Study of Microsurgical Anatomy of Middle Cerebral Artery in Human Cadaveric Brain

ABSTRACT Background: Micro-dissection of cadaver specimens is the base, on which our knowledge of the intricate anatomy of the human brain. Microsurgical anatomy of middle cerebral artery (MCA) is of particulate interest to neurosurgeons as it is the largest and most complex arterial system of the brain. Although various studies have been done on MCA, no such study has been done taking into consideration large sample size of the Indian population. This study will be advantageous in improving knowledge of MCA and its variations. This will prove useful for neurosurgeons in performing microsurgeries. Objective: A study of the microsurgical anatomy of the MCA in human cadaveric brain; comparison of the findings with the existing studies and implication of these finding in micro-neurosurgical procedures. Materials and Methods: Sixteen formalin-fixed cadaveric brains, that is, 32 vessels from its origin from the internal cerebral artery to M1 segment with respect to diameter, length and branching pattern were studied under high magnification (operating microscope) and the data compared with literature. Results: The mean length of M1 was 24.1 ± 11 mm with the outer diameter of 3.1 ± 08 mm. An average number of perforators pre-bifurcation was 7 and post-bifurcation was 3. The pattern of branching of the main trunk was bifurcation (70%), trifurcation (20%) and tetrafurcation (10%), and amongst this, inferior trunk dominance was seen in 70%. An average number of early cortical branch was 3. Conclusion: The knowledge of anatomy of MCA and its variations is important for neurosurgical residents’ training and neurosurgeons dealing with MCA aneurysm management or bypass surgeries.