Download a study of temporal branches of middle cerebral artery

J. Anat. Sciences, 23(2) : Dec. 2015, 15-21
Original Article
A STUDY OF TEMPORAL BRANCHES OF
MIDDLE CEREBRAL ARTERY
Medha Das*, Shirin Jahan*, Pranjal Pankaj**
* Department of Anatomy, Rama Medical College, Mandhana
** Department of Medicine, Rama Medical College, Mandhana.
ABSTRACT
Introduction : The microsurgical anatomy of middle cerebral artery is of particular interest to the cerebrovascular surgeons
as it supplies the most of the superolateral surface of cerebral hemispheres and is the most commonly involved artery in
stroke.. There are cases in which a temporal branch might represent the preferred recipient vessel when considering a
patient for microsurgical cerebral revascularization. However, descriptions of the middle cerebral temporal branches which
we found in the literature did not correlate with our preliminary observations of these arterial branches .Objective : This
study was done to define further the arterial anatomy of the temporal lobe, hoping to find immediate application of our
findings in the field of microsurgical cerebral revascularization.
Materials and Methods : Total 20 middle cerebral arteries were studied obtained from 10 brains .Meticulous dissection
was done and middle cerebral artery was exposed and cleaned in lateral sulcus on the inferior surface of brain. Its temporal
branches were studied in detail .Digital photographs were taken.
Result : In 16 out of 20 Middle cerebral arteries studied, a temporal branch was the first branch taking origin from M1
segment of Middle cerebral artery. In rest 4 specimens orbitofrontal artery was the first branch ,temporal being the second.
Keywords : middle cerebral artery , M1 segment ,temporal branches ,stroke , cerebral revascularization .
INRTODUCTION : The middle cerebral artery (MCA) is
one of the three major paired arteries that supplies
blood to the cerebrum . The MCA arises from the
internal carotid artery as the larger terminal
branch.At first it runs in the lateral fissure ,then
posterosuperiorly on the insula ,and divides into
branches distributed to the insula and the adjacent
lateral cerebral surface. It also supplies blood to the
anterior temporal lobes and the insular cortices[1].
The left and right MCAs arise from bifurcations of the
internal carotid arteries and thus are connected to
the anterior cerebral arteries and the posterior
communicating arteries, which connect to the
posterior cerebral arteries. The MCAs are not
considered a part of the Circle of Willis.
The middle cerebral artery can be classified into 4
parts[2]
• M1: The sphenoidal segment, so named due to
its origin and loose lateral tracking of the
sphenoid bone. Although known as the
horizontal segment, the segment may descend,
remain flat, or extend posteriorly in different
individuals. The M1 segment perforates the
brain with numerous anterolateral central
(lateral lenticulostriate) arteries, which irrigate
the basal ganglia.
• M2: Extending anteriorly on the insula, this
segment in known as the insular segment. It is
also known as the Sylvian segment when the
opercular segments are included. The MCA
branches may bifurcate or sometimes trifurcate
into trunks in this segment which then extend
Address for Correspondence :
Dr Medha Das
Assistant Professor Department of Anatomy Rama Medical College Hospital & Research Institute
Mandhana, Kanpur - 209217
Email: drmedhadas@rediffmail.
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A Study of Temporal Branches of Middle Cerebral Artery
into branches that terminate towards the
cortex.
• M3: The opercular segment extends laterally,
exteriorly from the insula towards the cortex.
This segment is sometimes grouped as part of
M2.
• M4: These finer terminal or cortical segments
irrigate the cortex. They begin at the external
end of the Sylvian fissure and extend distally
away on the cortex of the brain.
The branches (ramus) of the MCA can be described
by the areas they irrigate.The temporal
lobe
branches are named as:[3-4]
• Temporopolar: The artery extends from the
sphenoidal segment of the MCA via the
operculum inferior surface and supplies the
polar and anterior lateral portions of the
temporal lobe. The vessel can be identified in
52% of normal angiograms
• Anterior temporal: This artery extends in a
similar fashion as the temporopolar and
vascularises the same regions.
• Middle temporal: This artery extends from the
Sylvian fissure opposite to the inferior frontal
gyrus and suppies the superior and middle
portion of the middle temporal lobe. It can be
identified in 79% of angiograms.
• Posterior temporal: This artery extends out and
away from the operculum and turns in a
step-wise manner first inferiorly then
posteriorly into the superior temporal sulcus
then to the middle temporal sulcus. This vessel
supplies the posterior portion of the temporal
lobe and is the origin of several perforating
arteries that irrigate the insula. It is readily
identifiable most angiogram
Materials and methods
The present work was carried out in Department of
Anatomy , RIMS, Ranchi and continued in Rama
medical college,Kanpur. Middle cerebral artery was
observed in the brain obtained from cadaver used for
routine educational dissection .Total 20 MCAs were
studied obtained from 10 brains .
