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Spiriev T, Körner KM, Steuwe A, Wolf-Vollenbröker M, Trandzhiev M, Nakov V, Cornelius JF. Immersive Photorealistic Three-Dimensional Neurosurgical Anatomy of the Cerebral Arteries: A Photogrammetry-Based Anatomic Study. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01318. [PMID: 39254300 DOI: 10.1227/ons.0000000000001198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/28/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Neurosurgeons need a profound knowledge of the surgical anatomy of the cerebral arteries to safely treat patients. This is a challenge because of numerous branches, segments, and tortuosity of the main blood vessels that supply the brain. The objective of this study was to create high-quality three-dimensional (3D) anatomic photorealistic models based on dissections of the brain arterial anatomy and to incorporate this data into a virtual reality (VR) environment. METHODS Two formaldehyde-fixed heads were used. The vessels were injected with radiopaque material and colored silicone and latex. Before the dissections, the specimens were computed tomography scanned. Stratigraphical anatomic dissection of the neck and brain was performed to present the relevant vascular anatomy. A simplified surface scanning method using a mobile phone-based photogrammetry application was used, and the data were incorporated into a VR 3D modeling software for post-processing and presentation. RESULTS Fifteen detailed layered photorealistic and two computed tomography angiography-based 3D models were generated. The models allow manipulation in VR environment with sufficient photographic detail to present the structures of interest. Topographical relevant anatomic structures and landmarks were annotated and uploaded for web-viewing and in VR. Despite that the VR application is a dedicated 3D modeling platform, it provided all necessary tools to be suitable for self-VR study and multiplayer scenarios with several participants in one immersive environment. CONCLUSION Cerebral vascular anatomy presented with photogrammetry surface scanning method allows sufficient detail to present individual vessel's course and even small perforating arteries in photorealistic 3D models. These features, including VR visualization, provide new teaching prospects. The whole study was done with simplified algorithms and free or open-source software platforms allowing creation of 3D databases especially useful in cases with limited body donor-based dissection training availability.
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Affiliation(s)
- Toma Spiriev
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, Bulgaria
| | - Kay M Körner
- Institute for Anatomy I, Medical Faculty & University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Andrea Steuwe
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Michael Wolf-Vollenbröker
- Institute for Anatomy I, Medical Faculty & University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Martin Trandzhiev
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, Bulgaria
| | - Vladimir Nakov
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, Bulgaria
| | - Jan Frederick Cornelius
- Department of Neurosurgery, Medical Faculty & University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Ranjan R, Ken‐Dror G, Martinelli I, Grandone E, Hiltunen S, Lindgren E, Margaglione M, Duchez VLC, Triquenot Bagan A, Zedde M, Giannini N, Ruigrok YM, Worrall BB, Majersik JJ, Putaala J, Haapaniemi E, Zuurbier SM, Brouwer MC, Passamonti SM, Abbattista M, Bucciarelli P, Lemmens R, Pappalardo E, Costa P, Colombi M, Aguiar de Sousa D, Rodrigues S, Canhão P, Tkach A, Santacroce R, Favuzzi G, Arauz A, Colaizzo D, Spengos K, Hodge A, Ditta R, Pezzini A, Coutinho JM, Thijs V, Jood K, Tatlisumak T, Ferro JM, Sharma P. Coma in adult cerebral venous thrombosis: The BEAST study. Eur J Neurol 2024; 31:e16311. [PMID: 38646961 PMCID: PMC11235700 DOI: 10.1111/ene.16311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/04/2024] [Accepted: 04/06/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND AND PURPOSE Coma is an independent predictor of poor clinical outcomes in cerebral venous thrombosis (CVT). We aimed to describe the association of age, sex, and radiological characteristics of adult coma patients with CVT. METHODS We used data from the international, multicentre prospective observational BEAST (Biorepository to Establish the Aetiology of Sinovenous Thrombosis) study. Only positively associated variables with coma with <10% missing data in univariate analysis were considered for the multivariate logistic regression model. RESULTS Of the 596 adult patients with CVT (75.7% women), 53 (8.9%) patients suffered coma. Despite being a female-predominant disease, the prevalence of coma was higher among men than women (13.1% vs. 7.5%, p = 0.04). Transverse sinus thrombosis was least likely to be associated with coma (23.9% vs. 73.3%, p < 0.001). The prevalence of superior sagittal sinus thrombosis was higher among men than women in the coma sample (73.6% vs. 37.5%, p = 0.01). Men were significantly older than women, with a median (interquartile range) age of 51 (38.5-60) versus 40 (33-47) years in the coma (p = 0.04) and 44.5 (34-58) versus 37 (29-48) years in the non-coma sample (p < 0.001), respectively. Furthermore, an age- and superior sagittal sinus-adjusted multivariate logistic regression model found male sex (odds ratio = 1.8, 95% confidence interval [CI] = 1.0-3.4, p = 0.04) to be an independent predictor of coma in CVT, with an area under the receiver operating characteristic curve of 0.61 (95% CI = 0.52-0.68, p = 0.01). CONCLUSIONS Although CVT is a female-predominant disease, men were older and nearly twice as likely to suffer from coma than women.
