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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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slide1

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

introduction

Introduction

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

Method

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.

terminology

Terminology

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

slide5

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

branch pattern of this case right and left branches differ
Branch pattern of this case(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

slide7
Temporopolar arteries originate from inferior trunk or from M1 (as early branches) in medial spaces of temporal lobes

typical case

overwright of eight cases

slide8

Temporopolar 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

slide9

Peak of temporopolar 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

slide10

M3 portions of orbitofrontal 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

slide11
M3 portions of prefrontal arteries are in AAR of Sylvian fissure.M3 portions of posterior temporal arteries are under central sulci.

overwright of eight cases

typical case

slide12

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

overwright of eight cases

typical case

slide13

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

overwright of eight cases

typical case

slide14

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

slide15

M3 portions of 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

slide16

M3 portions of 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

conclusions
Conclusions
  • 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.
ad