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01616412.1984.11739662

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Neurological Research
A Journal of Progress in Neurosurgery, Neurology and Neurosciences
ISSN: 0161-6412 (Print) 1743-1328 (Online) Journal homepage: http://www.tandfonline.com/loi/yner20
Normal Anatomy And Aneurysms Of The
Middle Cerebral Artery: A Morphological,
Neuroradiological And Clinical Study
Yao-Shan Yeh
To cite this article: Yao-Shan Yeh (1984) Normal Anatomy And Aneurysms Of The Middle
Cerebral Artery: A Morphological, Neuroradiological And Clinical Study, Neurological Research,
6:1-2, 41-48, DOI: 10.1080/01616412.1984.11739662
To link to this article: http://dx.doi.org/10.1080/01616412.1984.11739662
Published online: 20 Jul 2016.
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Date: 27 October 2017, At: 19:03
Normal anatomy and aneurysms of the
middle cerebral artery:
A morphological, neuroradiological and
clinical study
Yao-Shan Yeh*
Neurochirurgische Klinik, Giessen, F.R.G.
The middle cerebral artery (MCA) has been the focus
of interest of anatomical 5 - 13 , radiological 4 ?28 ?29 31
andии clinica1 1 ?19 ?27 ?38 studies for many years. These
contributions built up th e foundation for further microsurgi cal work 6 ?2 7 ?3 8 . The trunk and the main branches
are embedded in the depth of the Sylvian fissure and
have a complex course 6 ?14 and therefore the radiological diagnosis of lesions in this region is'
difficult 14 ?35 ?36 and this is the segment that has a predilection for aneurysms 22 ?25 ?27 ?38 . The purpose of this
study was to re-examine the anatomy of the MCA and
the relationship of aneurysms to the main branches.
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.3░и
ANATOMY
Thirty adult cadaver brains (60 MCAs) were examined.
Each branch of the MCA was dissected and tra<;:ed to its
terminal arborization (0.5 mm diameter) after
removing the arachnoid and the veins. Special attention was directed towards the horizontal segment. The
bran ching pattern of each MCA was drawn in detail
and photographs were taken.
MAIN BRANCHES AND BRANCHING PATTERN
The MCA was found to give off three main branches in
all the sixty specimens that were dissected. The MCA
divid es twice and the trunk from the bifurcation of the
ICA t o the first main branching is called trunk 1 (T 1 ) .
Afte r giving off the first main branch the trunk of the
MCA continues laterally and then divides into two
main branches. The continuation of the trunk after the
first main branching is called trunk 2 (T2 ). The point of
first branching is called branching 1 (B 1) and the point
of th e second main branching is called branching 2 (B 2 )
(Figure 1).
All the three main branches were found constantly
supply a particular lobe. The branch supplying the frontal lobe has been called the anterior (frontal) main
branch (Amb), the branch supplying the parietal lobe
as the posterior (parietal) main branch (Pmb) and that
supplying the temporal lobe as the inferior (temporal)
main branch (1mb).
After recognising that all the MCAs studied divided
twice, two branching patterns emerged. These have
been called Type I and Type II branching pattern.
(Figures 2 and 3). In Type I pattern the 1mb is given off
first and then T 2 continues and divides into the Amb
and the Pmb. In Type II the Amb is given off first and
then T 2 continues and divides into the 1mb and the
Pmb. Type I was found in twenty eight specimens and
Type II in thirty two specimens. Type I and Type II were
found equally distributed on the left side. On the right
side there were thirteen specimens of Type I and
seventeen specimens of Type II.
Type I
Type II
Left
15
15
Right
13
17
Total
28
32
CORTICAL BRANCHES
3
m<.~
in
b ran c hes
~1CA
ICA
Figure 1: Schematic representation of the trunk, main branches
and branching points.
3 main branches: anterior main branch for frontal lo b e, posterior
main branch for parietal lobe and inferior main branch for
temporal lobe.
ICA internal carotid artery
ACA anterior cerebral artery
MCA middle cerebral artery
(branching 1 ) first branching of MCA
81
(branching 2) second branching of MCA
B2
(trunk 1 ) proximal part of MCA trunk
T1
(trunk 2 ) distal part of M CA trunk
T2
?senior m edical research scientist of n eurosurge ry, Advanced
neu ros urgery labo ratory, Huntington Medical Research Institu te,
734 Fairmo unt Ave., Pa sadena, CA 91105 USA
"'1984 Bu tte rworth & Co (Pub lishers) Ltd
01 60 - 64 1 2/84/060041 - 08$ 03 .00
The three main branches were generally found to
give rise t o constant cortical branches 6 ?15 ?31 .