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Affiliation(s)
- Redoy Ranjan
- Institute of Cardiovascular Research Royal HollowayUniversity of London (ICR2UL)LondonUK
| | - Gie Ken‐Dror
- Institute of Cardiovascular Research Royal HollowayUniversity of London (ICR2UL)LondonUK
| | - Ida Martinelli
- Fondazione IRCCS Ca'Granda–Ospedale Maggiore PoliclinicoA. Bianchi Bonomi Hemophilia and Thrombosis CentreMilanItaly
- Moncucco Hospital Group, Moncucco ClinicHematology ServiceLuganoSwitzerland
| | - Elvira Grandone
- Atherosclerosis and Thrombosis UnitIRCCS Home for the Relief of Suffering, S. Giovanni RotondoFoggiaItaly
- Medical and Surgical DepartmentUniversity of FoggiaFoggiaItaly
| | - Sini Hiltunen
- Department of NeurologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Erik Lindgren
- Department of Clinical Neuroscience, Institute of Neuroscience and PhysiologySahlgrenska Academy at University of GothenburgGothenburgSweden
- Department of NeurologySahlgrenska University HospitalGothenburgSweden
| | - Maurizio Margaglione
- Medical Genetics, Department of Clinical and Experimental MedicineUniversity of FoggiaFoggiaItaly
| | - Veronique Le Cam Duchez
- University of Rouen Normandy, Inserm U1096, CHU RouenVascular Hemostasis Unit and Inserm CIC‐CRB 1404RouenFrance
| | | | - Marialuisa Zedde
- Neurology Unit, Stroke UnitLocal Health Unit–Authority IRCCS of Reggio EmiliaReggio EmiliaItaly
| | - Nicola Giannini
- Department of Clinical and Experimental Medicine, Neurological InstituteUniversity of PisaPisaItaly
| | - Ynte M. Ruigrok
- UMC Utrecht Brain Centre, Department of Neurology and NeurosurgeryUniversity Medical Centre UtrechtUtrechtthe Netherlands
| | - Bradford B. Worrall
- Departments of Neurology and Public Health SciencesUniversity of VirginiaCharlottesvilleVirginiaUSA
| | | | - Jukka Putaala
- Department of NeurologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Elena Haapaniemi
- Department of NeurologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Susanna M. Zuurbier
- Department of Neurology, Amsterdam University Medical Centres, location AMC, Amsterdam NeuroscienceUniversity of AmsterdamAmsterdamthe Netherlands
| | - Matthijs C. Brouwer
- Department of Neurology, Amsterdam University Medical Centres, location AMC, Amsterdam NeuroscienceUniversity of AmsterdamAmsterdamthe Netherlands
| | - Serena M. Passamonti
- Fondazione IRCCS Ca'Granda–Ospedale Maggiore PoliclinicoA. Bianchi Bonomi Hemophilia and Thrombosis CentreMilanItaly
| | - Maria Abbattista
- Fondazione IRCCS Ca'Granda–Ospedale Maggiore PoliclinicoA. Bianchi Bonomi Hemophilia and Thrombosis CentreMilanItaly
| | - Paolo Bucciarelli
- Fondazione IRCCS Ca'Granda–Ospedale Maggiore PoliclinicoA. Bianchi Bonomi Hemophilia and Thrombosis CentreMilanItaly
| | - Robin Lemmens
- Department of Neurosciences, Experimental NeurologyKU Leuven–University of LeuvenLeuvenBelgium
- VIB Centre for Brain & Disease ResearchLeuvenBelgium
- Department of NeurologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Emanuela Pappalardo
- Fondazione IRCCS Ca'Granda–Ospedale Maggiore PoliclinicoA. Bianchi Bonomi Hemophilia and Thrombosis CentreMilanItaly
- Department of Pathophysiology and TransplantationUniversità degli Studi di MilanoMilanItaly
| | - Paolo Costa
- Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - Marina Colombi
- Division of Biology and Genetics, Department of Molecular and Translational MedicineUniversity of BresciaBresciaItaly
| | - Diana Aguiar de Sousa
- Stroke CentreLisbon Central University HospitalLisbonPortugal
- CEEM and Institute of Anatomy, Faculdade de MedicinaUniversidade de LisboaLisbonPortugal
| | - Sofia Rodrigues
