DOI QR코드

DOI QR Code

Middle Cerebral Artery Duplication : Classification and Clinical Implications

  • Chang, Hoe-Young (Department of Neurosurgery, Seoul Paik Hospital, Inje University College of Medicine) ;
  • Kim, Myoung-Soo (Department of Neurosurgery, Seoul Paik Hospital, Inje University College of Medicine)
  • 투고 : 2010.11.26
  • 심사 : 2011.02.27
  • 발행 : 2011.02.28

초록

Objective : Although there are several explanations for a duplicated middle cerebral artery (DMCA), its embryological origin is still an open question. We reviewed these anomalous vessels to postulate a theory of their different origins, sizes, and courses. Methods : A retrospective review of 1,250 cerebral angiographies, 1,452 computed tomography (CT)-angiographies, and 2,527 magnetic resonance (MR)-angiographies was performed to identify patients with DMCA. Results : Twenty-five patients had 25 DMCAs. Conventional angiography detected nine patients with DMCA (9/1250, 0.72%), MR-angiography detected seven patients with DMCA 0.28%), and CT-angiography detected nine patients with DMCA (9/1452, 0.62%). The DMCAs originated near the internal carotid artery terminal in eight patients (type A), and between the origin of the anterior choroidal artery and the terminal internal carotid artery in 17 patients (type B). The diameters of the eight type A DMCAs were the same or slightly smaller than those of the other branch of the DMCA. All type A DMCAs showed a course parallel to that of the other branch of the DMCA. The diameters of the 17 type B DMCAs were the same, slightly smaller, or very much smaller than that of the other branch of the DMCA. Nine type B DMCAs showed parallel courses, and the other eight curved toward the temporal lobe. Conclusion : The two branches of the type A DMCAs can be regarded as early bifurcations of the MCA. The branches of the type B DMCAs had parallel courses or a course that curved toward the temporal lobe. The type B DMCA can be regarded as direct bifurcations of the MCA trunk or the early ramification of the temporal branch of the MCA.

