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Anatomy Atlases: Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System: Arteries: Head, Neck, and Thorax: Middle Cerebral Artery

Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System: Arteries: Head, Neck, and Thorax

Middle Cerebral Artery

Ronald A. Bergman, PhD
Adel K. Afifi, MD, MS
Ryosuke Miyauchi, MD

Peer Review Status: Internally Peer Reviewed


In a study of 25 brains (50 middle cerebral arteries), 10 forms of division were found. The principal forms of variation included: a) a single vessel arising proximal to the sylvian fissure (34%), b) more than one major vessel arising proximal to the sylvian fissure (26%), c) a trifurcation at the mouth of the sylvian fissure (34%), and d) a bifurcation at the mouth of the sylvian fissure (16%).

The middle cerebral may be absent or replaced by a branch from the deep cerebral.

On occasion it gives rise to an accessory posterior communicating artery, the posterior communicating artery may be connected to the middle cerebral instead of the trunk of the internal carotid artery.

The anterior choroidal artery may arise from the middle cerebral or posterior communicating.

Jain (1964) has reported on the variations in the circle of Willis and on the middle cerebral and accessory middle cerebral arteries from the brains of 300 consecutive autopsies. Circle of Willis Artery.

The configuration of the Circle of Willis was complete in 293 cases (97.7%) of 300 subjects. In 90 cases (30%), one or both posterior cerebral arteries were classified as having an "embryonic origin from the internal carotid arteries," and their connections from the basilar artery were hypoplastic.

The anterior communicating artery was absent in one case only. In 20 cases, Jain reported this artery was duplicated. In addition there were numerous small connections between the two pericallosal arteries.

In 19 cases (6.3%) both anterior cerebral arteries were supplied from one of the internal carotid arteries. In 26 cases (8.7%) there were three anterior cerebral arteries. The median anterior cerebral artery in each case arose from the anterior communicating artery and coursed over the corpus callosum giving branches to the medial surfaces of both frontal lobes. In one case there were four anterior cerebral arteries.

The recurrent perforating branch of the anterior cerebral artery (Heubner's artery ) was the most constant of all the branches at the base of the brain, and was present bilaterally in all cases. This artery, according to Jain, arose from the anterior cerebral artery in the region of the anterior communicating artery and coursed caudally to enter the anteni or perforated substance medial to the perforating branches of the middle cerebral artery. It was duplicated bilaterally in two cases. In one instance there was an additional Heubner's artery on one side arising from an accessory middle cerebral artery.

Middle Cerebral Artery.

Jain reported that the average length of 610 middle cerebral arteries was 1.6 cm., with a range of 0.5 to 3 cm. The diameter ranged from 0.3 to 0.5 cm.

The most common pattern of initial branching was by bifurcation, 270 cases (90%); in the rest, the branching was by trifurcation. Additional branching was by bifurcation in all cases. In all cases there were constant branches from the middle cerebral trunk or accessory middle cerebral artery to the lateral part of the orbital frontal cortex and the tip of the temporal lobe. There were numerous small perforating branches (6 to 20) from the middle cerebral artery. Jain found in all brains one or two of these branches arising in the distal portion were more prominent and larger, with diameters up to 1.0 cm.

The site of origin of these distal striate (Charcot's) artery branches from 600 middle cerebral arteries was: In 325 (51. 1 %), the origin was from the middle cerebral trunk; in 1 (25.6%), at the point of division of the middle cerebral artery; in 121 (20.3%), from one of the branches of the middle cerebral artery.

The middle cerebral artery terminates in a bifurcation in 20% of cases; trifurcation in 53%; quadrifurcation in 24% and quintafurcation in 3% of cases studied by Lang (1983).

Accessory Middle Cerebral Artery.

In nine cases (3%) there were accessory middle cerebral arteries, unilateral in eight and bilateral in one; there being ten arteries in all. Eight of the arteries (80%) arose from the anterior cerebral and two (20%) from the internal carotid. In each instance this artery proceeded laterally in the Sylvian fissure to share a part of the territory of supply of the middle cerebral artery, i.e., the
lateral part of the orbital surface of the frontal lobe.

In these cases the brunches of the middle cerebral to this territory were replaced by brunches from the accessory middle cerebral artery. No perforating vessels arose from these arteries except in two cases - an accessory Heubner's artery in one and a major striate perforating artery in the other. There were abundant anastomoses on the cortical surface between the branches of the accessory middle cerebral surface and the middle cerebral arteries. Jain points out that there are, on a developmental basis, numerous possibilities for variation in the blood vessels of the brain.

