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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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Abe H, Mori K, Fukui I, Tamase A, Yamashita R, Takeda M, Nakano T, Nomura M, Yamamoto T. A Case of Cerebral Infarction due to Internal Carotid Artery Occlusion Accompanied by Persistent Primitive Trigeminal Artery. Asian J Neurosurg 2024; 19:174-178. [PMID: 38974450 PMCID: PMC11226249 DOI: 10.1055/s-0044-1787085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
An 85-year-old woman with a history of diabetes mellitus became aware of motor weakness of the left lower extremity. Magnetic resonance imaging showed multiple small cerebral infarctions in the right corona radiata. Angiography revealed persistent primitive trigeminal artery (PPTA) originating from the right internal carotid artery (ICA) and connecting to basilar artery, and the right ICA occluded distal to PPTA. Collateral blood circulation had developed, and sufficient collateral blood flow was expected. From these findings, the right ICA was considered to show stenosis due to atherosclerotic changes before occlusion. Conservative treatment was conducted with the transoral administration of rivaroxaban. It is important to correctly diagnose the anatomy and existence of an anomalous vessel in a stroke patient, not only when endovascular treatment is planned, but also for conservative medical treatment. Rapid and accurate radiological examinations facilitate safe and effective treatment.
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Affiliation(s)
- Hiroyuki Abe
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Kanagawa, Japan
- Department of Neurosurgery, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan
| | - Kentaro Mori
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Kanagawa, Japan
| | - Issei Fukui
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Kanagawa, Japan
| | - Akira Tamase
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Kanagawa, Japan
| | - Ryotaro Yamashita
- Department of Neurology, Yokohama Sakae Kyosai Hospital, Yokohama, Kanagawa, Japan
| | - Mutsuki Takeda
- Department of Neurology, Yokohama Sakae Kyosai Hospital, Yokohama, Kanagawa, Japan
| | - Tatsu Nakano
- Department of Neurology, Yokohama Sakae Kyosai Hospital, Yokohama, Kanagawa, Japan
| | - Motohiro Nomura
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Kanagawa, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan
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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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Bonasia S, Di Caterino F, Robert T. Embryology of the vertebral artery and variants of the adult. Neurochirurgie 2024; 70:101517. [PMID: 38277860 DOI: 10.1016/j.neuchi.2023.101517] [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: 08/12/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 01/28/2024]
Abstract
The vertebral arteries represent in the adult the main blood supply of the posterior cranial fossa, even if they appear relatively late during the embryological life. We reviewed all the most important steps of the vertebral artery's embryological development and the most common variants that can occur in the adult. The aim of this review is to summarize the main events of the development of this artery and to give an embryological explication for the most common variants of this artery.
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Affiliation(s)
- Sara Bonasia
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France.
| | - Fortunato Di Caterino
- Department of Interventional Neuroradiology, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Thomas Robert
- University of Southern Switzerland, Lugano, Switzerland
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Ahmad H, Albayar A, Muhammad N, Romeo D, Salem M, Yang AI, Burkhardt JK. Ruptured Anterior Inferior Cerebellar Artery Aneurysm From a Persistent Trigeminal Artery: A Case Report. Cureus 2024; 16:e60648. [PMID: 38903290 PMCID: PMC11187456 DOI: 10.7759/cureus.60648] [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: 05/20/2024] [Indexed: 06/22/2024] Open
Abstract
Persistent trigeminal artery (PTA) is the most common remnant of the primitive carotid-vertebrobasilar anastomoses, which typically form and obliterate during the early stages of human embryonic development. While PTA can be non-pathologic and is usually an incidental finding, it is also associated with various other vascular abnormalities, such as arteriovenous malformations and fistulae, but most commonly cerebral aneurysms. In these cases, aneurysms are usually reported in the anterior cerebral circulation or in the PTA trunk itself; to date, only one report exists of an associated aneurysm in the posterior circulation (basilar artery). These associated vascular pathologies are not only a source of morbidity and mortality but can also complicate subsequent endovascular treatment due to different flow patterns and increased vessel tortuosity. In this case report, we present the first reported case of PTA-associated aneurysm in the anterior inferior cerebellar artery and its resulting impact on the endovascular treatment of this aneurysm.
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Affiliation(s)
- Hasan Ahmad
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Ahmed Albayar
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Najib Muhammad
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Dominic Romeo
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Mohamed Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Andrew I Yang
- Department of Neurosurgery, Barrow Neurological Institute, Philadelphia, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA
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Kang DW, Kim DY, Kim J, Baik SH, Jung C, Singh N, Song JW, Bae HJ, Kim BJ. Emerging Concept of Intracranial Arterial Diseases: The Role of High Resolution Vessel Wall MRI. J Stroke 2024; 26:26-40. [PMID: 38326705 PMCID: PMC10850450 DOI: 10.5853/jos.2023.02481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/27/2023] [Accepted: 12/04/2023] [Indexed: 02/09/2024] Open
Abstract
Intracranial arterial disease (ICAD) is a heterogeneous condition characterized by distinct pathologies, including atherosclerosis. Advances in magnetic resonance technology have enabled the visualization of intracranial arteries using high-resolution vessel wall imaging (HR-VWI). This review summarizes the anatomical, embryological, and histological differences between the intracranial and extracranial arteries. Next, we review the heterogeneous pathophysiology of ICAD, including atherosclerosis, moyamoya or RNF213 spectrum disease, intracranial dissection, and vasculitis. We also discuss how advances in HR-VWI can be used to differentiate ICAD etiologies. We emphasize that one should consider clinical presentation and timing of imaging in the absence of pathology-radiology correlation data. Future research should focus on understanding the temporal profile of HR-VWI findings and developing quantitative interpretative approaches to improve the decision-making and management of ICAD.