The branches of th e Amb were found t o be:
the orbitofrontal,
the prefrontal and
the precentral arteries.
The branches of the Pmb are:
the central,
the anterior parietal,
the posterior parietal and
the angular arteries.
The branches of the 1mb are:
the temporo-occipital,
the posterior temporal,
the middle temporal,
th e anterior temporal and
the t emporo-polar arteries.
But t he te mporo-po lar artery is a small branch wh ich is
not easy to identif/.
41
Middle cerebral artery: Yao-Shan Yeh
'
Type I
.и
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......
?
,и
I
\ .....и
-~
'.
\
I.
,
... / v
/
(
"и)_I.
.
.
.
))) A:
~L
.
/-..
I
._
... и-...-и-<..
Type II
'l ,)-'
;
.\ ...... /
Type III
rи/
и-и-.,
\
~Pmb
T1............
. .........
::::~::::::::::::::::::
,......_ ..
11111111111111
_..,_.,_,_._
Jllllfft::uu'l.????
Amb
anterior cerebral branch
Pmb
posterior cerebral branch
Imb
inferior cerebral branch
T1
( trunk1 ) proximal part of MCA trunk
T2
( trunk2 ) distal part of MCA trunk
~Amb
T
2 ........._ Imb
-
Figure 2: Thre e types of branching pattern
42
Neurologica l Research, 1984, Volume 6, Ma rch/june
Middle cerebral artery: Yao-Shan Yeh
Unusual origin from trunk 1
Four MCAs had cortical branches originating from T 2 .
They were one precentral artery, two central arteries
and one posterior parietal artery.
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Unusual origin from the neighboring main branches
The central and the angular arteries usually originate
from the Pmb. In sixty specimens the central artery
originated in forty eight from the Pmb and in eight fro m
the Amb, in two from the precentral artery (Am b) and
in two from T 2 . The angular artery originated from the
1mb in seven specimens. The pre-central artery originated normally from the Amb but in one specimen it
arose from the Pmb and in another from T 2 . The
unusual origin of the cortical b ra nches from other main
branches occurred fifteen tim es on the :right and eight
times on the left side.
a
Fron ta l
(
l obe
1
Amb
anterior cerebral branch
Pmb
posterior cerebral hranch
Imb
inferior cerebral branch
-ICA
Anomalies
In one specimen the angular artery originated from the
1mb and later in its course it gave rise to a large branch
which anastomosed with the Pmb (Figure 4). In
another an abnormally lon g T 2 was found wh ich
measured 87 mm. Accessory MCA, duplication or
fenestration were not seen in our specimens, but they
have been reported in the literature 7 .
THE COURSE OF THE MCA
This was studied using plastoid injections. The trunk of
the MCA runs laterally and enters the Sylvian fissure.
Usually here the trunk begins to divide into main
branches. The main branches then run laterally and
turn upwards at the limen insulae. This point of turning
is called the genu. The genu is situated on the anteroinferior part of the insula, is 2 .3-2.7 em lateral to the
bifurcation of the I CA and 4 em from the midline.
The insular segment begins at the genu. Then the
main or the cortical branches run on the surface of the
-
lllll\1111111
Figure 3: (a) Type I MCA (base view of left MCA) (b) Type II MCA
(bas e view of right M CA)
VARIATIONS AND ANOMALIES
In some of the specimens cortical branches arose
either from the trunk or from a main branch from which
they do not usually arise.
Unusual origin from trunk 1
The anterior temporal artery was found to arise from T 1
in thirty specimens (50% in 60 specimens). Ten of
these were in Type I and twenty were in Type II. In five
specim e nts the orbitofrontal artery arose from T 1
(8.2%). Fo ur w e re in Type I and o ne was in Typ e II. Two
of th e M CAs had both the anterior temporal and the
orbitofrontal arteries taking origin from T 1 .
N eurological Research, 1984, Volume 6, March/jun e
Amb
anterior cerebral branch
--ии~-~и.-~-:~и::-
Pmb
poster i or c erebral branch
---c:=:::
Irnb
inferior cerebral branc h
-c:=
11111111111111
Figure 4: Unusual origin of angular artery from the 1mb. (base
view of ri ght MCA)
43
Middle cerebral artery: Yao-Shan Yeh
retrosylvian region and it is tortuous as it runs across
the transverse gyrus of Hesch I. 34 ?35
The 1mb courses posteriorly and then inferiorly and
during its course it gives off the temporal cortical
branches. These run on the superior border of the temporal lobe, outlining it and then loop over the temporal
operculum to their respective areas of supply.
