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Hamasaki T, Uchikawa H, Ohmori Y, Kaku Y, Ono T, Tochihara S, Hirai T, Kawano T, Mukasa A. Variations in the branching patterns of the anterior choroidal artery: an angiographic study with special reference to temporal lobe epilepsy surgery. Acta Neurochir (Wien) 2022; 164:2165-2172. [PMID: 35789290 DOI: 10.1007/s00701-022-05294-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/23/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND The preservation of the anterior choroidal artery (AChA) is essential for avoiding neurological sequelae after mesial temporal lobe epilepsy (mTLE) surgery. The purpose of this study is to reveal the anatomical variation in which the perforating branches arise from the plexal segment of the AChA by using a modern neuroimaging modality. METHODS This study analyzed 3D rotational angiography (3DRA) images from 56 subjects. The AChA and perforating branches were visualized using slab MIP. We analyzed branching patterns, courses of the perforating arteries arising from the plexal segment of the AChA, and the anastomosis of the AChA with other cerebral arteries. RESULTS The slab MIP applied to 3DRA visualized one or more perforating branches from the AChA in 92.9% of cases. The presence of perforating branches arising from the AChA plexal segment was 17.3%. Most of the branching points of plexal perforators were likely located in the operative field during hippocampal resection. The course of the AChA plexal perforators included the posterior limb of the internal capsule. Anastomosis with other cerebral arteries was visualized in 25% of the AChA with plexal perforators. CONCLUSIONS 3DRA slab MIP was useful for visualizing the perforating branches of the AChA. Our results showed the possibility that surgical manipulation of the choroid plexus may cause infarction in the AChA territory. We suggest that the existence of the AChA plexal perforators should be recognized to further enhance the safety of hippocampal resection for mTLE.
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Affiliation(s)
- Tadashi Hamasaki
- Department of Neurosurgery, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
| | - Hiroki Uchikawa
- Department of Neurosurgery, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yuki Ohmori
- Department of Neurosurgery, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yasuyuki Kaku
- Department of Neurosurgery, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Tomonori Ono
- Department of Neurosurgery, Epilepsy Center, National Hospital Organization Nagasaki Medical Center, 2-1001-1, Kuhara, Omura, Nagasaki, 856-8562, Japan
| | - Shuichi Tochihara
- Department of Central Radiology, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Toshinori Hirai
- Department of Diagnostic Radiology, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Tatsuya Kawano
- Department of Neurosurgery, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Akitake Mukasa
- Department of Neurosurgery, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
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Liang J, Liu Y, Xu X, Shi C, Luo L. Cerebral Perforating Artery Disease : Characteristics on High-Resolution Magnetic Resonance Imaging. Clin Neuroradiol 2018; 29:533-541. [PMID: 29572675 DOI: 10.1007/s00062-018-0682-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/07/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Our aims were to evaluate the feasibility of high-resolution magnetic resonance imaging (HR-MRI) for displaying the cerebral perforating arteries in normal subjects and to discuss the value of HR-MRI for detecting the causes of infarctions in the territory of the lenticulostriate artery (LSA). METHODS Included in this study were 31 healthy subjects and 28 patients who had infarctions in the territory supplied by the LSA. The T1-weighted imaging (T1WI), T2WI, diffusion-weighted imaging (DWI), and HR-MRI, including 3‑dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA) and 3D fast spin-echo T1WI (namely CUBE T1 in GE Healthcare), were applied on a 3-Tesla scanner. The numbers and route of the perforating arteries on both sides were independently confirmed on HR-MRI by two physicians. The Wilcoxon test was used to compare the differences. RESULTS The numbers of perforating arteries in healthy subjects observed on 3D-TOF-MRA were as follows: numbers of the bilateral recurrent artery of Heubner (RAH) ranged from 0-3 (median 1), numbers of the left LSA ranged from 0-7 (median 3), numbers of the right LSA ranged from 0-5 (median 3), numbers of the bilateral anterior choroidal artery ranged from 1-2 (median 1) and the numbers of the bilateral thalamoperforating artery ranged from 1-2 (median 1). In the patients with lenticulostriate infarctions, the numbers of LSAs on the affected side were lower than on the opposite and ipsilateral sides in the healthy subjects. The results were statistically significant. An abnormality of the RAH may lead to a centrum semiovale infarct pattern, whereas an abnormality of the LSA is associated with a corona radiata infarct pattern. CONCLUSION The use of HR 3D-TOF-MRA and CUBE T1 had unique advantages in displaying the tiny perforating arteries in vivo. Moreover, effective recognition of the associated cerebral perforating artery and infarct patterns may enhance our understanding of the mechanism of stroke in patients with lenticulostriate infarctions.
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Affiliation(s)
- Jianye Liang
- Medical Imaging Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Yiyong Liu
- Medical Imaging Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Xiaoshuang Xu
- Medical Imaging Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Changzheng Shi
- Medical Imaging Center, The First Affiliated Hospital, Jinan University, Guangzhou, China.
| | - Liangping Luo
- Medical Imaging Center, The First Affiliated Hospital, Jinan University, Guangzhou, China.