- Centro de Estudos Egas MonizFaculdade de Medicina da Universidade de LisboaLisbonPortugal
- Department of Neurosciences, Hospital of Santa MariaUniversity of LisbonLisbonPortugal
| | - Patrícia Canhão
- Centro de Estudos Egas MonizFaculdade de Medicina da Universidade de LisboaLisbonPortugal
- Department of Neurosciences, Hospital of Santa MariaUniversity of LisbonLisbonPortugal
| | | | - Rosa Santacroce
- Medical Genetics, Department of Clinical and Experimental MedicineUniversity of FoggiaFoggiaItaly
| | - Giovanni Favuzzi
- Atherosclerosis and Thrombosis UnitIRCCS Home for the Relief of Suffering, S. Giovanni RotondoFoggiaItaly
| | - Antonio Arauz
- Stroke ClinicNational Institute of Neurology and Neurosurgery Manuel Velasco SuarezMexico CityMexico
| | - Donatella Colaizzo
- Atherosclerosis and Thrombosis UnitIRCCS Home for the Relief of Suffering, S. Giovanni RotondoFoggiaItaly
| | - Kostas Spengos
- Department of Neurology, Eginition HospitalUniversity of Athens School of MedicineAthensGreece
| | - Amanda Hodge
- Pathology and Molecular Medicine, Population Health Research Institute and Thrombosis and Atherosclerosis Research Institute, Hamilton Health SciencesMcMaster UniversityHamiltonOntarioCanada
| | - Reina Ditta
- Pathology and Molecular Medicine, Population Health Research Institute and Thrombosis and Atherosclerosis Research Institute, Hamilton Health SciencesMcMaster UniversityHamiltonOntarioCanada
| | - Alessandro Pezzini
- Department of Medicine and SurgeryUniversity of ParmaParmaItaly
- Stroke Program, Department of EmergenciesParma University HospitalParmaItaly
| | - Jonathan M. Coutinho
- Department of Neurosciences, Experimental NeurologyKU Leuven–University of LeuvenLeuvenBelgium
- VIB Centre for Brain & Disease ResearchLeuvenBelgium
- Department of NeurologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental HealthUniversity of MelbourneHeidelbergVictoriaAustralia
| | - Katarina Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and PhysiologySahlgrenska Academy at University of GothenburgGothenburgSweden
- Department of NeurologySahlgrenska University HospitalGothenburgSweden
| | - Turgut Tatlisumak
- Department of NeurologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
- Department of Clinical Neuroscience, Institute of Neuroscience and PhysiologySahlgrenska Academy at University of GothenburgGothenburgSweden
- Department of NeurologySahlgrenska University HospitalGothenburgSweden
| | - José M. Ferro
- Instituto de Medicina Molecular João Lobo AntunesUniversidade de LisboaLisboaPortugal
| | - Pankaj Sharma
- Institute of Cardiovascular Research Royal HollowayUniversity of London (ICR2UL)LondonUK
- Department of Clinical NeuroscienceImperial College Healthcare NHS TrustLondonUK
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Riina HA, Raz E, Shapiro M. Commentary: The Promise, Mystery, and Perils of Stenting for Symptomatic Internal Jugular Vein Stenosis: A Case Series. Neurosurgery 2024; 95:e41-e42. [PMID: 38477569 DOI: 10.1227/neu.0000000000002918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 03/14/2024] Open
Affiliation(s)
- Howard A Riina
- Department of Neurosurgery, NYU Grossman School Medicine, New York , New York , USA
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4
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Yu J. Endovascular treatment of traumatic anterior communicating artery-cavernous sinus fistula. Neuroradiol J 2024; 37:372-375. [PMID: 37579065 PMCID: PMC11138333 DOI: 10.1177/19714009231196469] [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] [Indexed: 08/16/2023] Open
Abstract