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.
Figure 5: Diagram of the course of the MCA
MCA middle cerebral artery
Amb anterior main branch of MCA (anterior cerebral branch)
Pmb posterior main branch of MCA (posterior cerebral
branch)
1mb inferior main branch of MCA (inferior cerebral branch)
insula and supply the insular cortex 6 ?33 ?34 ?35 . The
course of these branches is fan shaped, diverging from
the limen insulae upwards to separate into anterior,
posterior and inferior groups. (Figure 5) .
The Amb courses upwards and forwards over the
gyrus brevis of the insula. Its course across the insula is
short and it crosses the anterior part of the frontal operculum to reach the frontal lobe 29 .
The Pmb runs parallel to the gyrus longus of the
insula and its branches course posteriorly, diverging
across the length of the insula34 ?35 . The central and the
anterior and posterior parietal arteries are given off
successively, anteroposteriorly. They after division
course posterosuperiorly and reach their areas of supply. The last branch, the angular artery, courses in the
/
THE LENTICULOSTRIATE ARTERIES5 , 11 , 13, 16
These varied in number from 6 to 15 and in size from
0.2 to 2 mm. They were found to originated from T 1
alone or from T 1 and T 2 and in a few exclusively from T 2 .
They could arise from the Amb in a Type II MCA or at B1
but were never found to be given off at B2 . Three or four
vessels may arise in sporadic groups or single vessels
may be given off which divide later into two or
three branches.
MEASUREMENTS OF THE TRUNKS THE MCA
The length of T 1 is the distance between the origin of
the MCA a_nd B1 and the length of T 2 is the distance
between B1 and B2 . 16 T 1 measures 3 to 31 mm, with an
average of 13.5 mm. T 2 measures 1 to 41 mm w ith the
average being 12.2 mm. T 1 plus T 2 is the distance between the carotid bifurcation and B2 . It measures 11 to
53 mm with an average of 25.4 mm. The abnormally
-long T 2 has not been included in calculating the
average measurements.
Neuroradiology
The MCA has been described in four segments 14?28 ?31 .
The branching of the trunk is usually seen in the pars
sphenoidal is (M 1) . The branching pattern can be made
out in angiographic films.
IDENTIFICATION OF THE BRANCHING PAITERN
(Figure 6)
The branching pattern of the MCA can be identified
better in the Ap-view than in the lateral view due to
.I
rи-
.<
\..и'V
\
/
(
._
/j
.
и(. -и __. . ......._....
(
\. .
-~иииииииииии., - /
'.
.
-и __I ,... ......иии: \.~
./"" ..
I
.:
..и:,:
I
!-:.. -~и::,.., и и - ........;,и
~:::.:
~ ...~}....,,. ~\:~и:и:
(и.....
....
?
J
\
и~
.
\
~
=
~
,,
i~
?
,:-
a
b
Figure 6: Normal angiographi c f ilm showin g th e type of bran ching pattern in the A P-vi ew : (a) Typ e 1: 1mb is th e first b ranch of t he M CA. (b)
Type II: Amb is the first branch of the M CA. Key as Figure 4.
44
Neuro logical Research, 1984, Volum e 6, March/ jun e
Middle cerebral artery: Yao-Shan Yeh
~'I
.
.-и-. __.,.;;)и'
'\
.
\
----- ----- - --- \,--и -и ~и
each on the MCA. 86 aneurysms were analysed and 83
of these were found on the horizontal segment of the
MCA. Two of the remaining were fusiform and the
other was a mycotic aneurysm situated on one of the
cortical b ranches in the periphery. The situation of the
aneurysms were as follows:
Aneurysms on the trunk
Main branching aneurysms
Giant and large aneurysms
Fusiform aneurysms
Mycotic aneurysm
13
15.1%
58
67.4%
12
2
1
14.0%
2.3%
1.2%
The angiographic films of 72 patients with 7 4
aneurysms were studied to classify them according to
the new anatomical classification. The aneurysms have
Figure 7: Schematic representation of the reflections of the three
mainи branches. Key as Figure 4.