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Affiliation(s)
- Dong-Wan Kang
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
- Headquarters for Public Health Care, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Neurology, Gyeonggi Provincial Medical Center, Icheon Hospital, Icheon, Korea
| | - Do Yeon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
- Headquarters for Public Health Care, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Neurology, Gyeonggi Provincial Medical Center, Icheon Hospital, Icheon, Korea
| | - Jonguk Kim
- Department of Neurology, Inha University Hospital, Incheon, Korea
| | - Sung Hyun Baik
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Cheolkyu Jung
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Nishita Singh
- Department of Internal Medicine-Neurology Division, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Jae W. Song
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
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Toro-Tobon S, Manrique M, Paredes-Gutierrez J, Mantilla-Rivas E, Oh H, Ahmad L, Oh AK, Rogers GF. Pharyngeal Arches, Chapter 1: Normal Development and Derivatives. J Craniofac Surg 2023; 34:2237-2241. [PMID: 37264513 PMCID: PMC10521768 DOI: 10.1097/scs.0000000000009374] [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: 03/14/2023] [Accepted: 04/10/2023] [Indexed: 06/03/2023] Open
Abstract
The pharyngeal arches form the cornerstone of the complex anatomy of the face and neck. These embryologic structures are the foundation of face and neck development, and anomalous growth can result in craniofacial abnormalities. Surgeons who manage head and neck pathology and pathoanatomy will invariably encounter conditions associated with aberrant pharyngeal arch anatomy, and a thorough understanding of the normal and pathological development of these important structures is paramount to accurate diagnosis and treatment. This manuscript is the first of a three-part educational series that addressed the pharyngeal/branchial arch embryology, development, nomenclature, and normal anatomy (Part I), pathologic anomalies of ear and neck derived from abnormal development of the arches (Part II), and different types of orofacial clefts, including Tessier clefts (Part III).
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Shah P, Shrivastava M, Kale H, Mundada K. Interventions and imaging in patients with anatomic variations of cerebral circulation: a pictorial review. Acta Radiol 2023; 64:2455-2469. [PMID: 37143263 DOI: 10.1177/02841851231171687] [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: 05/06/2023]
Abstract
The cerebral arterial system shows a wide spectrum of variations. Minor degrees of anatomic differences can be seen in almost all patients. Recognition of these anatomic variants is essential for the following: evaluating collateral circulation; some anatomic variants may mimic pathology; increased risk for aneurysm formation with some variants (e.g. fenestration, persistent trigeminal artery); dealing with pathologies that can arise with these variations; and for preoperative planning. The anterior and posterior groups of intracranial circulation show numerous anastomoses that play a major role in maintaining adequate blood supply to the cerebral parenchyma. This review focuses on the imaging features of these variants as seen on computed tomography and magnetic resonance imaging with relevant digital subtraction angiography imaging. We also present some case illustrations where understanding of these variants contributed to providing appropriate management.
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Affiliation(s)
- Pratik Shah
- Department of Neuro-interventional Radiology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Manish Shrivastava
- Department of Neuro-interventional Radiology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Hrishikesh Kale
- Department of Radiology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Krishna Mundada
- Department of Radiology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
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Ito S, Asai T, Kimata M, Ohno M, Suzaki N, Kajita Y, Takahashi T. Mechanical Thrombectomy for Basilar Artery Occlusion with a Type 1 Persistent Proatlantal Artery: A Case Report and Literature Review. JOURNAL OF NEUROENDOVASCULAR THERAPY 2023; 17:139-144. [PMID: 37546343 PMCID: PMC10400907 DOI: 10.5797/jnet.cr.2023-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/16/2023] [Indexed: 08/08/2023]
Abstract
Objective Persistent proatlantal artery (PPA) is a primitive carotid-vertebrobasilar anastomosis (CVA); acute ischemic stroke due to basilar artery (BA) occlusion via a PPA is extremely rare. Case Presentation An 84-year-old female developed disturbance of consciousness (Glasgow Coma Scale E2V1M5) and quadriparesis with a National Institutes of Health Stroke Scale score of 35. Head CT revealed early ischemic changes in the right temporal lobe, and a hyperdense vessel sign in the BA. Cerebral angiography showed that the left vertebral artery (VA) did not originate from the left subclavian artery or aortic arch. A left common carotid artery angiogram showed the presence of the left PPA originating from the left external carotid artery. Mechanical thrombectomy (MT) with contact aspiration using a Penumbra 5MAX ACE 60 aspiration catheter was performed, and successful recanalization was achieved after clot retrieval in the first attempt (thrombolysis in cerebral infarction scale 2b). MRI performed the following day, however, revealed a newly developed large hemorrhagic infarction in the pons, with no improvement in her symptoms (modified Rankin Scale score of 5 at 90 days). Conclusion Although MT achieved successful recanalization of the BA via the PPA, her clinical symptoms did not improve, probably because of poor collateral circulation or the long length of the occlusion. In patients with acute vertebro-BA occlusion, if the VA does not originate from the subclavian artery or aortic arch, the presence of a primitive CVA should be considered.
