open access

Vol 77, No 3 (2018)
ORIGINAL ARTICLES
Published online: 2017-12-08
Submitted: 2017-07-05
Accepted: 2017-10-26
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Middle cerebral artery anatomical variations and aneurysms: a retrospective study based on computed tomography angiography findings

P. Brzegowy, J. Polak, J. Wnuk, B. Łasocha, J. Walocha, T. J. Popiela
DOI: 10.5603/FM.a2017.0112
·
Pubmed: 29235088
·
Folia Morphol 2018;77(3):434-440.

open access

Vol 77, No 3 (2018)
ORIGINAL ARTICLES
Published online: 2017-12-08
Submitted: 2017-07-05
Accepted: 2017-10-26

Abstract

Background: Anatomical variations of the middle cerebral artery (MCA) are an important clinical issue, due to high prevalence of intracranial aneurysms. Anatomical variations of vessels can lead to higher shear stress, which is thought to be the main factor leading to aneurysm formation and consequently to higher prevalence of aneurysms. The aim of this study was to evaluate anatomy of the MCA; to classify MCA aneurysms using computed tomography angiography and to correlate anatomical variations of MCA and circle of Willis with prevalence of MCA aneurysms.
Materials and methods: Two hundred and fifty patients without MCA aneurysms and 100 patients with unruptured MCA aneurysms were qualified for the study, with exclusion of patients after MCA clipping. Four aspects of MCA anatomy were evaluated: division point, its relation to the genu, distance to M1 division and the genu and domination of post-division trunks.
Results: Middle cerebral artery bifurcation was found in 86.2% and trifurcation in 13.8% of the cases. 78.4% of MCAs divided before the genu, 19.2% in the genu and 2.4% after the genu. Upper branch domination was seen in 26%, lower branch in 25.4%, middle branch in 4% and no domination in 44.6% of the cases.
In the study group 116 aneurysms were found. 86.2% of the aneurysms were located in M1 division point, 6.9% in M2 segment, 3.4% near lenticulostriatae arteries and 3.4% near early cortical branches. The only anatomical variation, which had significantly higher prevalence in patients with left MCA aneurysms, was domination of upper post-division trunk of MCA. No other statistically significant differences in circle of Willis and MCA variations were found between patients with aneurysms and without them.
Conclusions: 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.

Abstract

Background: Anatomical variations of the middle cerebral artery (MCA) are an important clinical issue, due to high prevalence of intracranial aneurysms. Anatomical variations of vessels can lead to higher shear stress, which is thought to be the main factor leading to aneurysm formation and consequently to higher prevalence of aneurysms. The aim of this study was to evaluate anatomy of the MCA; to classify MCA aneurysms using computed tomography angiography and to correlate anatomical variations of MCA and circle of Willis with prevalence of MCA aneurysms.
Materials and methods: Two hundred and fifty patients without MCA aneurysms and 100 patients with unruptured MCA aneurysms were qualified for the study, with exclusion of patients after MCA clipping. Four aspects of MCA anatomy were evaluated: division point, its relation to the genu, distance to M1 division and the genu and domination of post-division trunks.
Results: Middle cerebral artery bifurcation was found in 86.2% and trifurcation in 13.8% of the cases. 78.4% of MCAs divided before the genu, 19.2% in the genu and 2.4% after the genu. Upper branch domination was seen in 26%, lower branch in 25.4%, middle branch in 4% and no domination in 44.6% of the cases.
In the study group 116 aneurysms were found. 86.2% of the aneurysms were located in M1 division point, 6.9% in M2 segment, 3.4% near lenticulostriatae arteries and 3.4% near early cortical branches. The only anatomical variation, which had significantly higher prevalence in patients with left MCA aneurysms, was domination of upper post-division trunk of MCA. No other statistically significant differences in circle of Willis and MCA variations were found between patients with aneurysms and without them.
Conclusions: 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.

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Keywords

middle cerebral artery; circle of Willis; intracranial aneurysms

About this article
Title

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

Journal

Folia Morphologica

Issue

Vol 77, No 3 (2018)

Pages

434-440

Published online

2017-12-08

DOI

10.5603/FM.a2017.0112

Pubmed

29235088

Bibliographic record

Folia Morphol 2018;77(3):434-440.