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Type I
superimposition of the arteries and oblique views are
useful and sometimes necessary. In the Type I MCA
the inferior main branch (1mb) divides from the trunk
at an angle of 80- 90 ░ and then courses downwards,
laterally and slightly forwards. In the Type II MCA the
anterior main branch (Amb) divides at an angle and
then curves upwards forwards and laterall/ 9 ?
IDENTIFICATION OF 8 1 AND 8 2
The first main branching (B 1 ) is usually located
13.5 mm lateral to the carotid bifurcation, on the lateral
half of the horizontal segments. The second branching
(B 2 ) is usually located 25.4 mm lateral to the carotid
bifurcation and is close to the genu. The site of B2 was
found either just before or after the genu.
IDENTIFICATION OF THE MAIN BRANCHES
The characteristic reflections 31 ?33 ?35 of the main
branches have been used to identify them and their
cortical branches.
In the Ap-film (Figure 7) the reflection of the Pmb is
situated medially and superiorly and its cortical
branches after reflection run horizontally laterally and
then upwards 34 ?35 . The Amb reflection is situated
superficially and inferiorly an d its cortical branches
after the reflection run oblique!Ц downwards and
laterally and then turn upwards и29 ?34 ?35 . The 1mb
reflection is located between the other two main
branches, however in some cases the identification of
the 1mb is difficult. A superior convexity and running
downwards of the cortical branches to the t emporal
lobe are characteristic findin gs 3 1 .
In the Lateral film: Th e supp lyin g areas ofth e cortical
branches are used to identify the branches 14 ?31 . The
reflections of the cortical branches on the superior
insular line are used, especially to identify the Pmb 35 .
The 1mb runs in the lower part of the Sylvian fissure
more or less parallel to the Pmb. It can be seen to take a
hair pin b end 3 1 as it turn s upwards and lateral ly to pass
through th e hori zontal limb of th e Sylvian fissure and
then downwards over the temporal operculum. The
1mb leaves the Sylvian fissure usually at its midpoint.
The Amb is usually superimposed by other vessels and
is therefore difficult to id entify, but it can be made out
by id entifying its corti cal branches an d following
th em proximally.
MCA aneurysms
In ou r se ri es t here were 89 cases with 9 1 aneurysms of
the MCA23 ?24 и 25 ?26 . Two patients had two aneurysms
Ne uro l ogical Research, 1984, Volume 6, March/june
Type II
Amb
anterior cerebral branch
Pmh
pos terior cerebral br anch
lmb
inferior cerebral branch
Aneurysms of different sites
1111111111111
C1D
Figure 8: Schematic representation of the sites and the direction
of projection of aneurysms on th e two types of MCA
Continuation of different sites on the MCA:
Aneurysm on the first branching of the MCA
B1
(bran ching,)
B1 Type I Aneu rysm on the first branching of a Type I MCA
B1 Type II Aneurysm on the first branching of a Type II MCA
Aneurysm on the second branching of the M CA
B2
(branching 2 )
B2 Type I Aneurysm on the secon d branching of a Type I
MCA
B2 Type II Ane urysm on the second branching of a Type II
MCA
T
Aneurys m on the trunk of the M CA (related to lenticulostriate
arteries)
Aneurysm on th e proximal part of the MCA trunk
(before the first branch ing)
Aneurysm on t he distal part of the MCA t ru nk (after
the first bran chin g)
Ane urysm on t he b ranching of a co rti cal branch from
the proximal part of the MCA trunk (unusual origin of
t he co rtical bran ch from t he MCA trunk)
45
Middle cerebral artery: Yao-Shan Yeh
,.
been divided into main branching aneurysms and
trunk aneurysms. There were found to be as follows:
Main branching aneurysms
Trunk aneurysms
Large and giant aneurysms
Fusiform aneurysms
Mycotic aneurysm
r
I
49
12
10
2
\
\
:'<
............ '\..
Downloaded by [Australian Catholic University] at 19:03 27 October 2017
The main branching aneurysms are classified
according to their site of origin and Type of MCA
(Figure 8).
Branching 1
34
B1 Type I
B1 Type II
19
15
Branching 2
11
B2 Type I
B2 Type II
5
6
Branching 1 and 2 (B 1B2 )
/
'-.-..
.......
.
\
и,......_/.;-;.,
... i
.и: . i
.,.и I/..
j
4
In two cases th e aneurysm arose from the main
branching but could not be exactly classified as the
contrast in the film was poor.