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Affiliation(s)
- Shohei Ito
- Department of Neurosurgery, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Takumi Asai
- Department of Neurosurgery, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan
- Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Aichi, Japan
| | - Masayuki Kimata
- Department of Neurosurgery, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Masasuke Ohno
- Department of Neurosurgery, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Noriyuki Suzaki
- Department of Neurosurgery, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Yasukazu Kajita
- Department of Neurosurgery, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Tatsuo Takahashi
- Department of Neurosurgery, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan
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Huang W, Zhang Y, Zhuang Y, Shi Y, Feng Y. An anatomical study of persistent trigeminal artery detected by computed tomography angiography and magnetic resonance angiography: proposal for a modified classification and a novel basilar artery grading system. Surg Radiol Anat 2023:10.1007/s00276-023-03164-1. [PMID: 37233779 DOI: 10.1007/s00276-023-03164-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/05/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE The purpose of this study is to investigate the anatomical characteristics of persistent trigeminal artery (PTA) detected by computed tomography angiography (CTA) and magnetic resonance angiography (MRA), propose a modified classification and a novel grading system for basilar artery (BA). METHODS Patients who underwent head CTA or MRA in our hospital between August 2014 and August 2022 were reviewed retrospectively. The prevalence, sex, and course of PTA were evaluated. PTA types were modified based on Weon's classification. Type I to IV were similar to those in Weon's classification except the presence of intermed fetal-type posterior cerebral artery (IF-PCA). Type V was the same as that in Weon's classification. Type VI included subtypes of VIa (concomitant IF-PCA based on type I to IV) and VIb (other variants). BA was assessed based on a scale of 0 to 5 compared with PTA's caliber (0, BA aplasia; 1 and 2, BA non-dominant; 3, equilibrium; 4 and 5, BA dominant). RESULTS A total of 57 patients (0.06%) with PTA, including 36 females and 21 males, were detected in 94,487 patients. Six patients (10.5%) were medial type and 51 patients (89.5%) were lateral type. Thirty-seven patients (64.9%) were type I, 1 (1.8%) as type II, 13 (22.8%) as type III, 3 (5.3%) as type IV, 1 (1.8%) as type V, and 2 (3.5%) as type VI. For BA grading, 4 (7.0%), 21 (36.8%), 17 (29.8%), 6 (10.5%), 6 (10.5%), and 3 (5.3%) of the patients were grade 0, 1, 2, 3, 4, and 5, respectively. Fifteen patients (26.3%) had intracranial aneurysms. One cases (1.8%) had a fenestration of the PTA. CONCLUSION The prevalence of PTA in our study was lower than that in most previous reports. The modified PTA classification and BA grading system can be used to better understand the vascular structure of PTA patients.
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Affiliation(s)
- Wei Huang
- Department of Medical Imaging, the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Yan Zhang
- Department of Radiotherapy, the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Yingying Zhuang
- Department of Medical Imaging, the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Yuzhen Shi
- Department of Medical Imaging, the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Yun Feng
- Department of Medical Imaging, the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China.
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Catalano M, Crimi L, Belfiore G, Grippaldi D, David E, Spatola C, Cristaudo C, Foti PV, Palmucci S, Basile A. Congenital and acquired anomalies of the basilar artery: A pictorial essay. Neuroradiol J 2023:19714009231177412. [PMID: 37210636 DOI: 10.1177/19714009231177412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023] Open
Abstract
INTRODUCTION The basilar artery is one of the two cases in our body where an arterial vessel is formed by the union of two others - the vertebral arteries. It provides vascular supply to essential structures for the main vital functions; the posterior cerebral arteries originate from it as terminal branches, and form part of the anastomotic circle of Willis. IMAGING FINDINGS Congenital and acquired anomalies of the basilar trunk are described. We provide a schematic and detailed representation of normal anatomical variants - mainly represented by the fenestrated basilar artery or the persistence of carotid-basilar anastomosis; course anomalies are also illustrated, with reference to neuro-vascular conflicts and dolichoectasia. Among congenital anomalies, this pictorial review also shows the variants of the basilar origin, such as in the case of basilar trunk arising from only one of the two vertebral arteries, and the calibre changes - which are represented by aneurysm and hypoplasia. The latter appears to be a risk factor for posterior circulation stroke, when associated with a bilateral posterior foetal variant.Among the acquired forms, this pictorial essay describes some clinical cases of dissections, non-congenital aneurysms, thrombosis and tumour with vascular encasing or compression of basilar artery. CONCLUSION CT angiography and MRI allow us to study the posterior intracranial circulation in detail, providing useful pre-treatment information. Therefore, knowledge of congenital or acquired anomalies of the basilar artery is essential for radiologists, neuroradiologists and neurosurgeons.
