The callosomarginal artery is the second major branch of the anterior cerebral artery (ACA), arising from the ACA just after the anterior communicating artery and running posteriorly in the cingulate sulcus, supplying the cingulate gyrus, the supplementary motor area, and the medial and parasagittal frontal cortex. It is a major territory artery in most individuals, though its presence and size are variable.
Callosomarginal artery infarction produces leg-predominant contralateral weakness (from medial motor strip involvement) and may cause transcortical motor aphasia if the dominant hemisphere supplementary motor area is involved. In ACA aneurysm surgery, the callosomarginal artery origin must be identified and preserved during clipping. Distal ACA aneurysms (A3 segment) typically involve the callosomarginal-pericallosal bifurcation. The callosomarginal territory is at risk during interhemispheric approaches to the corpus callosum, where the cingulate gyrus is retracted to expose the callosal surface.
Callosomarginal artery territory infarction produces contralateral leg and foot weakness and sensory loss from medial motor strip and somatosensory cortex involvement, with the arm and face relatively spared compared to MCA stroke; supplementary motor area involvement causes transient mutism and reduced spontaneous movement on the ipsilateral side as well.
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