Microsurgical anatomy of the proximal middle cerebral artery and the internal carotid artery bifurcation.

Knowledge of the distribution of the perforating branches along the proximal middle cerebral artery and at the internal carotid artery bifurcation is important for the surgeon approaching aneurysms and other lesions in these areas. The microsurgical anatomy of the proximal middle cerebral artery and the internal carotid artery bifurcation was analyzed in 36 fixed hemispheres. The number, size, and location of all perforators along the proximal middle cerebral artery and the internal carotid artery bifurcation were noted. Three distinct patterns of perforators arising from the proximal middle cerebral artery were found. The implications of the anatomical variations in this area are discussed.