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Affiliation(s)
- Marco Catalano
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", Italy
| | - Luca Crimi
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", Italy
| | - Giuseppe Belfiore
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", Italy
| | - Daniele Grippaldi
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", Italy
| | - Emanuele David
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", Italy
| | - Corrado Spatola
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", Italy
| | - Concetto Cristaudo
- UOC Neuroradiologia, Azienda Ospedaliera per L'Emergenza Cannizzaro, Italy
| | - Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", Italy
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", Italy
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", Italy
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Raz E, Nayak G, Sharashidze V, Nossek E, Malak W, Bueno H, Komiyama M, Nelson PK, Shapiro M. An unusual anatomical variant: A transclival artery supplying the vertebrobasilar circulation. Interv Neuroradiol 2023:15910199231165613. [PMID: 37032452 DOI: 10.1177/15910199231165613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023] Open
Abstract
The persistent carotid-vertebrobasilar anastomoses are arterial communications between the anterior and posterior circulations due to the persistence of embryological connections. We here present an extremely rare instance of a transclival persistent carotid-vertebrobasilar anastomosis in a 10-month-old infant, which does not fit into any of the traditionally described categories, such as the trigeminal artery, hypoglossal artery, or proatlantal artery.
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Affiliation(s)
- Eytan Raz
- Neurointerventional section, Department of Radiology, NYU Langone Health, New York, NY, USA
- Department of Radiology, 12297NYU Langone Health, New York, NY, USA
| | - Gopi Nayak
- Department of Radiology, 12297NYU Langone Health, New York, NY, USA
| | - Vera Sharashidze
- Neurointerventional section, Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Erez Nossek
- Neurointerventional section, Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Wassim Malak
- Department of Radiology, 12297NYU Langone Health, New York, NY, USA
| | - Hugo Bueno
- Department of Radiology, 12297NYU Langone Health, New York, NY, USA
| | | | - Peter Kim Nelson
- Neurointerventional section, Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Maksim Shapiro
- Neurointerventional section, Department of Radiology, NYU Langone Health, New York, NY, USA
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13
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Phukan P, Saikia B, Sarma A, Baruah SD, Das GC, Gayan PS. Retrospective Study of Normal Variations in Vertebral Artery on Computed Tomography Angiography With Special Emphasis on Relevant Embryology. Cureus 2023; 15:e38063. [PMID: 37234137 PMCID: PMC10208390 DOI: 10.7759/cureus.38063] [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: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
Background The vertebral arteries (VA) nourish the posterior cerebral circulation. Planning neck and cervical interventions like drilling and instrumentation, which involves VA manipulation, require an in-depth acquaintance with the normal and variant patterns encountered in the origin and course of the VA. Embryological events involved in forming these variant patterns can be correlated to their prior disposition in the lower vertebrate's understanding which becomes crucial while planning cervical interventions. Study design This is a single-center, retrospective study. Materials and methods The study involved 70 patients of both sexes and was done from September 2021 to February 2022 in the Department of Radiodiagnosis and Imaging at North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Meghalaya, India. The CT angiographies were studied for variations of VA under V1 - from origin to entrance into the foramen transversarium (FT), V2 - part inside FT, V3 - from its exit from FT till it pierces the cranial dura mater, and V4 - intracranial part. Further, VA was observed for its origin, dominance, level of entry in FT, and any associated anomalies. Results The VA was found mostly to be codominant. There was an opposite directional relationship between the basilar artery curvature and the dominance of VA. The association of ischemic events with hypoplastic VA was more on the left side (66.67%). Left VA originated from the aorta in 4.3% of subjects. One case presented a dual origin of VA. The abnormal origin of the LVA from the aorta showed a higher rate of abnormal entry into FT which was also found to be statistically significant. Conclusion Our study identifies and documents the anatomical variations present in VA specific to the population of northeast India by CT angiography and thus provides a much-needed reference for the healthcare professionals working in the field of Head and Neck interventions by providing opportunities further to understand these patterns for better diagnostic and therapeutic outcomes.
