Position of intrasylvian cortical branches of middle cerebral artery
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Position of intrasylvian cortical branches of middle cerebral artery on MRA original image Suzuki Yasuhiro Sizuoka saiseikai general hospital Shizuoka, Japan 2009. Introduction. Identifying branches of middle cerebral artery (MCA) is difficult using only MR angiography (MRA).

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Position of intrasylvian cortical branches of middle cerebral artery on MRA original imageSuzuki YasuhiroSizuoka saiseikai general hospital Shizuoka, Japan2009


Introduction l.jpg

Introduction cerebral artery

Identifying branches of middle cerebral artery (MCA) is difficult using only MR angiography (MRA).

However, MRA original image make it capable, since cerebral gyri are visible.


Method l.jpg

Method cerebral artery

Objects: eight cases examined with MRA and conventional angiography

(male 6, female 2; average age 56.6 y.o. (33-71 y.o.))

Procedure: I identified MCA M4 branches on MRA original image, referring conventional angiography, and traced branches backward into Sylvian fissure.


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Terminology cerebral artery

M3

M2

M4

Name of twelve cortical branches are presented by Gibo et al.

(J Neurosurg, 1981)

M1: horizontal portion

M2: insular portion

M3: opercular portion

M4: cortical portion

newly defined words:

ascending branches: 6 branches going to frontal or parietal cortex as M4 portion

(orbitofrontal – posterior parietal artery)

descending branches: 6 branches going to temporal cortex as M4 portion

(angular – temporopolar artery)

M1


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Angiography of typical case (68 y.o. male) cerebral arteryarteries: orbitofrontal, prefrontal, precentral, central, anterior parietal, posterior parietal, angular,temporaloccipital, posterior temporal, middle temporal, anterior temporal, temporopolar


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Branch pattern of this case cerebral artery(right and left branches differ)

left

orbitofrontal

prefrontal

precentral

central

anterior parietal

posterior parietal

angular

temporaloccipital

posterior temporal

middle temporal

anterior temporal

temporopolar

right

orbitofrontal

prefrontal

precentral

central

anterior parietal

posterior parietal

angular

temporaloccipital

posterior temporal

middle temporal

anterior temporal

temporopolar

superior

trunk

superior

trunk

M1

M1

inferior

trunk

inferior

trunk

early branch


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Temporopolar cerebral artery arteries originate from inferior trunk or from M1 (as early branches) in medial spaces of temporal lobes

typical case

overwright of eight cases


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Temporopolar cerebral artery arteries go down along temporal ridge.Anterior and middle temporal arteries are seen in medial and lateral spaces of temporal lobes.

typical case

overwright of eight cases


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Peak of cerebral arterytemporopolar artery is approximately in this slice.Anterior, middle, posterior temporal arteries, and temporaloccipital arteries are seen in medial and lateral space of temporal lobes.

overwright of eight cases

typical case


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M3 portions of cerebral arteryorbitofrontal arteries are in anterior ascending rami (AAR) of Sylvian fissure. M3 portions of anterior and middle temporal arteries are under AAR of Sylvian fissure.

typical case

overwright of eight cases


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M3 portions of cerebral arteryprefrontal arteries are in AAR of Sylvian fissure.M3 portions of posterior temporal arteries are under central sulci.

overwright of eight cases

typical case


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M3 portions of cerebral arteryprecentral arteries are in AAR or under central sulci.M3 portions of posterior temporal arteries are under central sulci.

overwright of eight cases

typical case


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Peak of cerebral arteryorbitofrontal artery is approximately in this slice. M3 portions of temporaloccipital and angular arteries are under postcentral sulci.

overwright of eight cases

typical case


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In this slice and upper slices, most M2 arteries are ascending branches. M3 portions of central arteries are under central sulci or under postcentral sulci.

overwright of eight cases

typical case


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M3 portions of ascending branches.central arteries are under central sulci or under postcentral sulci. M3 portions of anterior parietal arteries are under postcentral sulci.

overwright of eight cases

typical case


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M3 portions of ascending branches.anterior parietal arteries are under postcentral sulci. M3 portions of posterior parietal arteries are at posterior terminal of Sylvian fissure.

overwright of eight cases

typical case


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M3 portion of ascending branches.MCA cortical branches


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Conclusions ascending branches.

  • Identification of branches is not possible without clarifying whether the branch is ascending or descending on M4 portion.

  • In upper half of insula, only ascending branches exist in M2 portion, and identification is easy.

  • In lower half of insula, ascending and descending branches are mixed and complicated.


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