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Position of intrasylvian cortical branches of middle cerebral artery on MRA original image Suzuki Yasuhiro Sizuoka saiseikai general hospital Shizuoka,

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Presentation on theme: "Position of intrasylvian cortical branches of middle cerebral artery on MRA original image Suzuki Yasuhiro Sizuoka saiseikai general hospital Shizuoka,"— Presentation transcript:

1 Position of intrasylvian cortical branches of middle cerebral artery on MRA original image Suzuki Yasuhiro Sizuoka saiseikai general hospital Shizuoka, Japan 2009

2 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.

3 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.

4 Terminology 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 M2 M3 M4

5 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

6 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 M1 superior trunk inferior trunk superior trunk inferior trunk M1 early branch

7 Temporopolar arteries originate from inferior trunk or from M1 (as early branches) in medial spaces of temporal lobes typical caseoverwright of eight cases

8 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

9 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. typical case overwright of eight cases

10 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 caseoverwright of eight cases

11 M3 portions of prefrontal arteries are in AAR of Sylvian fissure. M3 portions of posterior temporal arteries are under central sulci. typical case overwright of eight cases

12 M3 portions of precentral arteries are in AAR or under central sulci. M3 portions of posterior temporal arteries are under central sulci. typical case overwright of eight cases

13 Peak of orbitofrontal artery is approximately in this slice. M3 portions of temporaloccipital and angular arteries are under postcentral sulci. typical case overwright of eight cases

14 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. typical case overwright of eight cases

15 M3 portions of central arteries are under central sulci or under postcentral sulci. M3 portions of anterior parietal arteries are under postcentral sulci. typical case overwright of eight cases

16 M3 portions of anterior parietal arteries are under postcentral sulci. M3 portions of posterior parietal arteries are at posterior terminal of Sylvian fissure. typical case overwright of eight cases

17 M3 portion of MCA cortical branches Ascending branches Descending branches Under triangle part of frontal lobe Temporopolar A. In or under AAR of Sylvian fissure Orbitofrontal A. Prefrontal A. Precentral A. Anterior temporal A. Middle temporal A. Under central sulcus Precentral A. Central A. Posterior temporal A. Under postcentral sulcus Central A. Anterior parietal A. Temporaloccipital A. Angular A. Posterior terminal of Sylvian fissure Posterior parietal A.

18 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.


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