Traumatic anterior communicating artery (AcomA)-cavernous sinus (CS) fistula is rare. Flow diverter (FD) deployment associated with coiling may be an alternative but has never been reported. We reported such a case. A 61-year-old man who was involved in a traffic accident presented with progressive exophthalmos for 2 weeks. Digital subtraction angiography showed a fistula between the AcomA and CS. First, the fistula was coiled. Then, the FD was deployed to cover the rupture point of the AcomA. The fistula was obliterated. Postoperatively, the patient recovered well, and his eye symptoms disappeared. Follow-up angiography showed no recurrence of the fistula. Therefore, for traumatic AcomA-CS fistula, FD deployment associated with coiling may be a feasible alternative.
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Affiliation(s)
- Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
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Morales-Roccuzzo D, Sabahi M, Obrzut M, Najera E, Monterroso-Cohen D, Bsat S, Adada B, Borghei-Razavi H. A primer to vascular anatomy of the brain: an overview on anterior compartment. Surg Radiol Anat 2024; 46:829-842. [PMID: 38630270 PMCID: PMC11161539 DOI: 10.1007/s00276-024-03359-0] [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: 02/05/2024] [Accepted: 03/30/2024] [Indexed: 06/09/2024]
Abstract
PURPOSE Knowledge of neurovascular anatomy is vital for neurosurgeons, neurologists, neuro-radiologists and anatomy students, amongst others, to fully comprehend the brain's anatomy with utmost depth. This paper aims to enhance the foundational knowledge of novice physicians in this area. METHOD A comprehensive literature review was carried out by searching the PubMed and Google Scholar databases using primary keywords related to brain vasculature, without date restrictions. The identified literature was meticulously examined and scrutinized. In the process of screening pertinent papers, further articles and book chapters were obtained through analysis and additional assessing of the reference lists. Additionally, four formalin-fixed, color latex-injected cadaveric specimens preserved in 70% ethanol solution were dissected under surgical microscope (Leica Microsystems Inc, 1700 Leider Ln, Buffalo Grove, IL 60089 USA). Using microneurosurgical as well as standard instruments, and a high-speed surgical drill (Stryker Instruments 1941 Stryker Way Portage, MI 49002 USA). Ulterior anatomical dissection was documented in microscopic images. RESULTS Encephalic circulation functions as a complex network of intertwined vessels. The Internal Carotid Arteries (ICAs) and the Vertebral Arteries (VAs), form the anterior and posterior arterial circulations, respectively. This work provides a detailed exploration of the neurovascular anatomy of the anterior circulation and its key structures, such as the Anterior Cerebral Artery (ACA) and the Middle Cerebral Artery (MCA). Embryology is also briefly covered, offering insights into the early development of the vascular structures of the central nervous system. Cerebral venous system was detailed, highlighting the major veins and tributaries involved in the drainage of blood from the intracranial compartment, with a focus on the role of the Internal Jugular Veins (IJVs) as the primary, although not exclusive, deoxygenated blood outflow pathway. CONCLUSION This work serves as initial guide, providing essential knowledge on neurovascular anatomy, hoping to reduce the initial impact when tackling the subject, albeit the intricate vasculature of the brain will necessitate further efforts to be conquered, that being crucial for neurosurgical and neurology related practice and clinical decision-making.