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Affiliation(s)
- Pranjal Phukan
- Radiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Science (NEIGRIHMS), Shillong, IND
| | - Bishwajeet Saikia
- Anatomy, North Eastern Indira Gandhi Regional Institute of Health and Medical Science (NEIGRIHMS), Shillong, IND
| | - Amitav Sarma
- Anatomy, North Eastern Indira Gandhi Regional Institute of Health and Medical Science (NEIGRIHMS), Shillong, IND
| | - Sudipta D Baruah
- Anatomy, North Eastern Indira Gandhi Regional Institute of Health and Medical Science (NEIGRIHMS), Shillong, IND
| | - Gautam C Das
- Anatomy, Silchar Medical College and Hospital, Silchar, IND
| | - Partha S Gayan
- Ophthalmology, Nagaon Medical College and Hospital, Nagaon, IND
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14
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PulseRider-assisted coil embolization for an unruptured internal carotid artery-persistent primitive trigeminal artery aneurysm. J Stroke Cerebrovasc Dis 2023; 32:106876. [PMID: 36470175 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106876] [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: 06/02/2022] [Revised: 10/18/2022] [Accepted: 11/04/2022] [Indexed: 12/04/2022] Open
Abstract
A persistent primitive trigeminal artery (PPTA) is a vessel remnant of carotid-vertebrobasilar anastomosis. The aneurysm at the bifurcation of the internal carotid artery (ICA) and PPTA tends to have a broad neck with the branch incorporated into the sac. Because PPTA supplies to the posterior circulation and branches off direct pontine perforators, PPTA preservation should always be considered when treating PPTA aneurysms to avoid ischemic complications.We report a case of the wide-neck ICA-PPTA aneurysm successfully treated with the PulseRider-assisted coil embolization, resulting in complete occlusion with PPTA patency. Relevant anatomy and endovascular strategy of the PPTA aneurysms are discussed.
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15
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Ota T, Komiyama M. Vascular supply of the hindbrain: Basic longitudinal and axial angioarchitecture. Interv Neuroradiol 2022; 28:756-764. [PMID: 34935534 PMCID: PMC9706269 DOI: 10.1177/15910199211063011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 11/15/2022] Open
Abstract
The basic pattern of arterial vascularization is highly conserved across vertebrates and develops under neuromeric rules. The hindbrain has an angioarchitecture that is homologous to that of the spinal cord, and the hindbrain vascular system can be analyzed at the longitudinal and axial structures. During development, there are two main longitudinal arteries: the longitudinal neural artery and primitive lateral basilovertebral anastomosis. This review discusses the basic pattern of the blood supply of the hindbrain, the development of vascularization, and the anatomical variations, with a special reference to the embryological point of view of two main longitudinal anastomoses (longitudinal neural artery and primitive lateral basilovertebral anastomosis). The formation of commonly observed variations, such as fenestration and duplication of the vertebrobasilar artery, or primitive trigeminal artery variant, can be explained by the partial persistence of the primitive lateral basilovertebral anastomosis. Understanding the pattern and the development of the blood supply of the hindbrain provides useful information of the various anomalies of the vertebrobasilar junction and cerebellar arteries.
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Affiliation(s)
- Takahiro Ota
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo,
Japan
| | - Masaki Komiyama
- Department of Neurointervention, Osaka City General Hospital, Osaka,
Japan
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16
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de Sousa Costa R, Ventura N, de Andrade Lourenção Freddi T, da Cruz LCH, Corrêa DG. The Hypoglossal nerve. Semin Ultrasound CT MR 2022; 44:104-114. [PMID: 37055141 DOI: 10.1053/j.sult.2022.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The hypoglossal nerve is the 12th cranial nerve, exiting the brainstem in the preolivary sulcus, passing through the premedullary cistern, and exiting the skull through the hypoglossal canal. This is a purely motor nerve, responsible for the innervation of all the intrinsic tongue muscles (superior longitudinal muscle, inferior longitudinal muscle, transverse muscle, and vertical muscle), 3 extrinsic tongue muscles (styloglossus, hyoglossus, and genioglossus), and the geniohyoid muscle. Magnetic resonance imaging (MRI) is the best imaging exam to evaluate patients with clinical signs of hypoglossal nerve palsy, and computed tomography may have a complementary role in the evaluation of bone lesions affecting the hypoglossal canal. A heavily T2-weighted sequence, such as fast imaging employing steady-state acquisition (FIESTA) or constructive interference steady state (CISS) is important to evaluate this nerve on MRI. There are multiple causes of hypoglossal nerve palsy, being neoplasia the most common cause, but vascular lesions, inflammatory diseases, infections, and trauma can also affect this nerve. The purpose of this article is to review the hypoglossal nerve anatomy, discuss the best imaging techniques to evaluate this nerve and demonstrate the imaging aspect of the main diseases that affect it.
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17
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de Sousa Costa R, Ventura N, de Andrade Lourenção Freddi T, da Cruz LCH, Corrêa DG. The Glossopharyngeal, Vagus and Accessory nerves: Anatomy and Pathology. Semin Ultrasound CT MR 2022; 44:95-103. [PMID: 37055144 DOI: 10.1053/j.sult.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The glossopharyngeal, vagus, and accessory nerves are discussed in this article, given their intimate anatomical and functional associations. Abnormalities of these lower cranial nerves may be intrinsic or extrinsic due to various disease processes. This article aims to review these nerves' anatomy and demonstrates the imaging aspect of the diseases which most commonly affect them.
