol Res 14 : 421-424, 1992 https://doi.org/10.1080/01616412.1992.11740097
  3. Elmac I, Baltacioglu F, Ekinci G, Erzen C, Pamir N : Middle cerebral artery duplication associated with multiple intracranial aneurysms. Case report. J Neurosurg Sci 45 : 232-234, 2001
  4. Gailloud P, Albayram S, Fasel JH, Beauchamp NJ, Murphy KJ : Angiographic and embryologic considerations in five cases of middle cerebral artery fenestration. Am J Neuroradiol 23 : 585-587, 2002
  5. Gibo H, Lenkey C, Rhoton AL Jr : Microsurgical anatomy of the supraclinoid portion of the internal carotid artery. J Neurosurg 55 : 560-574, 1981 https://doi.org/10.3171/jns.1981.55.4.0560
  6. Han DH, Gwak HS, Chung CK : Aneurysm at the origin of accessory middle cerebral artery associated with middle cerebral artery aplasia : case report. Surg Neurol 42 : 388-391, 1994 https://doi.org/10.1016/0090-3019(94)90341-7
  7. Handa J, Shimizu Y, Matsuda M, Handa H : The accessory middle cerebral artery : report of further two cases. Clin Radiol 21 : 415-416, 1970 https://doi.org/10.1016/S0009-9260(70)80084-8
  8. Hong JT, Huh PW, Chung DS, Kye DK, Cho KS, Kim DS, et al : Accessory Middle Cerebral Artery. J Korean Neurosurg Soc 26 : 435-438, 1997
  9. Kang SD, Kim JM : An aneurysm arising at the site of the middle cerebral artery duplication. J Korean Neurosurg Soc 25 ; 1318-1322, 1996
  10. Komiyama M, Nakajima H, Nishikawa M, Yasui T : Middle cerebral artery variations : duplicated and accessory arteries. Am J Neuroradiol 19 : 45-49, 1998
  11. Koyama S, Kotani A, Sasaki J, Tazoe M, Tsubokawa T : Ruptured aneurysm at the origin of duplication of the middle cerebral arterycase report. Neurol Med Chir (Tokyo) 35 : 671-673, 1995 https://doi.org/10.2176/nmc.35.671
  12. Mueller DP, Sato Y, Yuh WT : Accessory middle cerebral artery as a source of collateral blood flow. Am J Neuroradiol 12 : 1223-1224, 1991
  13. Nakamura H, Takada A, Hide T, Ushio Y : Fenestration of the middle cerebral artery associated with an aneurysm-case report. Neurol Med Chir (Tokyo) 34 : 555-557, 1994 https://doi.org/10.2176/nmc.34.555
  14. Nakazawa T, Suzuki F, Miyamoto Y, Matsuda M : Aplasia of the proximal middle cerebral artery associated with an aneurysm of the proximal anterior cerebral artery. Case report. Nippon Geka Hokan 54 : 521-525, 1985
  15. Okudera H, Koike J, Toba Y, Kuroyanagi T, Kyoshima K, Kobayashi S : Fenestration of the middle cerebral artery associated with cerebral infarction. Report of two cases. Neurol Med Chir (Tokyo) 27 : 559-563, 1987 https://doi.org/10.2176/nmc.27.559
  16. Park IS, Huh PW, Lee GS, Choi CR : Duplication of the middle ceraebral artery-case report-. J Korean Neurosurg Soc 22 ; 1026-1028, 1993
  17. Sanders WP, Sorek PA, Mehta BA : Fenestration of intracranial arteries with special attention to associated aneurysms and other anomalies. Am J Neuroradiol 14 : 675-680, 1993
  18. Stabler J : Two cases of accessory middle cerebral artery, including one with an aneurysm at its origin. Br J Radiol 43 : 314-318, 1970 https://doi.org/10.1259/0007-1285-43-509-314
  19. Tacconi L, Johnston FG, Symon L : Accessory middle cerebral artery. Case report. J Neurosurg 83 : 916-918, 1995 https://doi.org/10.3171/jns.1995.83.5.0916
  20. Takahashi S, Hoshino F, Uemura K, Takahashi A, Sakamoto K : Accessory middle cerebral artery : Is it a variant form of the recurrent artery of Heubner? Am J Neuroradiol 10 : 563-568, 1989
  21. Teal JS, Rumbaugh CL, Bergeron RT, Segall HD : Anomalies of the middle cerebral artery : accessory artery, duplication, and early bifurcation. Am J Roentgenol Radium Ther Nucl Med 118 : 567-575, 1973 https://doi.org/10.2214/ajr.118.3.567
  22. Uchino A, Kato A, Takase Y, Kudo S : Middle cerebral artery variations detected by magnetic resonance angiography. Eur Radiol 10 : 560-563, 2000 https://doi.org/10.1007/s003300050960
  23. Umansky F, Dujovny M, Ausman JI, Diaz FG, Mirchandani HG : Anomalies and variations of the middle cerebral artery : a microanatomical study. Neurosurgery 22 : 1023-1027, 1988 https://doi.org/10.1227/00006123-198806010-00008
  24. Umansky F, Juarez SM, Dujovny M, Ausman JI, Diaz FG, Gomes F, et al : Microsurgical anatomy of the proximal segments of the middle cerebral artery. J Neurosurg 61 : 458-467, 1984 https://doi.org/10.3171/jns.1984.61.3.0458