Cited by 35Cerebrovascular and Carotid Artery DiseasesIntracranial Aneurysms: Treatment and ComplicationsMedical and Biological Sciences

The branching pattern of the middle cerebral artery: is the intermediate trunk real or not? An anatomical study correlating with simple angiography: Laboratory investigation

Kahilogullari, Gokmen, Ugur, Hasan Caglar, Comert, Ayhan, Tekdemir, Ibrahim, Kanpolat, Yucel·2012·Journal of neurosurgery

Abstract

OBJECT: The branching structure of the middle cerebral artery (MCA) remains a debated issue. In this study the authors aimed to describe this branching structure in detail. METHODS: Twenty-seven fresh, human brains (54 hemispheres) obtained from routine autopsies were used. The cerebral arteries were first filled with colored latex and contrast agent, followed by fixation with formaldehyde. All dissections were done under a microscope. During examination, the trunk structures of the MCA and their relations with cortical branches were demonstrated. Lateral radiographs of the same hemispheres were then obtained and comparisons were made. Angles between the MCA trunks were measured on 3D CT cerebral angiography images in 25 patients (50 hemispheres), and their correlations with the angles obtained in the cadaver brains were evaluated. RESULTS: A new classification was made in relation to the terminology of the intermediate trunk, which is still a subject of debate. The intermediate trunk was present in 61% of cadavers and originated from a superior trunk in 55% and from an inferior trunk in 45%. Cortical branches supplying the motor cortex (precentral, central, and postcentral arteries) significantly originated from the intermediate trunk, and the diameter of the intermediate trunk significantly increased when it originated from the superior trunk. In measurements of the angles between the superior and intermediate trunks, it was found that the intermediate trunk had significant dominance in supplying the motor cortex as the angle increased. The intermediate trunk was classified into 3 types based on the angle values and the distance to the bifurcation point as Group A (pseudotrifurcation type), Group B (proximal type), and Group C (distal type). Group A trunks were seemingly closer to the trifurcation structure that has been reported on in the literature and was seen in 15%. Group B trunks were the most common type (55%), and Group C trunks were characterized as the farthest from the bifurcation point. Group C trunks also had the smallest diameter and fewest cortical branches. Similarities were found between the angles in cadaver specimens and on 3D CT cerebral angiography images. Beyond the separation point of the MCA, trunk structures always included the superior trunk and inferior trunk, and sometimes the intermediate trunk. CONCLUSIONS: Interrelations of these vascular structures and their influences on the cortical branches originating from them are clinically important. The information presented in this study will ensure reliable diagnostic approaches and safer surgical interventions, particularly with MCA selective angiography.

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Crossref · 10.3171/2012.1.jns111013

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  1. [1][1] Houry, Guillaume, Boeken, Tom, Allassonnière, Stèphanie, and Feydy, Jean, 2026, Medical Image Computing and Computer Assisted Intervention – MICCAI 2025 Vol. 15968, pp 669, 978-3-032-05114-1 Crossref
  2. [2][2] Shahrabani, Ahmed M., Hoz, Samer S., Na, John, Hoffman, Harry, Kakazu, Aaron, Zucca, Beatrice, Johnson, Mark D., and Prestigiacomo, Charles J., 2026, "Cortical middle cerebral artery aneurysms: Scoping review of presentation and aneurysmal characteristics" Surgical Neurology International Vol. 17, pp 345, 2152-7806 Crossref
  3. [3][3] Iwasaki, Mitsuhiro, Saito, Makoto, Nemoto, Akihiro, Suzuki, Takanori, Hikita, Chiyoe, Fukuta, Shinya, Sato, Hiroaki, and Morimoto, Masafumi, 2018, "Diluted Contrast-enhanced Cone-beam CT during Acute-phase Recanalization Therapy for Occlusion of the Middle Cerebral Artery" Journal of Neuroendovascular Therapy 2186-2494 Crossref Metrics All Time Past Year Past 30 Days Abstract Views 6275 105 31 Full Text Views 1057 3 0 PDF Downloads 1514 5 0 EPUB Downloads 0 0 0 PubMed Citation Articles by Gokmen Kahilogullari Articles by Hasan Caglar Ugur Articles by Ayhan Comert Articles by Ibrahim Tekdemir Articles by Yucel Kanpolat Similar articles in PubMed Article by Gokmen Kahilogullari Article by Hasan Caglar Ugur Article by Ayhan Comert Article by Ibrahim Tekdemir Article by Yucel Kanpolat Similar articles in Google Scholar AANS logo © Copyright 1944-2026 American Association of Neurological Surgeons. All rights reserved, including those for text and data mining, AI training, and similar technologies. Permissions Legal Notices Feedback Editorial Boards CME For Advertisers Job Seekers JNSPG Shop Facebook Twitter Instagram Powered by PubFactory Powered by PubFactory [18.209.44.215] 18.209.44.215 Close My Stuff Sign in Sign up Home COVID-19 Journals Just Published For Authors For Librarians About Us Submit Subscribe Journal of Neurosurgery Journal of Neurosurgery: Spine Journal of Neurosurgery: Pediatrics Journal of Neurosurgery: Case Lessons Neurosurgical Focus Neurosurgical Focus: Video Journal of Neurosurgery Journal of Neurosurgery: Spine Journal of Neurosurgery: Pediatrics Journal Club COVID-19 Leksell Top 25 - Meningioma Leksell Top 25 - Vestibular Schwannoma Leksell Top 25 - Since 2005 Top 25 Cited Gamma Knife® Surgery Articles - Trigeminal Neuralgia Top 25 Cited Gamma Knife® Surgery Articles - Volume 111 Deep Brain Stimulation Best of 2017 Best of 2016 Best of JNSPG - 75th Anniversary Best of 2019 Best of 2020 Parkinson Disease: Top 25 Cited Articles Rhoton Editor's Choice About Us Editorial Boards Publishing Policies JNSPG Staff Job Seekers Contact Us Permissions JNSPG Shop Oxford University Press Partnership ProCite RefWorks Reference Manager BibTeX Zotero EndNote Buy Now

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Authors
Kahilogullari, G., Ugur, H. C., Comert, A., Tekdemir, I., & Kanpolat, Y.
Affiliations
  • Departments of Neurosurgery and
  • Anatomy, Ankara University, Faculty of Medicine, Ankara, Turkey
Venue
Journal of neurosurgery
Published
2012-05
Volume
116
Issue
5
Pages
1024-1034
ISSN
  • 0022-3085 (ISSN-L)
  • 1933-0693
OpenAlex
W1581062830
Cited by
35
References
36
Citations by year
2026: 2 · 2025: 3 · 2023: 6 · 2021: 3 · 2020: 2 · 2019: 3 · 2018: 2 · 2017: 3 · 2016: 5 · 2015: 2 · 2014: 3 · 2013: 1
FWCI
1.54
Type
journal article
Language
en
Open access
closed
Locations
  • Journal of neurosurgery (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cerebrovascular and Carotid Artery Diseases
  • Health Sciences › Medicine › Neurology › Intracranial Aneurysms: Treatment and Complications
  • Health Sciences › Medicine › Anatomy › Medical and Biological Sciences
Keywords
middle cerebral artery, arterial branching pattern, central arteries, cerebral angiography, cadaveric dissection, surgical safety, bifurcation points
MeSH terms
Cadaver, Cerebral Angiography, Cerebral Arteries, Cerebral Cortex, Cerebrovascular Circulation, Humans, Image Processing, Computer-Assisted, Temporal Arteries, Tomography, X-Ray Computed, Middle Cerebral Artery

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