A Study on Branching Pattern of Middle Cerebral Artery and its Variations: A Systematic Review and Meta-analysis

Area of Science:

• Neuroanatomy
• Vascular Neurology
• Neurosurgery

Background:

• The middle cerebral artery (MCA) is vital, supplying 80% of brain blood flow, including motor and sensory cortex areas.
• Accurate MCA anatomy knowledge is critical for preventing complications during neurovascular interventions like thrombolysis, angiography, and stent insertion.

Purpose of the Study:

• To comprehensively describe the anatomical variations and morphometric characteristics of the middle cerebral artery (MCA).
• To provide detailed data on MCA branching patterns and segment dimensions for improved neurosurgical and endovascular procedure planning.

Main Methods:

• Analysis of MCA branching patterns, including bifurcations, trifurcations, and quadrifurcations.
• Measurement of M1, M2, and M3 segment lengths and diameters, with comparisons based on sex, side, and aneurysmal status.
• Identification and categorization of accessory MCA origins and MCA fenestration defects.

Main Results:

• MCA termination variations are common: bifurcation (64.70%), trifurcation (12.35%), and quadrifurcation (2.35%).
• Significant differences in M1 segment volume, length, and diameter were observed between sexes, hemispheres, and in relation to aneurysms.
• M2 and M3 segment diameters also showed variations, with larger diameters noted on the left side and in females for M2.

Conclusions:

• The study highlights significant anatomical variability in MCA branching and dimensions, crucial for interventionalists.
• Detailed morphometric data on MCA segments (M1, M2, M3) offer valuable insights for neurosurgical planning and risk assessment.
• Understanding these anatomical nuances, including fenestrations and accessory arteries, can enhance the safety and efficacy of cerebrovascular procedures.