K Mohan

Abstract

Background: Knowledge of the aortic arch branching pattern is important during supra-aortic angiography, aortic instrumentation, thoracic and neck surgery. The aortic arch (AA) is located in the superior mediastinum. In 65–80% of the cases, the three branches arise from the aortic arch, namely, the brachiocephalic trunk (BCT), the left common carotid artery (LCCA), and the left subclavian artery (LSA). Objective: The purpose of this study is to describe different branching patterns of the arch of the aorta in Indian subjects. Materials and Methods: This observational study is based on dissection performed on Sixty embalmed arches of the aorta in adult Indian cadavers (in manuscript it was written as, 20 dissected heart specimens were collected of still-born fetuses) were exposed and their branches examined during cadaveric dissection in the department of Anatomy. The anatomical variations of the arch of the aorta and its branches, its branches at site of origin, and the distance of each branch from the point of origin to the median plane were measured. Results: The usual three-branched pattern of arch of aorta was found in 44 specimens (73.33%). The common trunk for both brachiocephalic trunk and left common carotid artery was present in 11 specimens (18.33%). In 2 specimens (3.33%), the arch gives four branches. In 1 specimen (1.67%), give three branches. Conclusion: The wide spectrum of variations in the anatomical arrangement of the human aortic arch and its branches offer valuable information to catheterize the aortic arch and its branches for safely performing endovascular surgery. These anatomical and morphologic variations in the arch of the aorta and its branches are significant for diagnostic and surgical procedures in the thorax, head and neck regions.   Keywords: Thoracic aorta, Variations, Branches, Vascular surgery, Aortic arch.

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Abstract

Background: Middle cerebral artery (MCA) is the largest and most complex arterial system of the brain. Variations of the aortic arch branches are due to alteration in the development of specific branchial arch arteries during the embryonic period. Knowledge of these variations is important during aortic instrumentation, thoracic, and neck surgeries. The anatomy of the anterior cerebral artery branches and the anterior communicating artery complex needs to be investigated individually to minimise neurovascular morbidity before iatrogenic procedures. Aim: The study aimed to study the variations in the microsurgical anatomy of the MCA in our population and compare the variables and discuss their importance with anatomic and surgical considerations.  Materials and Methods: Specimens were collected from the embalmed cadavers and the post-mortem bodies in the department of forensic medicine of Thanjavur Medical College. The different variables regarding the MCA in our population were analysed and compared with the studies in the Western population and other Indian studies.  Results: The mean length of the MCA in this study was 12.8 mm with a standard error of 3.79 mm. The outer diameter of the M1 segment was with a mean length of 3.75mm. In 69.2% middle, Cerebral Artery shows bifurcation and in 20%, it shows trifurcation and in 10.8%, it shows ramification types of branching patterns. The 39.1% cases show Temporo polar, 21.7% orbitofrontal, 9.1% anterior temporal, 6.6% prefrontal, and 4.1% middle temporal branches. Our results also reveal that the origin of the lenticulostriate branch in the middle cerebral artery was 85.85% from the trunk and 14.2% from division, respectively. Conclusion: MCA branching pattern is slightly higher in trifurcation pattern as compared to bifurcation and ramification. Thorough knowledge of the microvascular anatomy and the myriads of variations is essential for the operating surgeon to choose the ideal technique to avoid any catastrophe during and after surgery and give the best possible functional outcome.   Keywords: Middle cerebral artery, Anatomical research, Branching patterns, M1 segment, Neurosurgical importance, Anterior, Posterior branching.

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