The trunk aneurysms have been classified into:
Trunk 1 (T 1) aneurysms
Trunk 2 (T 2 ) aneurysm
11
First branching aneurysms
The site of the first branching (B 1) is the commonest
site of the occurrence of MCA aneurysms. 8 1 Type I
aneurysms are located on the branching of the 1mb
from the trunk 1. The 1mb branches at an angle of
almost 90 and runs downwards and forwards. These
aneurysms will usually project caudally, ventrally and
laterally. T 2 and the 1mb surround the aneurysm 23 ?25 .
(Figure 9a) 8 1 Type II aneurysms occur on the fork of
the Amb and the trunk. The Amb branches at an angle
of about 90 and runs upwards, forwards and then
laterally and aneurysm in this location project cranially,
ventrally and laterally. T 2 and Amb surround these
aneurysms.
a
/
.I
I
lI
~>')
l:---и
.
..... .........
Second branching aneurysms
The projection of second branching aneurysms is
dependant on the direction of T 2 and the two main
branches and is a direct prolongation ofT 2 23 ?2 5. They
project laterally but may also project cranially or
craniolaterally, if T 2 is long and the second branching
takes place distal to the genu ofthe MCA. They can also
subdivided into B2 Type I and B2 Type II. 8 2 Type I
aneurysms are located on the fork between the Amb
and the Pmb and 8 2 Type II on the fork between the
1mb and the Pmb, but they are not infrequently surrounded by all the three main branches. (Figure 9a).
8 1 8 2 aneurysms
These are located on those MCAs where the first and
second main branchings are very close to each other.
The sites of the main branchings cannot clearly be
made out on the angiographic film, but during the
operation they can be distinguished. They project
laterally as a direct prolongation of T 1 and are surrounded by all the three main branches.
46
b
Neurological Res earch, 1984, Vo lum e 6, March/jun e
Downloaded by [Australian Catholic University] at 19:03 27 October 2017
Middle cerebral artery: Yao-Shan Yeh
c
Figure 9: Examples of different MCA aneurysms: (angiography)
_
.
(a) B1 Type I (Case D.G.)
Aneurysm locates in the first branchmg of the MCA, the f1rst
branch is the 1mb.
(b) B2 Type II (Case T. R.)
Aneurysm locates in the second branching of the MCA, the
first branch is the Amb.
(c) T 1 (Case M.M.)
Aneurysm locates on the trunk 1 (proximal part) of the MCA,
the first branch is 1mb.
Key as Figure 4.
Aneurysms on the trunk (Figure 9c)
They are located usually on T 1 but also occur on
T/ 2 ?25 ?27 ?38 and may be associated with the lenticulostriate arteries and project cranially or they may be
associated with a cortical branch arising as a variation
from T 1 and project caudally.
24 36 37
?
aneurysms 20 ' 22 ' ' '
large and gtant
They have to be classified separately as it is very often
difficult to locate their point of origin angiographical ly
and most of them have a wide neck which includes the
trunk and the main branching points.
DISCUSSION
The normal anatomy and branching pattern of the
MCA is complex. In the literature, so far published the
descriptions of main branching and branching
patterns 5и6.7и 8и14 и17 are confusing and contradictory to
each other. In this study, it has been observed the MCA .
always branches twice. Two types of branching pattern
were found in the sixty specimens. A third possible pattern where the Pmb is given off first, was not seen in our
specimens. It has been assumed that this pattern does
not exist. In the embryo as the three main branches of
the MCA develop, the Amb and the 1mb will be
separated from each other by the Pmb, which is in the
middle 14 и33 . As the MCA branches it can only give off
either the 1mb orthe Amb first and then divide again. It
cannot give off the Pmb first and then reunite to form
trunk 2 and later divide into the 1mb and the Amb.
Ne urologi cal Research, 1984, Volume 6, March/ june
The bifurcation pattern has been previously described by Jain (1964) 8, Salamon and Huang (1976) 3\
and Gibo eta/ (1981 ) 6. Gibo et al have differentiated
three types: equal, inferior trunk dominant and
superior trunk dominant bifurcation. The inferior trunk
dominant pattern corresponds to Type II, where the
Amb is given off first and T 2 which is larger, continues
and divides into the 1mb and the Pmb. The superior
trunk dominant bifurcation corresponds to Type I,
where the 1mb is given off first and T 2 is larger than the
1mb. In the equal bifurcation pattern a cortical branch
which is normally given off by the Pmb, arises from the
first branching main branch (unusual origin) and
therefore T 2 and the first main branch are equal in size.
