Type of Article:  Original Research

Volume 6; Issue 4.3 (December 2018)

Page No.: 5936-5944

DOI: https://dx.doi.org/10.16965/ijar.2018.376


Hema. N *1, J.H. Sharieff 2.

*1 Associate professor, Department of Anatomy, ESICMC and PGIMSR, Rajajinagar, Bangalore, Karnataka, India.

2 Professor, Department of Anatomy, DM WIMS, Wayanad, Kerala, India.

Address for correspondence:   Dr. Hema. N, Associate Professor, Department of Anatomy, ESICMC and PGIMSR, Rajajinagar, Bangalore- 560010, Karnataka, India. E-Mail: hemanesi@gmail.com


Background: Human brain gets its nutrition from carotido and vertebro-basilar system of vessels. MCA, being the larger terminal branch of ICA supplies the cortical areas of brain concerned with speech and language. It is the most commonly involved artery in cerebro-vascular accidents as in stroke which is characterised by sudden onset of focal neurological deficit. The anatomical study is of utmost important to neurovascular surgeons.

Materials and methods: The present study was undertaken in 140  cadaveric human brain hemispheres of 70 formalin fixed brains from Department of Anatomy and Forensic medicine of Mysore medical college and ESIC MC and PGIMSR, Bangalore. Fixed brains were sagitally bisected into right and left halves by brain cutting knife. Meninges were cleared and MCA was identified which was the larger and direct branch of ICA. Measurements of ICA and MCA was taken using thread and measuring scale. LSAs arising from MI segment MCA were counted using hand lens. Any early branch if present was noted. Angle was noted between M1 and M2 segment. Presence of any anomalies were studied

Results:  The mean of length of M1 was found slightly more on the left side (2.09 cms) in comparison to right side (1.90 cms).  The mean diameter of M1 segment of MCA was more on the left side (0.352 cms), in comparison to right side (0.317 cms).  The mean diameter of left MCA (0.352 cms) and left ICA (0.359 cms) were of the same size. The mean diameter of right MCA (0.317 cms) and right ICA (0.323 cms) were almost of the same size. The number of LSAs were more on left side (5.9) in comparison to right side (5.67). Early branches were found to be more on right side (5) than left side (3). The angle was observed to be acute in all specimens.

Conclusion: This study was undertaken due to its clinical significance to stroke. Observations made on MCA revealed greater length of MCA carrying greater proportion of blood flow to the left side – a feature which supports the concept of vascular asymmetry. The knowledge of early branch arising from proximal segment of MCA is helpful for neurovascular surgeons to make a fairer decision in planning the treatment for any neurovscular disorders.  The authors felt the necessity of documentation of data inferred by our study as there are very few articles on MCA found published  in Indian literature.

KEY WORDS: M1 Segment Of Middle  Cerebral Artery, Lenticulostriate Branches, Early Branch, Stroke, Vascular Anomalies, Neurovascular Surgeons.