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Yamauchi S, Kawakami T, Murata K, Ishiguro T, Ikeda H, Nishio A. Choroid plexus AVM with anomalous origin of the capsulothalamic artery: A case report. Interv Neuroradiol 2017; 24:76-81. [PMID: 29125025 DOI: 10.1177/1591019917739841] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background and importance Traditionally, it has been believed that the plexal segment of the anterior choroidal artery (AChoA) can be sacrificed safely. Here, we present a case of choroid plexus arteriovenous malformation (AVM) in which the capsulothalamic artery originated from distal plexal segment of the AChoA. Clinical presentation A 45-year-old man was diagnosed with arteriovenous malformation involving the left inferior horn in screening MRI. Preceding stereotactic radiosurgery, transarterial target embolization was performed. In this procedure, 20% n-butyl-2-cyanoacrylate (NBCA) was successfully injected from the lateral plexal branch of the AChoA. After embolization, right homonymous hemianopsia developed due to cerebral infarction on the left optic radiation. This infarction was considered to be within the territory of the capsulothalamic artery. Conclusion This anomalous capsulothalamic artery might be formed by hemodynamic compromise of the brain surrounding AVM in early gestation. We must be aware of this unusual anatomical variation to avoid ischemic complication in embolization of the AChoA.
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Affiliation(s)
- Shigeru Yamauchi
- 1 Department of Neurosurgery, Hokuto Social Medical Corporation Hokuto Hospital, Obihiro, Japan.,2 Department of Neurosurgery, Shimada Municipal Hospital, Shimada, Japan
| | - Taichiro Kawakami
- 3 Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Keiji Murata
- 2 Department of Neurosurgery, Shimada Municipal Hospital, Shimada, Japan
| | - Tomoya Ishiguro
- 4 Department of Neurosurgery, Osaka City General Hospital, Osaka, Japan
| | - Hidetoshi Ikeda
- 1 Department of Neurosurgery, Hokuto Social Medical Corporation Hokuto Hospital, Obihiro, Japan.,4 Department of Neurosurgery, Osaka City General Hospital, Osaka, Japan
| | - Akimasa Nishio
- 1 Department of Neurosurgery, Hokuto Social Medical Corporation Hokuto Hospital, Obihiro, Japan
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Xiang J, Routhe LJ, Wilkinson DA, Hua Y, Moos T, Xi G, Keep RF. The choroid plexus as a site of damage in hemorrhagic and ischemic stroke and its role in responding to injury. Fluids Barriers CNS 2017; 14:8. [PMID: 28351417 PMCID: PMC5371201 DOI: 10.1186/s12987-017-0056-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 03/08/2017] [Indexed: 12/13/2022] Open
Abstract
While the impact of hemorrhagic and ischemic strokes on the blood–brain barrier has been extensively studied, the impact of these types of stroke on the choroid plexus, site of the blood-CSF barrier, has received much less attention. The purpose of this review is to examine evidence of choroid plexus injury in clinical and preclinical studies of intraventricular hemorrhage, subarachnoid hemorrhage, intracerebral hemorrhage and ischemic stroke. It then discusses evidence that the choroid plexuses are important in the response to brain injury, with potential roles in limiting damage. The overall aim of the review is to highlight deficiencies in our knowledge on the impact of hemorrhagic and ischemic strokes on the choroid plexus, particularly with reference to intraventricular hemorrhage, and to suggest that a greater understanding of the response of the choroid plexus to stroke may open new avenues for brain protection.
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Affiliation(s)
- Jianming Xiang
- Department of Neurosurgery, University of Michigan, R5018 BSRB, 109 Zina Pitcher Place, Ann Arbor, MI, 48109-2200, USA
| | - Lisa J Routhe
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - D Andrew Wilkinson
- Department of Neurosurgery, University of Michigan, R5018 BSRB, 109 Zina Pitcher Place, Ann Arbor, MI, 48109-2200, USA
| | - Ya Hua
- Department of Neurosurgery, University of Michigan, R5018 BSRB, 109 Zina Pitcher Place, Ann Arbor, MI, 48109-2200, USA
| | - Torben Moos
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Guohua Xi
- Department of Neurosurgery, University of Michigan, R5018 BSRB, 109 Zina Pitcher Place, Ann Arbor, MI, 48109-2200, USA
| | - Richard F Keep
- Department of Neurosurgery, University of Michigan, R5018 BSRB, 109 Zina Pitcher Place, Ann Arbor, MI, 48109-2200, USA. .,Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, USA.
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Grigoryan YA, Sitnikov AR, Timoshenkov AV, Grigoryan GY. [An aneurysm of the medial posterior choroidal artery: a case report and a literature review]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2017; 81:101-107. [PMID: 28914876 DOI: 10.17116/neiro2017814101-107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Aneurysms of the medial posterior choroidal artery are very rare. To date, only 5 cases have been reported. The article presents a case of successful surgical treatment of an aneurysm of the medial posterior choroidal artery and a literature review. CLINICAL CASE A 57-year-old male was admitted to the Center 1 month after a massive subarachnoid hemorrhage. CT angiography revealed an aneurysm of the right posterior medial choroidal artery in the perimesencephalic cistern and resolved hemorrhage. TREATMENT The paramedian supracerebellar transtentorial approach to the lateral surface of the midbrain was used. The posterior cerebral artery was identified in the perimesencephalic cistern, and the medial posterior choroidal artery aneurysm was isolated and successfully clipped, with the parent artery being preserved. Postoperative CT and MRI scans revealed a small asymptomatic ischemic lesion in the tectal region on the right. The patient was discharged without any neurological symptoms 10 days after surgery. CONCLUSION Medial posterior choroidal artery aneurysms can be clipped using the paramedian supracerebellar transtentorial approach.
