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Chrissicopoulos C, Mavrovounis G, Piagkou M, Triantafyllou G, Nasis N, Stranjalis G, Andreou A, Kalamatianos T. The Anatomical Variation of the Distal Anterior Cerebral Artery: An Angiographic Study in a Greek Population Sample. Cureus 2024; 16:e54800. [PMID: 38529447 PMCID: PMC10961669 DOI: 10.7759/cureus.54800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 03/27/2024] Open
Abstract
Objective The current retrospective angiographic study establishes the rates of variants in the distal anterior cerebral artery (DACA) in a sample of the Greek population. Methods Data were collected from 456 patients who underwent two-dimensional (2D) or three-dimensional (3D) digital subtraction angiography (DSA) of the carotid and vertebral arteries bilaterally. The study focused on patients with good visualization of the anterior and posterior circulations and employed magnetic resonance (MR) or computed tomography (CT) angiography for 3D reconstruction. The anterior cerebral artery (ACA) was classified into one of its two basic configurations, that is, with or without the callosomarginal artery (CMA). The bihemispheric, median, and azygos ACA patterns were also identified. Results The majority (373/456, 81.8%) exhibited a typical DACA pattern. The bihemispheric, median, and azygos patterns were identified in 66/456 (14.5%), 10/456 (2.2%), and 7/456 (1.5%), respectively. The CMA was present in 824/912 (90.4%) of the hemispheres, with a trend toward male predominance for bilateral presence (males: 167/192, 86.98%; females: 210/264, 79.55%; p = 0.05). In particular, the CMA was present significantly more frequently (p = 0.002) in the left hemispheres of male patients. Gender differences in CMA presence persisted in the analysis of the patients with a typical DACA pattern. Conclusion This study provides insights into the variations of the DACA in the Greek population. The observed gender differences in CMA rates suggest potential morphological variations in cerebral vasculature between males and females and contribute to a better understanding of vascular anatomy for clinical and surgical applications.
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Affiliation(s)
| | | | - Maria Piagkou
- Anatomy, National and Kapodistrian University of Athens, Athens, GRC
| | | | - Nikolaos Nasis
- Neurosurgery and Interventional Neuroradiology, Hygeia Hospital, Athens, GRC
| | - George Stranjalis
- Neurosurgery, National and Kapodistrian University of Athens, Athens, GRC
| | - Alexander Andreou
- Neurosurgery and Interventional Neuroradiology, Hygeia Hospital, Athens, GRC
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Moon M, Jang DK, Cho BR. Alternate Simultaneous Bilateral Carotid Angiography in Y-stent-Assisted Coil Embolization for an Anterior Communicating Artery Aneurysm with Triplicate A2 Variant. World Neurosurg 2023; 170:38-42. [PMID: 36464155 DOI: 10.1016/j.wneu.2022.11.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 12/05/2022]
Abstract
The triplicate A2 variant is one of several common anomalies of the anterior cerebral artery. An anterior communicating artery aneurysm with triplicate A2 variant in close proximity to the aneurysm neck is challenging to treat due to potential unilateral/bilateral corpus callosum or parietal lobe infarction. Alternate simultaneous bilateral carotid angiography can differentiate triplicate A2 branches through time-difference alternate injection of contrast into the carotid arteries bilaterally, which can enhance anatomic understanding of complex anterior communicating artery aneurysms during complex endovascular treatment. In this case, a complex aneurysm with an associated triplicate A2 variant was treated successfully with Y-stent-assisted coil embolization using alternate simultaneous bilateral carotid angiography.
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Affiliation(s)
- Minhyeong Moon
- Department of Neurosurgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bupyeong-gu, Incheon, Republic of Korea
| | - Dong-Kyu Jang
- Department of Neurosurgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bupyeong-gu, Incheon, Republic of Korea.
| | - Byung-Rae Cho
- Department of Neurosurgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bupyeong-gu, Incheon, Republic of Korea
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House AE, Romano MF, Orczykowski ME, Zumwalt A, Devaiah AK. Multimodal Microvascular Mapping for Head and Neck, Skull Base Research and Education: An Anatomical Donor Study. Skull Base Surg 2022; 83:435-442. [DOI: 10.1055/s-0041-1725026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
Abstract
Objective This study was aimed to develop a method combining computed tomography (CT) and fluorescence imaging, allowing identification of microvasculature in anatomical donors and facilitating translational research and education.
Methods We investigated homogeneity and radiopacity of 30 different mixtures including radiopaque substances povidone–iodine (Betadine), barium sulfate (BaSO4), and bismuth subsalicylate (Pepto-Bismol) varying in suspension and dilution with agar, latex, or gelatin. Three candidate mixtures were selected for testing the extent of perfusion in renal vasculature to establish methodology. From these candidate mixtures, two were selected for mixture with fluorescein and infusion into cadavers based on their ability to perfuse renal vasculature. The extent to which these two candidate mixtures combined with fluorescein were able to perfuse vasculature in a cadaver head was used to determine which mixture was superior.
Results BaSO4 and bismuth subsalicylate–based mixtures demonstrated superior opacity in vials. In terms of solidifying agents, gelatin-based mixtures demonstrated increased friability and lower melting points compared with the other agents, so only latex and agar-based mixtures were used moving forward past the vial stage. Combinations of BaSO4 and latex and BaSO4 and 3% agar were found to perfuse kidneys superiorly to the mixture containing bismuth subsalicylate. Finally, in cadaver heads, the mixture containing BaSO4, agar, and fluorescein was found to perfuse the smallest vasculature.
Conclusion A final combination of BaSO4, 3% agar, and fluorescein proves to be a powerful and novel combination enabling CT imaging, fluorescence imaging, and dissection of vasculature. This paves the way for future translational research and education.