For example when the angular artery arises from the
1mb in a Type I MCAorthe central artery from the Amb
in a Type II MCA.
It is recommended that terms bifurcation and trifurcation should be avoided. A bifurcation is defined as a
division of an arterial trunk into two branches as is typical for the I CA and the basilar artery. In the case of an
artery with three main branches as in the MCA, as
shown in our examinations, even in the few specimens
where the origin of the main branches were close to
each other, two separate branching points could be
distinguished and there is no trifurcation actually 14 .
The division of the MCA trunk into three main
branches therefore seems to be correct.
Unusual origin of cortical branches were found in
our specimens. Thirty anterior temporal arteries originated from T 1, 10 in Type I and 20 in Type II MCA.
When a cortical branch arose directly from T 1, it was
found commonly that the normal parent main branch
was given off at 8 2 ?
In the previous literature the measurement of the
length of the trunk ofthe MCA depended on where the
branching (bifurcation) was thought to take place. If
bifurcation was thought to take place at the first main
branching then the measurement of the trunk was
short and corresponds to T 1 in this study. If the bifurcation was thought to take place at the second main
branching then the measurement of the trunk was
longer and corresponds to T 1 plus T 1. This led to
different measurements being reported by different
authors. Hermen et a/. (1963) stated that the trunk
measured 14 mm (range 7 - 22 mm) 16. The other
authors reported the length of the MCA trunk from
16.6- 18 mm 5и7и16. If the measurement T 1 and T2 are
used the exact measurement of the trunk can b.e
made out.
The main branches and the branching pattern can
be identified in angiographic films. This is most useful
in cases of MCA aneurysms and in small space occupying lesions. MCA aneurysms can be classified according to the new anatomical description from
angiograms 2 s. From the foregoing classification it
becomes clear that the precise location of the
aneurysm can be made out preoperatively angiographically. From the location the direction of the
projection of the aneurysm can be predicted exactly
be
can
approach
operative
best
the
and
37
38
36
25
15
vessels
the
of
number
The
decided и и и и upon.
surrounding the aneurysms can also be predicted and
during the operation they can be identified, dissected
carefully and protected.
47
Middle cerebral artery: Yao-Shan Yeh
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ACKNOWLE DGEMENTS
I would like to acknowledg e the support given to my
work in West Germany by my sister Yao-Chen Li and
brother-in-la w Dak-Sum Li. I wish to thank Prof. H.W.
Pia and Prof. A. Oksche (Dept. of Anatomy in JustusLiebig University, Giessen) for their advice and Dr. Ravi
Ramamurth i for his help in the preparation of the
manuscript.
REFERENCES
1 Crompton, M.R., The pathology of ruptured middle cerebral
aneurysms with special reference to the difference between
sexes, Lancet 1962, II, pp 421-425.
2 Crompton, M. R., Mechanism of growth and rupture in cerebral berry aneurysms, Brit. Med. }. 1966, 1, pp 1138-1142.
3 Crosby, E. C. eta/., Correlative anatomy of the nervous system,
Mac Millan Company, New York, 1962.
,4 Dahlestrom, L. eta/., Anatomical and angiographic studies if
arteries supplying anterior part of temporal lobe, Acta
radiological Diagn. 1969, pp 257-263.
5 Fontana, H., La distribucion de ly arteria silveana. Congreso
latinoamerican o de nerocirugia Nov. 1979. Buenos aires.
6 Gibo, H. eta/., Microsurgical anatomy of the middle cerebral
artery, }. neurosurg. 1981, 54, pp 151-169.
7 Grellier P. et al., Etude radio-anatomi que du segment basal de
I' art ere Sylvienne. Neurochirurgi e 1978, 24, pp 22 7-2 34 .
8 Jain K. K., Some observation of the anatomy of the middle
cerebral artery, Canad. }. Surg. 1964, 7, pp 134-139.
9 Kaplan, H. A., A technique for anatomical study of the blood
vessel of brain, Anat. Rev. 1953, 116, pp 507-510.
10 Kaplan, H. A, Arteries of the brain. Acta Radio/. 1956, 46,
pp 364-370.
11 Kaplan, H. A., The lateral perforating branches of the anterior
and middle cerebral arteries, }. Neurosurg. 1965, 23,
pp 305-310.
12 Kaplan H.A and Ford D. H., The brain vascular system, Elsevier
Publisher company, Amsterdam, London, New York, 1966.
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Contact address: Huntingdon Research
Neurological Research, 1984, Volume 6, March/june
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