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Vardakis JC, Tully BJ, Ventikos Y. Exploring the efficacy of endoscopic ventriculostomy for hydrocephalus treatment via a multicompartmental poroelastic model of CSF transport: a computational perspective. PLoS One 2013; 8:e84577. [PMID: 24391968 PMCID: PMC3877339 DOI: 10.1371/journal.pone.0084577] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 11/23/2013] [Indexed: 11/22/2022] Open
Abstract
This study proposes the implementation of a Multiple-Network Poroelastic Theory (MPET) model coupled with finite-volume computational fluid dynamics for the purpose of studying, in detail, the effects of obstructing CSF transport within an anatomically accurate cerebral environment. The MPET representation allows the investigation of fluid transport between CSF, brain parenchyma and cerebral blood, in an integral and comprehensive manner. A key novelty in the model is the amalgamation of anatomically accurate choroid plexuses with their feeding arteries and a simple relationship relaxing the constraint of a unique permeability for the CSF compartment. This was done in order to account for the Aquaporin-4-mediated swelling characteristics. The aim of this varying permeability compartment was to bring to light a feedback mechanism that could counteract the effects of ventricular dilation and subsequent elevations of CSF pressure through the efflux of excess CSF into the blood system. This model is used to demonstrate the impact of aqueductal stenosis and fourth ventricle outlet obstruction (FVOO). The implications of treating such a clinical condition with the aid of endoscopic third (ETV) and endoscopic fourth (EFV) ventriculostomy are considered. We observed peak CSF velocities in the aqueduct of the order of 15.6 cm/s in the healthy case, 45.4 cm/s and 72.8 cm/s for the mild and severe cases respectively. The application of ETV reduced the aqueductal velocity to levels around 16-17 cm/s. Ventricular displacement, CSF pressure, wall shear stress (WSS) and pressure difference between lateral and fourth ventricles (ΔP) increased with applied stenosis, and subsequently dropped to nominal levels with the application of ETV. The greatest reversal of the effects of atresia come by opting for ETV rather than the more complicated procedure of EFV.
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Affiliation(s)
- John C. Vardakis
- Institute of Biomedical Engineering and Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Brett J. Tully
- Oxyntix Ltd., Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Yiannis Ventikos
- Department of Mechanical Engineering, University College London, Torrington Place, London, United Kingdom
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Lee M, Saver JL, Hao Q, Starkman S, Salamon N, Ali LK, Kim D, Ovbiagele B, Song S, Raychev R, Abcede H, Fiaz R, Liebeskind DS. Anterior choroidal artery ischaemic patterns predict outcome of carotid occlusion. J Neurol Neurosurg Psychiatry 2012; 83:586-90. [PMID: 22492212 PMCID: PMC4157912 DOI: 10.1136/jnnp-2011-301493] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate whether anterior choroidal artery (AChA) territory sparing or AChA infarction restricted to the medial temporal lobe (MT), implying good collateral status, predicts good outcome, defined as modified Rankin Scale 0-2, at discharge in acute internal carotid artery (ICA) occlusion. METHODS The authors studied consecutive patients with acute ICA occlusion admitted to an academic medical centre between January 2002 and August 2010, who underwent MRI followed by conventional angiography. The pattern of AChA involvement on initial diffusion-weighted imaging was dichotomised as spared or MT only versus other partial or full. The association of AChA infarct patterns and good outcome at discharge was calculated by multivariate logistic regression with adjustment. RESULTS For the 60 patients meeting entry criteria, mean age was 68.3 years and median admission NIH Stroke Scale score was 19. AChA territory was spared or restricted to the MT in 27 patients and other partially involved or fully involved in 33 patients. AChA territory spared or ischaemia restricted to MT only, compared with other partial infarct patterns or full infarct, was independently associated with good discharge outcome (44.4% vs 12.1%, OR 7.24, 95% CI 1.32 to 39.89, p=0.023). CONCLUSION In acute ICA occlusion, the absence of AChA infarction or restriction to the MT is an independent predictor of good discharge outcome. Analysis of AChA infarct patterns may improve early prognostication and decision-making.
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Affiliation(s)
- Meng Lee
- UCLA Stroke Center, Los Angeles, CA 90095, USA
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Haegelen C, Berton E, Darnault P, Morandi X. A revised classification of the temporal branches of the posterior cerebral artery. Surg Radiol Anat 2011; 34:385-91. [DOI: 10.1007/s00276-011-0921-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 12/09/2011] [Indexed: 11/30/2022]
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