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Affiliation(s)
- Diego Morales-Roccuzzo
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
| | - Mohammadmahdi Sabahi
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Michal Obrzut
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Edinson Najera
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - David Monterroso-Cohen
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Shadi Bsat
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Badih Adada
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Hamid Borghei-Razavi
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
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Morales-Roccuzzo D, Sabahi M, Obrzut M, Najera E, Monterroso-Cohen D, Bsat S, Adada B, Borghei-Razavi H. Posterior vascular anatomy of the encephalon: a comprehensive review. Surg Radiol Anat 2024; 46:843-857. [PMID: 38652250 PMCID: PMC11161439 DOI: 10.1007/s00276-024-03358-1] [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: 02/05/2024] [Accepted: 03/30/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE This article presents a comprehensive exploration of neurovascular anatomy of the encephalon, focusing specifically on the intricate network within the posterior circulation and the posterior fossa anatomy; enhancing understanding of its dynamics, essential for practitioners in neurosurgery and neurology areas. METHOD A profound literature review was conducted by searching the PubMed and Google Scholar databases using main keywords related to neurovascular anatomy. The selected literature was meticulously scrutinized. Throughout the screening of pertinent papers, further articles or book chapters were obtained through additional assessment of the reference lists. Furthermore, four formalin-fixed, color latex-injected cadaveric specimens preserved in 70% ethanol solution were dissected under surgical microscope (Leica Microsystems Inc, 1700 Leider Ln, Buffalo Grove, IL 60089, USA), using microneurosurgical as well as standard instruments, and a high-speed surgical drill (Stryker Instruments 1941 Stryker Way Portage, MI 49002, USA). Ulterior anatomical dissection was performed. RESULTS Detailed examination of the basilar artery (BA), a common trunk formed by the union of the left and right vertebral arteries, denoted a tortuous course across the basilar sulcus. Emphasis is then placed on the Posterior Inferior Cerebellar Artery (PICA), Anterior Inferior Cerebellar Artery (AICA) and Superior Cerebellar Artery (SCA). Each artery's complex course through the posterior fossa, its divisions, and potential stroke-related syndromes are explored in detail. The Posterior Cerebral Artery (PCA) is subsequently unveiled. The posterior fossa venous system is explained, categorizing its channels. A retrograde exploration traces the venous drainage back to the internal jugular vein, unraveling its pathways. CONCLUSION This work serves as a succinct yet comprehensive guide, offering fundamental insights into neurovascular anatomy within the encephalon's posterior circulation. Intended for both novice physicians and seasoned neuroanatomists, the article aims to facilitate a more efficient clinical decision-making in neurosurgical and neurological practices.
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Affiliation(s)
- Diego Morales-Roccuzzo
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.
