A study of the anatomical variations in branching pattern of middle cerebral artery

Abstract

Middle cerebral artery (MCA) is the largest and most complex arterial system of the brain. Variations of the aortic arch branches are due to alteration in the development of specific branchial arch arteries during the embryonic period. Knowledge of these variations is important during aortic instrumentation, thoracic, and neck surgeries. The anatomy of the anterior cerebral artery branches and the anterior communicating artery complex needs to be investigated individually to minimise neurovascular morbidity before iatrogenic procedures. The study aimed to study the variations in the microsurgical anatomy of the MCA in our population and compare the variables and discuss their importance with anatomic and surgical considerations.  Specimens were collected from the embalmed cadavers and the post-mortem bodies in the department of forensic medicine of Thanjavur Medical College. The different variables regarding the MCA in our population were analysed and compared with the studies in the Western population and other Indian studies.  The mean length of the MCA in this study was 12.8 mm with a standard error of 3.79 mm. The outer diameter of the M1 segment was with a mean length of 3.75mm. In 69.2% middle, Cerebral Artery shows bifurcation and in 20%, it shows trifurcation and in 10.8%, it shows ramification types of branching patterns. The 39.1% cases show Temporo polar, 21.7% orbitofrontal, 9.1% anterior temporal, 6.6% prefrontal, and 4.1% middle temporal branches. Our results also reveal that the origin of the lenticulostriate branch in the middle cerebral artery was 85.85% from the trunk and 14.2% from division, respectively. MCA branching pattern is slightly higher in trifurcation pattern as compared to bifurcation and ramification. Thorough knowledge of the microvascular anatomy and the myriads of variations is essential for the operating surgeon to choose the ideal technique to avoid any catastrophe during and after surgery and give the best possible functional outcome.