Accessory middle cerebral artery

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% (range 0.3-4.0%). 

Gross anatomy

It runs parallel to the course of the MCA and supplies some of the MCA territory. The accessory MCA typically supplies anterior frontal lobe (as in this case).

Accessory MCA may arise from either the proximal or distal portion of the A1 segment of the ACA.

There are classification systems which reflect this (Teal and Manelfe).

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.


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.

Related pathology

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.

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