Accessory middle cerebral artery

• Concomitance of persistent primitive olfactory artery, accessory middle cerebral, and early bifurcated anterior cerebral arteries
• Accessory anterior cerebral artery of duplicate origin associated with accessory middle cerebral artery and anterior cerebral artery fenestration
• Diagnosis of C5 segmental vertebral artery using magnetic resonance angiography
• MRA, CTA and three-dimensional rotational angiography of incidentally detected bilateral accessory middle cerebral arteries
• Persistent primitive olfactory artery associated with accessory middle cerebral artery and partially duplicated anterior communicating artery
• Cortical Venous Approach for Transvenous Embolization of a Greater Sphenoid Wing Dural Arteriovenous Fistula: A Case Report
• Neuroimaging of middle cerebral artery anomalies: a report of three cases
• A Hybrid Approach for the Treatment of a Pure Arterial Malformation Located at an Accessory Middle Cerebral Artery. Cerebral Revascularization Followed by Endovascular Occlusion Using nBCA: Case Report

The accessory middle cerebral artery is a variant of the middle cerebral artery (MCA) that arises from the anterior cerebral artery (ACA). It is different from a duplicated middle cerebral artery, in which the duplicated vessel originates also from the distal end of the internal carotid artery (ICA).

The prevalence of accessory MCA is ~2%.

It runs parallel to the course of the MCA and supplies some of the MCA territory. The accessory MCA typically supplies anterior frontal lobe.

Accessory MCA may arise from either the proximal or distal portion of the A1 segment of the ACA. There are classification systems (Teal and Manelfe) which reflect this.

Other common embryological variants of the MCA include duplicated middle cerebral artery (vessel arising from the ICA bifurcation, and typically supplying the anterior temporal lobe), and fenestrated middle cerebral artery.

Accessory MCA may be present due to the persistence of two perforators. Early suggestions that the anomaly arises from a hypertrophied recurrent artery of Heubner (RAH) are now thought unlikely, as RAH often coexists, and the territory of supply is different. The vessel may be an anomalous early branch of the MCA.

There is an association between MCA variants and intracranial aneurysms. It is important to accurately document MCA anomalies as they have implications for operative or endovascular management ¹⁾

A case of distal origin accessory MCA associated with ACoA duplication diagnosed by magnetic resonance angiography (MRA).

A 63-year-old man visited another hospital for screening examinations for cerebrovascular disease. He was noted to have a possible intracranial aneurysm at the A1-A2 junction of the right anterior cerebral artery on MRA. He was referred to the hospital for its management. More detailed 3-Tesla MRA volume rendering images revealed ACoA duplication, not an aneurysm. MRA also showed the right distal origin accessory MCA arising from the A2 segment distal to the ACoA duplication.

This rare combination of anatomical variations requires careful imaging assessment. MRA volume rendering images were useful in this case ²⁾.

This case report effectively showcases the diagnostic capabilities of high-resolution MRA in identifying complex cerebrovascular anomalies. However, it could benefit from a more detailed exploration of the clinical and hemodynamic implications of the findings, as well as follow-up data to guide management strategies. Despite its limitations, the report is a valuable contribution to the understanding of rare anatomical variations and the importance of advanced imaging in neurovascular diagnosis.