키워드

참고문헌

  1. Abanou A, Lasjaunias P, Manelfe C, Lopez-Ibor L : The accessory middle cerebral artery (AMCA). Diagnostic and therapeutic consequences. Anat Clin 6 : 305-309, 1984 https://doi.org/10.1007/BF01654463
  2. Choi JW, Joo SP, Lee JK, Kim TS : Middle cerebral artery variations. Associated with intracranial aneurysmal rupture. J Korean Neurosurg Soc 39 : 467-470, 2006
  3. Crompton MR : The pathology of ruptured middle-cerebral aneurysms with special reference to the differences between the sexes. Lancet 2 : 421-425, 1962
  4. Dong LW, Yamada K, Ohta T, Takahashi N : [Ruptured intracranial aneurysm combined with multiple cerebral vessel anomalies; a case report.] No Shinkei Geka 19 : 975-978, 1991
  5. Fuwa I, Matsukado Y, Wada H : [Intracranial aneurysms associated with the accessory middle cerebral artery and duplication of the middle cerebral artery. Report of two cases.] Neurol Med Chir (Tokyo) 24 : 207-211, 1984 https://doi.org/10.2176/nmc.24.207
  6. Gibo H, Carver CC, Rhoton AL Jr, Lenkey C, Mitchell RJ : Microsurgical anatomy of the middle cerebral artery. J Neurosurg 54 : 151-169, 1981 https://doi.org/10.3171/jns.1981.54.2.0151
  7. Imaizumi S, Onuma T, Motohashi O, Kameyama M, Ishii K : Unruptured carotid-duplicated middle cerebral artery aneurysm : case report. Surg Neurol 58 : 322-324, 2002 https://doi.org/10.1016/S0090-3019(02)00887-X
  8. In S, In K, Kusano N, Mizuki H, Miyagi J, Kuramoto S : [A case of duplication of the middle cerebral artery with ruptured aneurysm on its origin during pregnancy (author's transl).] No Shinkei Geka 9 : 337-341, 1981
  9. Kai Y, Hamada J, Morioka M, Yano S, Kudo M, Kuratsu J : Treatment of unruptured duplicated middle cerebral artery aneurysm : case report. Surg Neurol 65 : 190-193; discussion 193, 2006 https://doi.org/10.1016/j.surneu.2005.05.032
  10. Kaliaperumal C, Jain N, McKinstry CS, Choudhari KA : Carotid "trifurcation" aneurysm : surgical anatomy and management. Clin Neurol Neurosurg 109 : 538-540, 2007 https://doi.org/10.1016/j.clineuro.2007.04.006
  11. Kang SD, Kim JM : An aneurysm arising at the site of the middle cerebral artery duplication. J Korean Neurosurg Soc 25 : 1318-1322, 1996
  12. Kitami K, Kamiyama H, Yasui N : [Angiographic analysis of the middle cerebral artery in cerebral aneurysms--its branching pattern and so-called vascular anomalies.] No Shinkei Geka 13 : 283-290, 1985
  13. Komiyama M, Nakajima H, Nishikawa M, Yasui T : Middle cerebral artery variations: duplicated and accessory arteries. AJNR Am J Neuroradiol 19 : 45-49, 1998
  14. Nomura M, Yamashima T, Kita D, Kida S, Kajinami K, Yamashita J : Duplication of the middle cerebral artery associated with an unruptured aneurysm. Acta Neurochir (Wien) 142 : 221-222, 2000 https://doi.org/10.1007/s007010050029
  15. Teal JS, Rumbaugh CL, Bergeron RT, Segall HD : Anomalies of the middle cerebral artery : accessory artery, duplication, and early bifurcation. Am J Roentgenol Radium Ther Nucl Med 118 : 567-575, 1973 https://doi.org/10.2214/ajr.118.3.567
  16. Uchino M, Kitajima S, Sakata Y, Honda M, Shibata I : Ruptured aneurysm at a duplicated middle cerebral artery with accessory middle cerebral artery. Acta Neurochir (Wien) 146 : 1373-1374; discussion 1375, 2004 https://doi.org/10.1007/s00701-004-0353-x
  17. Umansky F, Dujovny M, Ausman JI, Diaz FG, Mirchandani HG : Anomalies and variations of the middle cerebral artery : a microanatomical study. Neurosurgery 22 : 1023-1027, 1988 https://doi.org/10.1227/00006123-198806010-00008
  18. 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 significance. Neurol Med Chir (Tokyo) 32 : 262-267, 1992 https://doi.org/10.2176/nmc.32.262

피인용 문헌

  1. Aneurysm at origin of duplicated middle cerebral artery associated with another aneurysm vol.6, pp.22, 2011, https://doi.org/10.4103/2152-7806.168069
  2. An Unruptured Cerebral Aneurysm at the Origin of the Duplicated Middle Cerebral Artery vol.17, pp.3, 2011, https://doi.org/10.7461/jcen.2015.17.3.223
  3. Twin Middle Cerebral Artery with Aneurysm: A Variant of Early Bifurcation or a Discrete Entity vol.8, pp.1, 2017, https://doi.org/10.4103/jnrp.jnrp_27_17
  4. Cerebral Artery Diameter in Inbred Mice Varies as a Function of Strain vol.12, pp.None, 2018, https://doi.org/10.3389/fnana.2018.00010
  5. Duplicated middle cerebral artery origin with an aneurysm vol.97, pp.9, 2011, https://doi.org/10.1097/md.0000000000009947
  6. Duplicated middle cerebral artery associated with aneurysm at M1/M2 bifurcation: a case report vol.12, pp.1, 2018, https://doi.org/10.1186/s13256-018-1824-7
  7. Neuroanatomy of the middle cerebral artery: implications for thrombectomy vol.12, pp.8, 2011, https://doi.org/10.1136/neurintsurg-2019-015782
  8. Correlation between multiple cerebral aneurysms and a rare type of segmental duplication of the middle cerebral artery vol.20, pp.1, 2011, https://doi.org/10.1186/s12883-019-1588-8
  9. Neuroangiography patterns and anomalies of middle cerebral artery: A systematic review vol.12, pp.None, 2011, https://doi.org/10.25259/sni_125_2021
  10. A case of an unruptured duplicated middle cerebral artery aneurysm-An unusual presentation of the distal internal carotid artery aneurysm vol.23, pp.3, 2011, https://doi.org/10.7461/jcen.2021.e2020.10.004