Keywords

middle cerebral artery
circle of Willis
intracranial aneurysms

Authors

P. Brzegowy
J. Polak
J. Wnuk
B. Łasocha
J. Walocha
T. J. Popiela

References (21)
  1. Crompton MR. The pathology of ruptured middle-cerebral aneurysms with special reference to the differences between the sexes. Lancet. 1962; 2(7253): 421–425.
  2. Elsharkawy A, Lehečka M, Niemelä M, et al. A new, more accurate classification of middle cerebral artery aneurysms: computed tomography angiographic study of 1,009 consecutive cases with 1,309 middle cerebral artery aneurysms. Neurosurgery. 2013; 73(1): 94–102; discussion 102.
  3. Gibo H, Carver CC, Rhoton AL, et al. Microsurgical anatomy of the middle cerebral artery. J Neurosurg. 1981; 54(2): 151–169.
  4. Goyal M, Menon BK, Krings T, et al. What constitutes the M1 segment of the middle cerebral artery? J Neurointerv Surg. 2016 [Epub ahead of print].
  5. Huttunen T, von und zu Fraunberg M, Frösen J, et al. Saccular intracranial aneurysm disease: distribution of site, size, and age suggests different etiologies for aneurysm formation and rupture in 316 familial and 1454 sporadic eastern Finnish patients. Neurosurgery. 2010; 66(4): 631–8; discussion 638.
  6. Jain KK. Some observations on the anatomy of the middle cerebral artery. Can J Surg. 1964; 7: 134–139.
  7. Kahilogullari G, Ugur HC, Comert A, et al. The branching pattern of the middle cerebral artery: is the intermediate trunk real or not? An anatomical study correlating with simple angiography. J Neurosurg. 2012; 116(5): 1024–1034.
  8. Kang HG, Kim BJ, Lee J, et al. Risk factors associated with the presence of unruptured intracranial aneurysms. Stroke. 2015; 46(11): 3093–3098.
  9. Kathuria S, Gregg L, Chen J, et al. Normal cerebral arterial development and variations. Semin Ultrasound CT MR. 2011; 32(3): 242–251.
  10. Klimek-Piotrowska W, Kopeć M, Kochana M, et al. Configurations of the circle of Willis: a computed tomography angiography based study on a Polish population. Folia Morphol. 2013; 72(4): 293–299.
  11. Krasny A, Nensa F, Sandalcioglu IE, et al. Association of aneurysms and variation of the A1 segment. J Neurointerv Surg. 2014; 6(3): 178–183.
  12. Meissner I, Torner J, Huston J, et al. International Study of Unruptured Intracranial Aneurysms Investigators. Mirror aneurysms: a reflection on natural history. J Neurosurg. 2012; 116(6): 1238–1241.
  13. Nam SW, Choi S, Cheong Y, et al. Evaluation of aneurysm-associated wall shear stress related to morphological variations of circle of Willis using a microfluidic device. J Biomech. 2015; 48(2): 348–353.
  14. Pai SB, Varma RG, Kulkarni RN. Microsurgical anatomy of the middle cerebral artery. Neurol India. 2005; 53(2): 186–190.
  15. Papazova M, Zhivadinovik J, Trpkovska B, et al. Anatomy of middle cerebral artery. . Acta Morphol. 2012; 9(1): 5–9.
  16. Słowik A, Wnuk M, Brzegowy P, et al. Polish Thrombectomy Initiative. Mechanical thrombectomy in acute stroke - Five years of experience in Poland. Neurol Neurochir Pol. 2017; 51(5): 339–346.
  17. Rinne J, Hernesniemi J, Niskanen M, et al. Analysis of 561 patients with 690 middle cerebral artery aneurysms: anatomic and clinical features as correlated to management outcome. Neurosurgery. 1996; 38(1): 2–11.
  18. Songsaeng D, Geibprasert S, Willinsky R, et al. Impact of anatomical variations of the circle of Willis on the incidence of aneurysms and their recurrence rate following endovascular treatment. Clin Radiol. 2010; 65(11): 895–901.
  19. Tacconi L, Johnston FG, Symon L. Accessory middle cerebral artery. Case report. J Neurosurg. 1995; 83(5): 916–918.
  20. Tarulli E, Sneade M, Clarke A, et al. Effects of circle of Willis anatomic variations on angiographic and clinical outcomes of coiled anterior communicating artery aneurysms. AJNR Am J Neuroradiol. 2014; 35(8): 1551–1555.
  21. Umansky F, Dujovny M, Ausman JI, et al. Anomalies and variations of the middle cerebral artery: a microanatomical study. Neurosurgery. 1988; 22(6 Pt 1): 1023–1027.

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