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18
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Entrance and origin of the extracranial vertebral artery found on computed tomography angiography. Sci Rep 2022; 12:15274. [PMID: 36088490 PMCID: PMC9464228 DOI: 10.1038/s41598-022-19497-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/30/2022] [Indexed: 11/25/2022] Open
Abstract
To investigated morphological variability of vertebral artery (VA) origin and its entrance level into cervical transverse foramina by computed tomography angiography (CTA). To retrospectively investigated CTA of 223 subjects (446 VA courses). Investigated were origin of the VA and its level of entrance into vertebral transverse foramen with notification of the sex and side of variation. The VA entered the C6 transverse process in 91.70% of specimens (409 out of 446 VA courses). Abnormal entrance of VA was observed in 8.30% of specimens (37 VA courses), with the level of entrance into the C3, C4, C5, or C7 transverse foramen at 0.22%, 2.47%, 4.71% and 0.90% respectively. Comparably, the overall variability of abnormal origin of VA was 1.57% (7 out of 466 VA courses), in which the left vertebral arteries all arose from aortic arch. The variation rate of vertebral entrance rose up to 50% in abnormal origin subgroup. When comparing subgroups of subjects with normal and abnormal origin, there was significance difference in the frequency of entrance variation in the level of transverse foramen (p < 0.001). Abnormal entrance and origin of VA were observed in 8.30% and 1.57% of VA courses, which can be accurately appeared by CTA. Regarding to the subgroups of abnormal origin, the frequency of entrance variation was significantly increased in the level of transverse foramen compared to that of normal origin.
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19
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Murumkar V, Peer S, Saini J, Arvinda HR. Endovascular management of dissecting posterior cerebral artery aneurysm associated with persistent hypoglossal artery: A case report. J Vasc Bras 2021; 20:e20200142. [PMID: 34394204 PMCID: PMC8336981 DOI: 10.1590/1677-5449.200142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 11/18/2020] [Indexed: 11/22/2022] Open
Abstract
Persistent embryological connections between the anterior and posterior circulations are rare entities. Persistent hypoglossal artery is the second most common persistent carotid-basilar anastomosis. As it is often associated with hypoplasia of vertebral arteries, it poses a challenge during endovascular interventions. We present a case of a 32-year-old woman who presented with occipital headache of four weeks’ duration. Magnetic Resonance Angiography showed hypoplastic vertebral arteries with a persistent hypoglossal artery arising from the cervical segment of the left internal carotid artery and supplying the entire posterior circulation, associated with a dissecting aneurysm of the right posterior cerebral artery. Endovascular parent vessel occlusion was performed for the dissecting posterior cerebral artery aneurysm by navigating the guide catheter, microwire, and microcatheter through the persistent hypoglossal artery because the vertebral arteries were hypoplastic. Post-intervention, the patient did not develop any neurological deficit and was discharged in a stable condition.
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Affiliation(s)
- Vivek Murumkar
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Sameer Peer
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Hanumanthapura Ramalingaiah Arvinda
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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20
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Mathkour M, Scullen T, Debakey M, Beighley A, Jawad B, Riffle J, Abou-Al-Shaar H, Tubbs RS, Kalyvas J. Anterior cervical discectomy and fusion in the setting of kissing carotids: A technical report and literature review. Clin Neurol Neurosurg 2020; 200:106366. [PMID: 33276217 DOI: 10.1016/j.clineuro.2020.106366] [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: 10/12/2020] [Accepted: 11/07/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND The "kissing carotids" (KCS) phenomenon refers to bilateral retropharyngeal displacement of the internal carotid arteries (ICA). This anomalous anatomy can impose a significant surgical challenge to spine surgeons. OBJECTIVE In this report, we describe our approach for an anterior cervical discectomy and fusion in the setting of kissing carotids. METHODS We discuss our case, surgical technique, rationale, and outcome. Additionally, we conducted a systematic review of the literature. CASE DESCRIPTION An 82-year-old female presented to our service with progressive myelopathy. Cervical spinal imaging revealed a large disc herniation at C3-C4 and severe spinal canal stenosis. Vascular imaging showed anomalous ICAs bilaterally overlying the prevertebral fascia at the midline. The patient received aspirin preoperatively and underwent a multidisciplinary approach with neurosurgery and otolaryngology. A standard transcervical approach centered on the C5-C6 disc space, where the carotid arteries splayed most from midline, allowed for facilitated visualization and mobilization of the vessels. Prevertebral dissection was then performed rostrally to the C3-C4 disc space. The patient was put into burst suppression prior to retraction and underwent uncomplicated anterior discectomy and fusion. CONCLUSIONS KCS is a rare but critical presentation of extreme medial displacement of bilateral ICAs. Few cases have been reported in the spinal surgery literature. Knowledge of this rare variant is important to avoid iatrogenic injury and complications.