  1. Susan Standring, Neil R, Patricia C, Alan R, Michael A, Jeremiah C et al. Gray’s Anatomy, The Anatomical Basis Of Clinical Practice, 40 th ed. Spain: Elsevier Churchill Livingston 2008; p. 250.
  2. Idowu OE, Shokunbi MT, Malomo AO, Ogunbiyi JO: Size, course, distribution and anomalies of the middle cerebral artery in adult Nigerians. East Afr Med J, 2002; 79: 217-204.
  3. Pawel Brzegowy et al, Middle cerebral artery anatomical variations and aneurysms-retrospective study based on computed tomograghy and angiographic findings, Folia Morphologica, Sep 2015. 10.5603 /FM.a 2017.0112
  4. Rinne J. Hernesniemi J. Niskanen M et al. Analysis of 561 patients with 690 middle cerebral artery aneurysms: anatomic and clinical features as corelated to management outcome. Neurosurgery 1996 Jan;38(1):2-11.
  5. Polish Thrombectomy Initiative, Slowik A, Wnuk M etal. Mechanical thrombectomy in acute stroke -5years of experience in Poland. Neurol Neurochir Pol.2017 Sep-Oct;51(5):339-346
  6. Kathuria S, Gregg L, Chen etal. Normal cerebral arterial development and variations. Semin Ultrasound computed tomography magnetic resolution 2011 Jun; 32(3):242-51.
  7. Martinez F, Spagnuolo E, Calvo-Rubral A et al: Variants of the anterior circle of Willis. Anatomic and angiographic correlation and its implications in the surgery of intracranial aneurysms. (Acigos anterior cerebral artery, median artery of the corpus callosum and accessory midle cerebral artery). Neurocirugia (Astur), 204; 15: 578-88.
  8. Foix C, et Levy M. Les ramollissements sylviens. Rev Neurol 1927; 1
  9. Masaki Komiyama, Hideki Nakajima, Misao Nishikawa and Toshihiro Yasiu. Middle cerebral artery variations: Duplicated and Accessory arteries. AJNR Am J Neuroradiol 1998;19:45-49.
  10. Bederson JB, Spetzler RF. Anastomosis of the anterior temporal artery to a secondary trunk of the middle cerebral artery for treatment of a giant M1 segment aneurysm: case report. Journal of neurosurgery. 1992 May;76(5):863-6.
  11. Gibo H, Carver CC, Rhoton AL Jr et al: Microsurgical anatomy of middle cerebral artery. J Neurosurg, 1981;54:151-69.
  12. B Pai,R.G.Varma, R.N.Kulkarni. Microsurgical anatomy of the middle cerebral artery. Neurology India June 2005;53(2):186-190.
  13. Grellier P,Roche JL,Duplay J:Radio-anatomy study of the main trunk of the middle cerebral artery.Neurochirugie 1978;24(4):227-233.
  14. Sundari: Branching pattern of Middle cerebral artery: International journal of Science and Research 2016;5(11).
  15. Felix Umansky, Salvador Montoya Juarez, Manuel Dujojvny, James I Ausman, Fernando G Diaz, Francisco Gomes et al. Microsurgical anatomy of the proximal segments of the middle cerebral artery. J Neurosurg 1984; 61:458-467.
  16. Jose Manuel V et al: Changes in bloodflow velocity and diameter during hyperventilation: Assessment with MR and transcranial doppler sonography. AJUR Am J Neuroradiol 1997;18:1929-1934.
  17. URL Hiroki Hongo et al: Smaller outer diameter of atherosclerotic MCA associated with RNF 213 c. 14576 variant, 5 Jun- 2017; 8:104
  18. Osborn AG , Diagnostic cerebral Angiography, Lippincott Williams and Wilkins(1999). Google books
  19. Ronald A Bergman, Adel K, Ryosuke Miyauchi: illustrated encyclopaedia of human anatomic variations: Opus II: Cardiovascular system :Arteries: Head,Neck and Thorax. Anatomy Atlases
  20. Chummy SS. Last’s Anatomy Regional and Applied, 10th ed. Edinburgh, UK: Churchill Livingstone 1999; p. 466.
  21. Grand W: Microsurgical anatomy of proximal MCA and ICA bifurcation. Neurosurgery 1980;7:215-218.
  22. Jain KK. Some observations on the anatomy of the middle cerebral artery. Canad J Surg 1964; 7(2):134-139.
  23. Tanriover N, Kawashima M, Albert L et al: Microsurgical anatomy of the early branches of middle cerebral artery: morphometric analysis and classification with angiographic correlation. J Neurosurg, 2003;98:1277-90.
  24. Zang Hee Cho et al: observations of lenticulostriate arteries in the human brain in vivo using 7.0T MR Angiography: Stroke 2008;39(5):1604-6.