| | - Mohammadmahdi Sabahi
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
| | - Michal Obrzut
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
| | - Edinson Najera
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
| | - David Monterroso-Cohen
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
| | - Shadi Bsat
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
| | - Badih Adada
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
| | - Hamid Borghei-Razavi
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
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7
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Lai LM, Sato TS, Kandemirli SG, AlArab N, Sato Y. Neuroimaging of Neonatal Stroke: Venous Focus. Radiographics 2024; 44:e230117. [PMID: 38206831 DOI: 10.1148/rg.230117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Perinatal venous infarcts are underrecognized clinically and at imaging. Neonates may be susceptible to venous infarcts because of hypercoagulable state, compressibility of the dural sinuses and superficial veins due to patent sutures, immature cerebral venous drainage pathways, and drastic physiologic changes of the brain circulation in the perinatal period. About 43% of cases of pediatric cerebral sinovenous thrombosis occur in the neonatal period. Venous infarcts can be recognized by ischemia or hemorrhage that does not respect an arterial territory. Knowledge of venous drainage pathways and territories can help radiologists recognize characteristic venous infarct patterns. Intraventricular hemorrhage in a term neonate with thalamocaudate hemorrhage should raise concern for internal cerebral vein thrombosis. A striato-hippocampal pattern of hemorrhage indicates basal vein of Rosenthal thrombosis. Choroid plexus hemorrhage may be due to obstruction of choroidal veins that drain the internal cerebral vein or basal vein of Rosenthal. Fan-shaped deep medullary venous congestion or thrombosis is due to impaired venous drainage into the subependymal veins, most commonly caused by germinal matrix hemorrhage in the premature infant and impeded flow in the deep venous system in the term infant. Subpial hemorrhage, an underrecognized hemorrhage stroke type, is often observed in the superficial temporal region, and its cause is probably multifactorial. The treatment of cerebral sinovenous thrombosis is anticoagulation, which should be considered even in the presence of intracranial hemorrhage. ©RSNA, 2024 Test Your Knowledge questions in the supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.
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Affiliation(s)
- Lillian M Lai
- From the Department of Radiology, University of Iowa Stead Family Children's Hospital, 200 Hawkins Dr, Iowa City, IA 52242-1077
| | - Takashi Shawn Sato
- From the Department of Radiology, University of Iowa Stead Family Children's Hospital, 200 Hawkins Dr, Iowa City, IA 52242-1077
| | - Sedat Giray Kandemirli
- From the Department of Radiology, University of Iowa Stead Family Children's Hospital, 200 Hawkins Dr, Iowa City, IA 52242-1077
| | - Natally AlArab
- From the Department of Radiology, University of Iowa Stead Family Children's Hospital, 200 Hawkins Dr, Iowa City, IA 52242-1077
| | - Yutaka Sato
- From the Department of Radiology, University of Iowa Stead Family Children's Hospital, 200 Hawkins Dr, Iowa City, IA 52242-1077
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8
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Jianu AM, Vaida MA, Rusu MC, Vrapciu AD. The Basal or Sphenopetrosal Superficial Middle Cerebral Vein Type. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:209. [PMID: 38399497 PMCID: PMC10890409 DOI: 10.3390/medicina60020209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: The adult superficial middle cerebral vein (SMCV) commonly drains into the middle cranial fossa. However, different embryonic types persist, in which the SMCV drains into the lateral sinus. The basal type of SMCV coursing on the middle fossa floor is a scarce variant. Materials and Methods: During a retrospective study of archived computed tomography angiography (CTA) and magnetic resonance angiography (MRA) files, three rare adult cases of the basal or sphenopetrosal type of SMCV were found and further documented. Results: In the first case, which was evaluated via CTA, the basal type of SMCV formed a sagittal loop. It continued on the middle fossa floor, over a dehiscent tegmen tympani, to drain into the lateral sinus. In the second case, documented via MRA, the basal type of SMCV's anterior loop was in the coronal plane and closely related to the internal carotid artery and the cavernous sinus. It continued with the basal segment over a dehiscent glenoid fossa of the temporomandibular joint (TMJ). In the third case, documented via CTA, the initial cerebral part of the SMCV had a large fenestration. The middle fossa floor coursed within a well-configured sulcus of the SMCV and received a tributary through the tympanic roof. Its terminal had a tentorial course. Conclusions: Beyond the fact that such rare variants of the SMCV can unexpectedly interfere with specific approaches via the middle fossa, dehiscences of the middle fossa floor beneath such variants can determine otic or TMJ symptoms. Possible loops and fenestrations of the SMCV should be considered and documented preoperatively.