After removal of brain from the skull ,blood vessels
on the base of brain were cleaned from piamater on
the external surface of which it lies.Through
meticulous dissection middle cerebral artery was
cleaned and variation in origin of temporal branches
was observed. Digital photographs were taken.
OBSERVATION AND RESULTS
In all the cadavers middle cerebral artery originated
from internal carotid artery (ICA) as the larger
terminal branch opposite optic chiasma . In 16 out of
the 20 middle cerebral arterial specimens, the first
major branch of the middle cerebral artery was a
branch or trunk supplying the temporal lobe .In rest
four specimen orbitofrontal artery(OBF) was the first
branch originating from M1 segment of MCA
;temporal being the second .[Table No. 1]
In 10 out of 16 specimens the first trunk from M1
segment immediately divided into temporopolar and
anterior temporal artery (Fig.1) .The middle and
posterior temporal artery were taking origin from
inferior division in these cases .
In 4 out of 16 specimen the first branch was
temporopolar artery(TPA) arising separately from
M1 segment of MCA(Fig.2). In these cases, second
branch from M1segment was orbitofrontal artery.
Other temporal branches ; anterior temporal(ATA)
and middle temporal(MTA) were taking origin from
inferior division of MCA which continued as posterior
temporal artery(PTA).
In 2 out of 16 specimens the branch from M1
segment was a large arterial trunk supplying entire
temporal lobe by forming temporopolar ,anterior
temporal ,middle temporal and posterior temporal
arteries and then continuing as angular
artery(Fig.3).[Table No.2 ].
In these specimens only the origin of MTA and PTA
was from M1segment of MCA ;in rest 18 specimens
their origin was from inferior division of M2
segment.[Table No. 3 ]
In remaining 4 specimen where the first branch from
M1 segment of MCA was orbitofrontal artery ,the
second branch was a trunk which divided into
temporopolar and anterior temporal artery (Fig. 4)
.Middle temporal and posterior temporal arteries
were taking origin from inferior division .
These temporal branches or trunk arose from the
middle cerebral artery proximal or opposite to the
lenticulostriate arteries in 12 of the 20 cases (Fig.5),
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Medha Das, Shirin Jahan, Pranjal Pankaj
and distal to the lenticulostriate arteries in eight
cases.
After arising from the middle cerebral artery, the
temporal branches coursed over the superior surface
of the temporal pole and temporal lobe. Individual
branches then emerged from the Sylvian fissure and
ran posteroinferiorly over the superior temporal
gyrus to supply the anterior, middle, and posterior
parts of the temporal lobe .
The temporopolar artery arose as a branch of M1
segment in all the specimen and travelled in the
pia-arachnoid anteroinferiorly over the anterior and
medial aspects of the temporal pole .During the
arterial dissections, the arterial branches emerging
from the Sylvian fissure were arbitrarily grouped into
anterior, middle, or posterior temporal branches.
TABLE No. 1 showing first branch from M1 segment
of MCA
First branch of
M1segment of MCA
TABLE No.2 showing branching pattern of first
temporal trunk from M1 segment of MCA
16
Orbitofrontal artery
4
16
Combined trunk for temporopolar and
anterior temporal artery
10
Temporopolar artery arising separately
from M1 segment
4
Single trunk from M1 segment giving
origin to all temporal branches
2
TABLE No. 3 showing origin of MTA and PTA from
MCA
Origin of MTA
and PTA
Number of specimen
Temporal trunk
Total No. of specimen with temporal trunk
as first branch from M1 segment
Total
specimen
20
From M1
from M2 segment
segment of MCA of MCA (interior
division )
2
Fig. 01 showing origin of TPA and ATA by a common trunk from M1 segment of MCA
.ICA =internal carotid artery,MCA=middle cerebral artery ,TPA=temporopolar
arety ,ATA =anterior temporal artery
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A Study of Temporal Branches of Middle Cerebral Artery
Fig.02 Showing origin of TPA separately as the first branch of M1 segment of MCA .ICA
=internal carotid artery,MCA =middle cerebral artery ,TPA = temporopolar artey ,OBF
= orbitofrontal artery
Fig. 03 showing a large trunk from MCA supplying the temporal lobe by forming
TPA, ATA ,MTA ,PTA and then continuing as angular artery. MCA=middle cerebral
artery,TPA= temporopolar artery ,ATA = anterior temporal artery ,MTA =middle
temporal artery ,PTA =posterior temporal artery
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Medha Das, Shirin Jahan, Pranjal Pankaj
Fig.04 showing origin of TPA and ATA by a common trunk from M1 segment ; in
these specimen the first branch from M1 segment was OBF artery.OBF=
orbitofrontal artery,TPA =temporopolar artery ,ATA= anterior tempolar artery
Fig : 05 showing origin of temporal branch opposite lenticulostriate branches.
