The anatomy of the callosomarginal artery: applications to microsurgery and endovascular surgery

Abstract

Background: The callosomarginal artery (CMA), the main branch of the pericallosal artery, courses in or near the cingulate sulcus and gives rises to 2 or more major cortical branches. There is confusion about the artery best fitting the definition of "callosomarginal artery." Distal anterior cerebral artery aneurysms represent 1.5% to 9% of intracranial aneurysms, and most often occur at the origin of the CMA. The microsurgical anatomic features of the CMA, its relationship with the pericallosal artery, and clinical implications are presented.

Methods: The origin, course, branching pattern, and diameter of the CMA and its branches and its relationship with the pericallosal artery were studied in 60 cerebral hemispheres, including cadaveric dissections and angiographic images.

Results: The CMA was present in 93.3% of hemispheres studied and arose mainly from A3 (55.2%), a mean of 3.11 +/- 1.90 cm from the anterior communicating artery. The mean diameter of the CMA at its origin was 1.53 +/- 0.36 mm. The CMA ran 1.28 +/- 0.89 cm until its first branch, describing an anterior convex curve backward and upward (60.7%). An average of 3 lesser branches originated from the CMA. The most consistent branch was the posterior internal frontal artery (67.9%). The mean diameter of the CMA branches was 0.93 +/- 0.33 mm.

Conclusion: These morphometric measurements can help neurosurgeons access lesions located in distal intracranial vessels. The vessel coursing the longest pathway in or near the cingulate sulcus and otherwise following Moscow's classic definition should be considered the CMA.