It is unusual for an accessory middle cerebral artery to arise from the anterior cerebral artery and go to a territory usually supplied by the middle cerebral artery. This was deschibed by Crompton to occur in 3% of 347 cases that he examined at autopsy. In the study by Jain the incidence of middle cerebral artenes was the same as in Crompton's study, 3%, but the site of origin was the territory of the anterior communicating artery in 80% of the cases and the internal carotid artery in the remainder. An accessory middle cerebral artery in such cases can be an important source of collateral blood supply to the territory of the middle cerebral artery.


References

Anderhuber, F., Weiglein, A. and R.K. Pucher. (1990)über trifurcation der Arteria cerebri media. Acta Anat. 137:342-349.

Beevor, C.E. (1908) Cerebral blood supply. Brain 30:403-425.

Bergman, R.A., Thompson, S.A., Afifi, A.K. and F.A. Saadeh. (1988) Compendium of Human Anatomic Variation: Catalog, Atlas and World Literature. Urban & Schwarzenberg, Baltimore and Munich.

Castro-Rodrigues, M. (1955) Contribution a l'etude de l'artère sylvienne. Assoc. Anatomistes, Comptes Rendus 42:375-381.

Chess, M.A., Barsotti, J.B., Chang, J-K., Ketonen, L.M. and P-L Westesson. (1995) Duplication of the extracranial internal carotid artery. American Journal Neuroradiology (AJNR) 16:1545-1547.

Crompton, M.R. (1962) The pathology of ruptured middle-cerebral aneurysms. Lancet 2:421.

Duroux, P.E., Dujol, H. and J. Bossy. (1952) Contribution on l'étude de l'artè re sylvienne et de ses territoires vasculaires. Assoc. Anatomistes, Comptes Rendus 39:135-145.

Gabrielle, H., Latarjet, M., Lecuire, J. and P.E. Duroux. (1949) Contribution a l'étude de tronc de l'artère sylvienne et de la vascularisation artérielle du lobe de l'insula chez l'homme. Assoc. Anatomistes, Comptes Rendus 36:291-311.

Gabrielle, H., Latarjet, M., Lecuire, J., Replumaz, P.R. and G. Maret. (1949) Contribution a l'étude macroscopique des artères de la région Rolandique chez l'homme. Assoc. Anatomistes, Comptes Rendus 36:313-325.

Gabrielle, H., Latarjet, M., Lecuire, J. and P. Milleret. (1949) Contribution a l'étude macroscopic de la vascularisation du lobe temporal chez l'homme. Assoc. Anatomistes, Comptes Rendus 36:339-352.

Herman, L.H., Ostrowski, A.Z. and E.S. Gurdjian. (1963) Perforating branches of the middle cerebral artery. Arch. Neurol. (Chicago) 8:32-34.

Iontov, A. (1962) Variation in verlauf der arteria cerebri.... Tr. Nauchnoissl. Piskonevrol. Inst. Bekhter (Lenningrad) 28:45-68. In Russian.

Jain, K.K. (1964) Some observations on the anatomy of the middle cerebral artery. Canad. J. Surg. 7(2):134-139.

Kaplan, H.A. and D.H. Ford. (1966) The Brain Vascular System. Elsevier, Amsterdam.

Riggs, H.E. and C. Rupp. (1963) Variation in form of Circle of Willis. Archives of Neurology 8(1):8-14.

Riggs, H.E. and C. Rupp. (1963) Variation in form of circle of Willis. Arch. Neurol. (Chicago) 8:8- 15.

Ring, B.A. (1962) Middle cerebral artery: Anatomical and radiographic study. Acta Radiol. 57:289-300.

Schaefer, E.A., Symington, J. and T.H. Bryce, Eds. (1915) Quain's Anatomy, 11th ed. Longmans, Green and Co., London.

Stelibens, W.E. (1963) Aneurysms and anatomical variation of cerebral arteries. Arch. Path. (Chicago) 75:45-64.

Waddington, M.M. (1974) Atlas of Cerebral Angiography with Anatomic Correlation. Little, Brown and Co., Boston.

Willis, T. (1664) Cerebri anatome: cui accessit nervorum descriptio et usus. Martyn and Allestry, London.

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