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A Study of Temporal Branches of Middle Cerebral Artery
DISCUSSION
The microsurgical anatomy of MCA has interested
many researchers for years specially with the advent
of microneurosurgical techniques in cerebrovascular
surgery . Ring and Waddington [5-7] have described
the terminal configuration of the middle cerebral
artery, as well as the branching pattern of the artery
within the Sylvian fissure. Foix and Levy[8] described
an anterior temporal branch coursing from the
middle cerebral artery near its origin, and Vander
Eecken [9] mentions an anterior temporal artery as
well as an inconstant temporopolar artery. The
origins of the temporopolar artery and the anterior
temporal artery have been illustrated by Stephens
and Stilwell [10] in their meticulous photographic
study of the cerebral vasculature, and the
angiographical anatomy of the temporopolar
branches has been illustrated by Dahlstrom et al [11].
In 1967 Donaghy and Yasargil, working independently
at that time, each constructed in a patient a
superficial temporal artery-cortical artery vascular
bypass in an effort to relieve symptoms of
cerebrovascular insufficiency [12-13]. This procedure
has now been done by many neurosurgeons
throughout the world, but evaluation of the
procedure as a means of mitigating the effects of
cerebrovascular disease remains in the embryonic
stage. Yasargil has recommended that an arterial
branch lying on the temporal lobe be used as a
convenient recipient for such microsurgical
anastomoses.However, in cases of middle cerebral
artery stenosis or occlusion, such an artery may not
be a suitable recipient. If such patient is subjected to
such surgery, and if an artery lying on the anterior
temporal lobe had been used as the recipient vessel,
the angiogram demonstrates that any new collateral
blood delivered from the superficial temporal artery
via the anastomosis either would have been carried
into the middle cerebral artery proximal to the
occlusion, or would have been carried distally into
the terminal branches of the temporal arteries. None
would have been delivered to the ischemic area of
the cerebral hemisphere distal to the middle cerebral
artery occlusion.
Delong (1973) had studied temporal branches of
MCAs in 23 specimen. He reported that Nineteen out
of 23 middle cerebral arterial specimens had as the
first major branch of the middle cerebral artery a
sizable anterior temporal artery; a trunk forming the
anterior and middle temporal branches; a trunk
forming the anterior, middle, and posterior temporal
arteries; or a trunk forming temporal and angular
arterial branches [14]. In 14 specimens the first major
branch of the middle cerebral artery was an anterior
temporal-middle temporal-posterior temporal trunk,
a temporalangular trunk, or an anterior
temporal-middle temporal trunk. In three specimens,
the first major branch was the anterior temporal
artery which was followed immediately by a middle
temporal-posterior temporal- angular trunk . In two
specimens the first major branch was the anterior
temporal artery, with the middle and posterior
temporal branches arising more distally from the
middle cerebral complex . In the remaining four
specimens, the orbitofrontal and operculofrontal
complexes arose proximal to the origins of the
temporal branches.
1n 1984, Umansky studied microsurgical anatomy of
proximal segment of middle cerebral artery in 70
specimens. The authors studied the outer diameter
(OD), length, site of origin, and pattern of branching
of the main trunk, secondary trunks, and the initial
insular portion of the cortical branches of the MCA. .
The mean OD of the cortical branches measured near
their origin in the main and secondary trunks
indicated that the angular artery was the largest
vessel, with a mean OD of 1.5 mm on both sides of
the brain. The temporopolar artery was the smallest,
with a mean OD of 0.8 mm in the right hemisphere
and 0.9 mm in the left hemisphere [15].
In 2005,Pai and Varma did dissection based study on
the microsurgical anatomy of the MCA .In all 10
MCAs they studied the temporopolar(TPA) and the
anterior temporal (ATA) arose as a common trunk. In
few cases, the middle temporal artery (MTA), and the
posterior temporal artery (PTA) arise as a common
trunk from the M1 segment [16].
Ogengo (2011) studied branching pattern of middle
cerebral artery in African population. In this study
early cortical branch was reported in 47% of the cases
.In 63.9% of these 47% cases ,the early cortical
branch was a temporal trunk [17].
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Medha Das, Shirin Jahan, Pranjal Pankaj
CONCLUSION
There are cases in which a temporal lobe arterial
branch might represent the preferred recipient vessel
when considering a patient for microsurgical cerebral
revascularization. In patients harbouring surgically
inaccessible internal carotid stenoses or occlusions,
microsurgical anastomosis of the superficial
temporal artery to an anterior temporal arterial
branch might result in the delivery of a new blood
supply proximal to the lenticulostriate arteries close
to the origin of the middle cerebral artery. Such an
anastomosis in these cases would be ideal for
potentially perfusing the ischemic middle cerebral
arterial tree.
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