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Affiliation(s)
- Mansour Mathkour
- Department of Neurological Surgery, Ochsner Clinic Foundation, New Orleans, LA, United States; Neurosurgery Division, Surgery Department, Jazan University, Jazan, Saudi Arabia.
| | - Tyler Scullen
- Department of Neurological Surgery, Ochsner Clinic Foundation, New Orleans, LA, United States.
| | - Michael Debakey
- Department of Otolaryngology-Head & Neck Surgery, Ochsner Clinic Foundation, New Orleans, LA, United States.
| | - Adam Beighley
- Department of Otolaryngology-Head & Neck Surgery, Ochsner Clinic Foundation, New Orleans, LA, United States.
| | - Basit Jawad
- Department of Otolaryngology-Head & Neck Surgery, Ochsner Clinic Foundation, New Orleans, LA, United States.
| | - Jonathan Riffle
- Department of Neurological Surgery, Ochsner Clinic Foundation, New Orleans, LA, United States.
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
| | - R Shane Tubbs
- Department of Neurological Surgery, Ochsner Clinic Foundation, New Orleans, LA, United States.
| | - James Kalyvas
- Department of Neurological Surgery, Ochsner Clinic Foundation, New Orleans, LA, United States.
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21
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Case D, Kumpe D, Roark C, Seinfeld J. Neuroangiography: Review of Anatomy, Periprocedural Management, Technique, and Tips. Semin Intervent Radiol 2020; 37:166-174. [PMID: 32419729 DOI: 10.1055/s-0040-1709171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Neuroangiography (NA) is a minimally invasive procedure used to diagnose patients with neurovascular diseases. Noninvasive imaging has improved dramatically in recent years and is utilized more frequently; however, further evaluation with NA is still required in certain cases. NA indications include intracranial (cerebral aneurysms, arteriovenous malformations, dural arteriovenous fistula, cerebral vasculitis, cerebral vasospasm, ischemic stroke, nontraumatic subarachnoid hemorrhage, intracerebral hemorrhage, Moyamoya, vein of Galen malformation, intracranial tumors, and pseudotumor cerebri) and extracranial (internal and common carotid artery stenosis, vertebral artery stenosis, carotid artery blowout, vertebral artery blowout, epistaxis, oropharyngeal bleeding, and carotid body tumor) pathologies which can help with diagnosis and potential subsequent endovascular treatment. A thorough understanding of normal and variant cervical/cranial vascular anatomy is required. In addition, periprocedural management, catheter technique, equipment needed, and underlying disease pathology are paramount to successful and safe outcomes. This article will review basic neurovascular anatomy, periprocedural management, NA technique, and tips for safe and successful outcomes.
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Affiliation(s)
- David Case
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado
| | - David Kumpe
- Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Christopher Roark
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Joshua Seinfeld
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado
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22
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Trigeminal Neuralgia Due to Compression of Primitive Trigeminal Artery Variant: Usefulness of Fusion Images of Constructive Interference in Steady-State Magnetic Resonance Imaging and Computed Tomography Angiography. World Neurosurg 2020; 138:257-260. [PMID: 32151772 DOI: 10.1016/j.wneu.2020.02.168] [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: 01/15/2020] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Trigeminal neuralgia (TN) is one of the neuropathic pain syndromes, most commonly caused by vascular compression in the root entry zone of the trigeminal nerve in the cerebellopontine angle. It was rare as offending artery that primitive trigeminal artery and primitive trigeminal artery variant (PTAv) as an anomaly that occurs carotid-basilar anastomosis. We report a case of TN caused by the PTAv, and usefulness of fusion images of magnetic resonance imaging (MRI) and computed tomography angiography (CTA). CASE DESCRIPTION A 65-year-old man presented with a 2-year history of left paroxysmal facial pain in the second division of the trigeminal nerve. We diagnosed left TN due to PTAv using constructive interference in steady state magnetic resonance imaging (CISS MRI) and CTA. Microvascular decompression surgery disclosed trigeminal nerve compressed by PTAv consisted with findings from preoperative neuroimaging. We report a case of TN caused by PTAv, and usefulness of fusion images of CISS MRI and CTA to understand the neurovascular and bony structure during the perioperative period. CONCLUSIONS The fusion image created by CISS MRI and 3-dimensional CTA was useful to identify the offending vessel and to clearly understand the neurovascular structure preoperatively.
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23
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Elder TA, Verhey LH, Simon DB, Smith EC, Adel JG. Endovascular treatment of a basilar tip aneurysm via a persistent primitive proatlantal intersegmental artery. INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2019.100543] [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] Open
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Wan Z, Meng H, Xu N, Liu T, Chen Z, Zhang Z, Xu J, Wang H. Coil embolisation of multiple cerebral aneurysms with lateral type I persistent primitive trigeminal artery: A case report and literature review. Interv Neuroradiol 2019; 25:628-634. [PMID: 31220987 DOI: 10.1177/1591019919859507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The primitive trigeminal artery is an anastomotic vessel of the carotid-basilar artery system that occurs only transiently during the embryonic period. Persistent primitive trigeminal artery occurs in approximately 0.1-0.6% of the population. Here, we report the case of a 60-year-old woman with Fisher II grade subarachnoid haemorrhage. Computed tomography angiography demonstrated a lateral, Saltzman type I persistent primitive trigeminal artery with three cerebral aneurysms, including one anterior communicating artery aneurysm, one suspicious right anterior choroidal artery aneurysm and one distal basilar artery aneurysm supplied by the persistent primitive trigeminal artery. All three aneurysms were treated with coil embolisation. At the 8-month follow-up, the anterior communicating artery aneurysm had a neck remnant, the other two aneurysms exhibited complete occlusion. Persistent primitive trigeminal artery with multiple cerebral aneurysms is extremely rare, and only seven cases of persistent primitive trigeminal artery with multiple cerebral aneurysms have previously been reported in publications that included information on treatment. Most aneurysms were treated by open surgery. This is the first report of coil embolisation treatment of multiple aneurysms in persistent primitive trigeminal artery patients with follow-up results, and provides relevant and valuable information about the persistent primitive trigeminal artery and the endovascular treatment of multiple aneurysms in persistent primitive trigeminal artery patients.