  25. Abe T1 et al: Aneurysms at the eary branch of middle cerebral artery: No ShinkeiGeka. 2006 Apr;34(4):383-8.
  26. Marinkovic S Gibo H , Milisavljevic M, Cetkovic M: Anatomic and clinical correlations of Lenticulostriate arteries: Clin.Anat 2001 May; 14(3):190-5.
  27. Umansky F, Gomes FB, Dujovny M, Diaz FG, Ausman JI, Mirchandani, Berman SK. The   perforating   branches    of    the    middle    cerebral        A  microanatomical study. J Neurosurg 1985;62:261-268.
  28. Karen CILLIERS, Bendict John PAGE: Anatomy of the middle cerebral artery : cortical branches, branching pattern and anomalies. Turk Neurosurg, 2016 online journal
  29. Ogeng’o JA, Njongo W, Hemed E, Obimbo MM,GimongoJ: Branching pattern of middle cerebral artery in an African population. Clin Anat 2011;24(6):692-698.
  30. Uchino A,Saito N,Okada Y,Nakajima R:Duplicate origin and fenestration of the middle cerebral artery on MH angiography.Surg Radio Anat 2012;34(5):401-404.
  31. Yamamoto H,Marubayashi T,Soejima T, Matsuoka S,Matsukado Y,Ushio Y:Accessory middle cerebral artery and duplication of middle cerebral artery-terminology,incidence,vascular etiology, and developmental significanc.Neurol Med Chir (Tokyo) 1992;32(5):262-267.
  32. Ture U, Yasargil MG, Al-Mefty O, Yasargil DC: Arteries of the insula. J Neurosurg 92(4): 676-687, 2000.
  33. Arthur et al: Microsurgical and Angiographic Anatomy of Middle Cerebral Artery Aneurysms: Prevalence and Significance of Early Branch Aneurysms. Operative Neurosurgery 2008; 62(5): 344–353.
  34. Chuwan Wang et al : Endovascular treatment of 48 early branch aneurysms of middle cerebral arteryworld neurosurgery 2016; 94:131-136.
  35. Teal JS, Rumbaugh CL, Bergeron RT, Segall HD. Anomalies of the MCA: Accessory artery, duplication and early bifurcation. AJR AmJ Roentgenol 1973; 118:567-575.
  36. Figueras F etal MCAdoppler indices at different sites prediction of umbilical cord gases in prolonged pregnancies. ultarsound Obstet Gynecol.2004.Oct;24(5):529-533.
  37. Ciszek B: Microsurgical aspects of the anatomy of the middle cerebral artery [Anatomia tetnicysrodkowej mozgu w aspekcie mikrochirurgicznym]. Doctoral dissertation, Warsaw, 1993.
  38. Eugeniusz Tarasow et al. Measurements of MCA in digital subtraction angiography and MR angiography. Med Sci Monit, 2007; 13 (1): 65-72.
  39. Zurada A1, Gielecki J, Tubbs RS, Loukas M, Maksymowicz W, Cohen-Gadol AA, Michalak M, Chlebiej M, Zurada-Zielińska A. Three-dimensional morphometrical analysis of the M1 segment of the middle cerebral artery: potential clinical and neurosurgical implications .Clin Anat. 2011 Jan;24(1):34-46.
  40. Krabbe- Hartkamp NJ, van der Grond J, de Leeuw FE et al: Circle of Willis: morphologic variation on three dimensional time-of-flight MR angiograms. Radiology, 1998; 207: 103-117.
  41. Yang H Liu J, Wang JC et al: Anatomical study and three dimensional image characteristic analysis of basicranial artery and its clinical significance. Zhonghua YII XueZa Zhi, 2003; 13-17.
  42. Pacholec E, Golebiowski M, Jakiewicz-Kochman E, Ciezsanowski A: Magnetic resonance angiography in visualizing the circle of Willis [Angiografi a rezonansu magnetycznego w obrazowaniu kola tetniczego mozgu]. Pol J Radiol, 2003; 68: 46-51.
  43. Rhoton AL Jr. Anatomy of secular aneursysms. Surg Neurol 1980; 14:54-66.
  44. Fabrice Vuillier et al : Main anatomical features of the M1 segment of the middle cerebral artery: a 3D time-of-flight magnetic resonance angiography at 3 T study Surgical and Radiologic Anatomy, August 2008, Volume 30, Issue 6, pp 509–514.
  45. Chang Sub Lee, M.D., Joong Cheol Park, M.D., Ji Kang Park, M.D.,2 and Ki Bum Sim, M.D Angiographic Pattern in the Early Branches of the Middle Cerebral Artery. J Korean Soc Radiol. 2011 Feb;64(2):103-108.

Cite this article: Hema. N, J.H. Sharieff. STUDY OF M1 SEGMENT OF MIDDLE CEREBRAL ARTERY IN HUMAN CADAVERIC BRAINS WITH CLINICAL IMPLICATIONS OF ITS EARLY BRANCHES. Int J Anat Res 2018;6(4.3):5936-5944. DOI: 10.16965/ijar.2018.376