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Affiliation(s)
- Adrian E. House
- Department of Otolaryngology—Head and Neck Surgery, University of California San Francisco, San Francisco, California, United States
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts, United States
| | - Michael F. Romano
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts, United States
| | - Mary E. Orczykowski
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts, United States
- Division of Anatomical Sciences, University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Ann Zumwalt
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts, United States
| | - Anand K. Devaiah
- Department of Otolaryngology, Neurological Surgery, and Ophthalmology, Boston University School of Medicine,, Boston, Massachusetts, United States
- Institute for Health System Innovation and Policy, Boston University, Boston, Massachusetts, United States
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Llopis G, Quinones S, Konschake M, Simon De Blas C, Hernández LM, Abramovic A, Viñuela-Prieto JM, Sanudo J, Tubbs RS, Maranillo E. ATHEROMATOSIS OF THE BRAIN-SUPPLYING ARTERIES: CIRCLE OF WILLIS, BASILAR, VERTEBRAL AND THEIR BRANCHES. Ann Anat 2022; 243:151941. [PMID: 35378255 DOI: 10.1016/j.aanat.2022.151941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE Atherosclerotic plaques in the brain-supplying arteries are slowly-developing alterations of vascular structures that can lead to neurological impairment due to stenosis and insufficient oxygenation of eloquent brain areas. The aim of this study is to provide detailed demographic information related to the incidence of atherosclerotic plaques in the cerebral arteries. MATERIAL AND METHODS Forty-eight circles of Willis (21 men, 21 women, mean age: 70.26, six samples unknown) were macroscopically analyzed for length, diameter, and presence of atherosclerotic plaques. Statistical analysis was used to identify potential differences in the locations and frequencies of atherosclerotic plaques in relation to age and sex. RESULTS The study sample revealed 261 atherosclerotic plaques. The key findings were significant correlations between plaque development and age and between plaque location and age; however, there was no significant sex difference. CONCLUSION The upper and lower branches of the middle cerebral artery (MCA) were novel locations predisposing to plaque development. A cut-off value at 60 years revealed a significant difference in plaque development and distribution. There were no significant sex differences in the occurrence of atherosclerotic plaques.
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Affiliation(s)
- G Llopis
- Department of Anatomy and Embryology, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - S Quinones
- Department of Anatomy and Embryology, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - M Konschake
- Institute of Clinical and Functional Anatomy, Medical University of Innsbruck (MUI), Innsbruck, Austria.
| | - C Simon De Blas
- Department of Computer Science and Statistics, Universidad Rey Juan Carlos, Madrid, Spain
| | - L M Hernández
- Department of Human Anatomy and Embryology, School of Medicine, Alcalá University of Madrid, Madrid, Spain
| | - A Abramovic
- Institute of Clinical and Functional Anatomy, Medical University of Innsbruck (MUI), Innsbruck, Austria; Department of Neurosurgery, Medical University of Innsbruck (MUI), Innsbruck, Austria
| | | | - J Sanudo
- Department of Anatomy and Embryology, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - R S Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA; Department of Anatomical Sciences, St. George's University, Grenada; Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA; Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA; Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - E Maranillo
- Department of Anatomy and Embryology, School of Medicine, Complutense University of Madrid, Madrid, Spain
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A distal anterior cerebral artery tripod branching to a bihemispheric pericallosal artery. Surg Radiol Anat 2022; 44:303-306. [PMID: 34997855 DOI: 10.1007/s00276-021-02879-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 12/27/2021] [Indexed: 10/19/2022]
Abstract
The anterior cerebral artery (ACA) branching pattern may be particularly complex and variant including bifurcations, trifurcations or quadrifurcations, thus leading to typical or atypical vessels. The bihemispheric ACA (BhACA) variant crosses the midline to supply the contralateral hemisphere. The current case highlights a left-sided ACA trifurcation into a bihemispheric pericallosal artery, and two ipsilateral atypical arteries: a callosomarginal artery of short course and a left-sided pericallosal artery of an aberrant course into the cingulate sulcus. The depicted trifurcation was characterized as a distal ACA tripod. The bihemispheric branch supplied the contralateral pericallosal area and coursed into the cingulate sulcus. Deviations from the typical ACA pattern, especially when they coexist are quite rare and may complicate neurosurgical approaches or raise diagnostic difficulties. The BhACA may be implicated in aneurysm formation and bilateral ischemia after its occlusion. Knowledge of such variants, as well as awareness of the complications they may be related to, is of great significance.
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Castro Castro J, Yáñez Baña RM. Pericallosal lipoma associated with azygos anterior cerebral artery. NEUROLOGÍA (ENGLISH EDITION) 2021; 36:731-732. [PMID: 34266795 DOI: 10.1016/j.nrleng.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/07/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- J Castro Castro
- Servicio de Neurocirugía, Complexo Hospitalario Universitario de Ourense, Ourense, Spain.
| | - R M Yáñez Baña
- Servicio de Neurología, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
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Castro Castro J, Yáñez Baña RM. Pericallosal lipoma associated with azygos-type anterior cerebral artery. Neurologia 2021; 36:S0213-4853(21)00013-X. [PMID: 33715886 DOI: 10.1016/j.nrl.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/31/2020] [Accepted: 02/07/2021] [Indexed: 10/21/2022] Open
Affiliation(s)
- J Castro Castro
- Servicio de Neurocirugía, Complexo Hospitalario Universitario de Ourense, Ourense, España.
| | - R M Yáñez Baña
- Servicio de Neurología, Complexo Hospitalario Universitario de Ourense, Ourense, España
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Santillan A, Birnbaum LA, Behrouz R, Palacio S. Akinetic mutism in an older adult. J Clin Neurosci 2018. [DOI: 10.1016/j.jocn.2017.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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