Vol.:(0123456789) 1 3 Surgical and Radiologic Anatomy https://doi.org/10.1007/s00276-018-2074-5 ANATOMIC VARIATIONS Duplication of the middle cerebral artery in a neonate: case report Aleksandra Vuksanovic–Bozaric 1  · Batric Vukcevic 1  · Marija Abramovic 1  · Miroslav Radunovic 1 Received: 26 January 2018 / Accepted: 28 July 2018 © Springer-Verlag France SAS, part of Springer Nature 2018 Abstract The middle cerebral artery, a terminal branch of the internal carotid artery, participates greatly in the blood supply of the cerebral cortex and basal nuclei. The aim of this paper is to present a case of middle cerebral artery duplication in a 3-day-old neonate. A brief literature overview in this paper serves to summarize the research on the middle cerebral artery duplication. Also, possible etiology of this anatomical variation will be discussed, together with the embryology of the middle cerebral artery. The arteries of the circle of Willis are afected by numerous neurovascular diseases and the knowledge of these ana- tomical variations is important in the diagnostic and therapeutic interventions in this feld. Keywords Anatomical variation · Circle of Willis · Embryological development · Internal carotid artery · Middle cerebral artery Introduction The middle cerebral artery (MCA) arises from the bifurca- tion of the internal carotid artery (ICA), together with the anterior cerebral artery (ACA). MCA is phylogenetically the youngest artery of the brain, developing from the perforating branches which supply the cerebrum in its early stages of development. The MCA is divided in four topographic seg- ments: sphenoidal (M1), insular (M2), opercular (M3) and cortical segment (M4). M1 segment extends from the origin of the artery to its bifurcation. Also, other ways of branch- ing, such as trifurcation, are described. After the bifurcation, the branches of the MCA turn across the insular cortex (M2), after which they provide the blood supply to the frontal, parietal and temporal opercula (M3) and terminate by vascu- larizing the lateral surface of the cerebral hemisphere (M4) [1]. Anatomical variations of the MCA are rare and they usually appear as one of two main examples: duplication of the MCA and accessory MCA [1, 9]. The literature reports the duplicated MCA (dMCA) to appear approximately in 0.2–2.9% of all cases, while the accessory MCA (aMCA) appears in 0.3–4% of all cases [5]. In 1973, Teal et al. have proposed a definition of the dMCA: an arterial branch arising from the ICA after the origin of the anterior choroid artery and before the bifurcation of the ICA. On the other hand, aMCA is a branch of the ACA [7]. The importance of anatomical variations of the MCA lies in the diagnostic and therapeutical approach to neurovascular diseases. Case presentation A pathological autopsy was performed in the Department of Pathology, Clinical Center of Montenegro, aiming to determine the underlying disease and cause of death of a 3-day-old neonate. Upon birth, the neonate’s cry was absent and it showed signs of acute respiratory distress syndrome. The autopsy showed difuse alveolar damage and hyaline membranes in the lungs, which were recognized as the cause of the respiratory distress. The brain examination showed a duplication of the left MCA. The dMCA presented as a lateral branch of the ICA, arising proximally adjacent to the ICA bifurcation to the MCA and ACA. The course of the dMCA extended posteriorly to the Sylvian fssure, where it bifurcated. The branches of the dMCA supplied the tempo- ral pole of the hemisphere, where they terminated (Figs. 1). On the other hand, the M1 segment of the MCA provided a branch which supplied the inferior surface of the fron- tal lobe. Bifurcation of the MCA was located between its M1 and M2 segments and the remaining part of the MCA showed the usual course and ramifcation pattern. * Batric Vukcevic batricvukcevic@gmail.com 1 Faculty of Medicine, University of Montenegro, Ljubljanska 1, 20000 Podgorica, Montenegro