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Affiliation(s)
- Adelina Maria Jianu
- Department of Anatomy and Embryology, Faculty of Medicine, ”Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.M.J.); (M.A.V.)
| | - Monica Adriana Vaida
- Department of Anatomy and Embryology, Faculty of Medicine, ”Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.M.J.); (M.A.V.)
| | - Mugurel Constantin Rusu
- Division of Anatomy, Faculty of Dentistry, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Alexandra Diana Vrapciu
- Division of Anatomy, Faculty of Dentistry, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- University Emergency Hospital Bucharest, 050098 Bucharest, Romania
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Qiu B, Zhao Z, Wang N, Feng Z, Chen XJ, Chen W, Sun W, Ge WP, Wang Y. A systematic observation of vasodynamics from different segments along the cerebral vasculature in the penumbra zone of awake mice following cerebral ischemia and recanalization. J Cereb Blood Flow Metab 2023; 43:665-679. [PMID: 36524693 PMCID: PMC10108196 DOI: 10.1177/0271678x221146128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 12/23/2022]
Abstract
Different segments of the cerebral vascular network may react distinctly to brain ischemia and recanalization. However, there are limited systematic observations of these vascular responses in mice under a physiological state following ischemic stroke. Herein, we aimed to investigate the vasodynamics among several segments along the cerebral vessels in awake mice following cerebral ischemia/recanalization via two-photon imaging. Plasma in the blood vessels were labelled with fluorescein isothiocyanate dextran. Smooth muscle cells and pericytes were labelled via a genetic mouse line (PDGFRβ-tdTomato). We observed a no-reflow phenomenon in downstream microcirculation, and the vasodynamics of different segments of larger cerebral vessels varied in the penumbra area following cerebral ischemia-reperfusion. Despite obtaining reperfusion from the middle cerebral artery, there were significant constrictions of the downstream blood vessels in the ischemic penumbra zone. Interestingly, we observed an extensive constriction of the capillaries 3 hours following recanalization, both at the site covered by pericyte soma and by the pericyte process alone. In addition, we did not observe a significant positive correlation between the changed capillary diameter and pericyte coverage along the capillary. Taken together, abnormal constrictions and vasodynamics of cerebral large and small vessels may directly contribute to microcirculation failure following recanalization in ischemic stroke.
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Affiliation(s)
- Baoshan Qiu
- Department of Neurology, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
- Chinese Institute for Brain Research,
Beijing, China
| | - Zichen Zhao
- Department of Neurology, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
- Chinese Institute for Brain Research,
Beijing, China
| | - Nan Wang
- Department of Neurology, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
- Chinese Institute for Brain Research,
Beijing, China
| | - Ziyan Feng
- Chinese Institute for Brain Research,
Beijing, China
| | - Xing-jun Chen
- Chinese Institute for Brain Research,
Beijing, China
- Academy for Advanced Interdisciplinary
Studies (AAIS), Peking University, Beijing, China
| | - Weiqi Chen
- Department of Neurology, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Wenzhi Sun
- Chinese Institute for Brain Research,
Beijing, China
- School of Basic Medical Sciences, Capital
Medical University, Beijing, China
| | - Woo-ping Ge
- Chinese Institute for Brain Research,
Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
- Chinese Institute for Brain Research,
Beijing, China
- China National Clinical Research Centre for
Neurological Diseases, Beijing, China
- Advanced Innovation Centre for Human Brain
Protection, Capital Medical University, Beijing, China
- National Centre for Neurological Diseases,
Beijing, China
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10
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Steinman DA. Comprehensive Atlases of Intracranial Blood Flow Rates: A Hard Nut Finally Cracks? Radiology 2023; 307:e230381. [PMID: 36943083 DOI: 10.1148/radiol.230381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Affiliation(s)
- David A Steinman
- From the University of Toronto, 5 King's College Rd, Toronto, ON, Canada M5S 3G8
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11
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Chen M. JNIS spotlight: commissioned reviews. J Neurointerv Surg 2023; 15:jnis-2022-020019. [PMID: 36593117 DOI: 10.1136/jnis-2022-020019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Michael Chen
- Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
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