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Affiliation(s)
- Zheng Wan
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Hao Meng
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Ning Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Tianyi Liu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Zhongping Chen
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Zheming Zhang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Jianjun Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Honglei Wang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
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25
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Ho CL, Lam JJH, McAdory LE. Carotid Mycotic Aneurysm associated with Persistent Primitive Hypoglossal Artery. Case Report and Literature Review. J Radiol Case Rep 2019; 13:1-7. [PMID: 31565171 DOI: 10.3941/jrcr.v13i3.3588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Carotid mycotic aneurysm is extremely rare and even more unusual when it is associated with a persistent primitive hypoglossal artery. This artery is the second most common of the embryonic carotid-vertebrobasilar anastomoses. It originates from the cervical internal carotid artery and enters the cranium through a widened hypoglossal canal before anastomosing with the basilar artery. We report a case of an elderly man with a rare Salmonella-induced mycotic aneurysm associated with a persistent primitive hypoglossal artery. Surgical resection of the mycotic aneurysm was complicated by a posterior circulation stroke. To the best of our knowledge, there was no previous report of a carotid mycotic aneurysm associated with a persistent primitive hypoglossal artery thus far in the literature. Owing to the high mortality rate of the carotid mycotic aneurysm, it is imperative to be familiar with the vascular and imaging anatomy prior to surgery particularly in the presence of an embryonic carotid-vertebrobasilar anastomosis. In this report, we highlight the imaging characteristics and treatment options for this rare mycotic aneurysm together with a literature review.
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Affiliation(s)
- Chi Long Ho
- Department of Radiology, Sengkang General Hospital, Singapore
- Duke-NUS (National University of Singapore) Graduate Medical School, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | - Louis Elliott McAdory
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
- Duke-NUS (National University of Singapore) Graduate Medical School, Singapore
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26
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Lam JJH, Shah MTBM, Chung SL, Ho CL. Persistent primitive trigeminal artery associated with a cavernous carotid aneurysm. Case report and literature review. J Radiol Case Rep 2019; 12:1-11. [PMID: 30647831 DOI: 10.3941/jrcr.v12i11.3500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The persistent primitive trigeminal artery is the most common persistent carotid-vertebrobasilar anastomosis. Patients are usually asymptomatic and the persistent primitive trigeminal artery is commonly found incidentally on imaging. Rarely, they may present with symptoms of neurovascular conflict or cranial nerve compression syndromes as the artery may be intimately related to the cranial nerves. The basilar artery is often hypoplastic in this condition and blood supply to the posterior circulation is predominantly via the persistent primitive trigeminal artery. Recognizing the persistent primitive trigeminal artery is imperative as disease of the artery may result in ischemia of the posterior circulation. To date, there is no clear association between this artery and cerebral aneurysms. We present a rare case of a patient with a persistent primitive trigeminal artery and a concomitant cavernous carotid aneurysm together with a literature review.
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Affiliation(s)
| | - Mohammad Taufik Bin Mohamed Shah
- Department of Radiology, Sengkang General Hospital, Singapore
- Duke-NUS (National University of Singapore) Graduate Medical School, Singapore
| | - Siok Li Chung
- Department of Radiology, Sengkang General Hospital, Singapore
| | - Chi Long Ho
- Department of Radiology, Sengkang General Hospital, Singapore
- Duke-NUS (National University of Singapore) Graduate Medical School, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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27
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Goyal P, Mangla R, Gupta S, Malhotra A, Almast J, Sapire J, Kolar B. Pediatric Congenital Cerebrovascular Anomalies. J Neuroimaging 2018; 29:165-181. [DOI: 10.1111/jon.12575] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 10/11/2018] [Accepted: 10/13/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Pradeep Goyal
- Department of Radiology; St. Vincent's Medical Center; Bridgeport CT
| | - Rajiv Mangla
- Department of Radiology; SUNY Upstate Medical University; Syracuse NY
| | - Sonali Gupta
- Department of Medicine; St. Vincent's Medical Center; Bridgeport CT
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging; Yale School of Medicine; New Haven CT
| | - Jeevak Almast
- Department of Radiology; University of Rochester Medical Center; Rochester NY
| | - Joshua Sapire
- Department of Radiology; St. Vincent's Medical Center; Bridgeport CT
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