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Ikegaya N, Hayashi T, Higashijima T, Takayama Y, Sonoda M, Iwasaki M, Miyake Y, Sato M, Tateishi K, Suenaga J, Yamamoto T. Arteries Around the Superior Limiting Sulcus: Motor Complication Avoidance in Insular and Insulo-Opercular Surgery. Oper Neurosurg (Hagerstown) 2023; 25:e308-e314. [PMID: 37966479 DOI: 10.1227/ons.0000000000000879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/21/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Insulo-opercular surgery can cause ischemic motor complications. A source of this is the arteries around the superior limiting sulcus (SLS), which reach the corona radiata, but the detailed anatomy remains unclear. To characterize arteries around the SLS including the long insular arteries (LIAs) and long medullary arteries, we classified them and examined their distribution in relation to the SLS, which helps reduce the risk of ischemia. METHODS Twenty adult cadaveric hemispheres were studied. Coronal brain slices were created perpendicular to the SLS representing insular gyri (anterior short, middle short, posterior short, anterior long, and posterior long). The arteries within 10-mm proximity of the SLS that reached the corona radiata were excavated and classified by the entry point. RESULTS A total of 122 arteries were identified. Sixty-three (52%), 20 (16%), and 39 (32%) arteries penetrated the insula (LIAs), peak of the SLS, and operculum (long medullary arteries), respectively. 100 and six (87%) arteries penetrated within 5 mm of the peak of the SLS. The arteries were distributed in the anterior short gyrus (19%), middle short gyrus (17%), posterior short gyrus (20%), anterior long gyrus (19%), and posterior long gyrus (25%). Seven arteries (5.7%) had anastomoses after they penetrated the parenchyma. CONCLUSION Approximately 90% of the arteries that entered the parenchyma and reached the corona radiata were within a 5-mm radius of the SLS in both the insula and operculum side. This suggests that using the SLS as a landmark during insulo-opercular surgery can decrease the chance of ischemia.
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Affiliation(s)
- Naoki Ikegaya
- Department of Neurosurgery, Yokohama City University Graduate school of medicine, Yokohama , Japan
| | - Takahiro Hayashi
- Department of Neurosurgery, Yokohama City University Graduate school of medicine, Yokohama , Japan
| | - Takefumi Higashijima
- Department of Neurosurgery, Yokohama City University Medical center, Yokohama , Japan
| | - Yutaro Takayama
- Department of Neurosurgery, Yokohama City University Graduate school of medicine, Yokohama , Japan
| | - Masaki Sonoda
- Department of Neurosurgery, Yokohama City University Graduate school of medicine, Yokohama , Japan
| | - Masaki Iwasaki
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry (NCNP), Kodaira , Japan
| | - Yohei Miyake
- Department of Neurosurgery, Yokohama City University Graduate school of medicine, Yokohama , Japan
| | - Mitsuru Sato
- Department of Neurosurgery, Yokohama City University Graduate school of medicine, Yokohama , Japan
| | - Kensuke Tateishi
- Department of Neurosurgery, Yokohama City University Graduate school of medicine, Yokohama , Japan
| | - Jun Suenaga
- Department of Neurosurgery, Yokohama City University Graduate school of medicine, Yokohama , Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Yokohama City University Graduate school of medicine, Yokohama , Japan
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Parwez R, Zhang C, Ghosh A. Mini-Pterional Craniotomy for Microsurgical Ligation of a Sylvian Fissure Arteriovenous Fistula. Cureus 2023; 15:e35873. [PMID: 37033517 PMCID: PMC10079804 DOI: 10.7759/cureus.35873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 03/09/2023] Open
Abstract
Pial arteriovenous fistulae (pAVF) are rare lesions, arising from direct fistulation between an artery and vein, with absence of a nidus. We present the surgical treatment of a 22-year-old female found to have a right middle cerebral artery (MCA) pAVF in the Sylvian fissure. The patient underwent a right mini-pterional approach, and careful dissection of the arterial feeder, venous varix and fistulation point. The fistulation point was tested with a temporary clip and intra-operative indocyanine green (ICG) videoangiography. All arterial feeders were identified and ligated. Complete obliteration was confirmed using ICG and post-operative digital subtraction angiography (DSA). The patient made a good recovery with no neurological deficits, and her pulsatile tinnitus stopped. Pial arteriovenous fistulae are rare lesions amenable for a surgical cure in the appropriate context.
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Kuzucu P, Çeltikçi P, Demirtaş OK, Canbolat Ç, Çeltikçi E, Demirci H, Özışık P, Tubbs RS, Pamir MN, Güngör A. Arterial Supply of the Basal Ganglia: A Fiber Dissection Study. Oper Neurosurg (Hagerstown) 2023; 24:e351-e359. [PMID: 36719962 DOI: 10.1227/ons.0000000000000612] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/01/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The basal ganglia, a group of subcortical nuclei located deep in the insular cortex, are responsible for many functions such as motor learning, emotion, and behavior control. Nowadays, because it has been shown that deep brain stimulation and insular tumor surgery can be performed by endovascular treatment, the importance of the vascular anatomy of the basal ganglia is being increasingly recognized. OBJECTIVE To explain the arterial blood supply of the basal ganglia using white matter dissection. METHODS The Klingler protocol was used to prepare 12 silicone-injected human hemispheres. The dissections were performed from lateral to medial with the fiber dissection technique to preserve arteries. RESULTS The globus pallidus blood supply came from the medial lenticulostriate, lateral lenticulostriate, and anterior choroidal arteries; the substantia nigra and subthalamic nucleus were supplied by the branches of posterior cerebral artery; the putamen was supplied by the lateral and medial lenticulostriate arteries; and the caudate nucleus was supplied by the lateral lenticulostriate and medial lenticulostriate arteries and the recurrent artery of Heubner. CONCLUSION Knowledge of the detailed anatomy of the basal ganglia and its vascular supply is essential for avoiding postoperative ischemic complications in surgeries related to the insula. In addition, knowledge of this anatomy and vascular relationship opens the doors to endovascular deep brain stimulation treatment. This study provides a 3-dimensional understanding of the blood supply to the basal ganglia by examining it using the fiber dissection technique. Further studies could use advanced imaging modalities to explore the vascular relationships with critical structures in the brain.
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Affiliation(s)
- Pelin Kuzucu
- Department of Neurosurgery, Bilkent City Hospital, Ankara, Türkiye
| | - Pınar Çeltikçi
- Department of Radiology, Bilkent City Hospital, Ankara, Türkiye
| | - Oğuz Kağan Demirtaş
- Department of Neurosurgery, Gazi Universtiy Faculty of Medicine, Ankara, Türkiye
| | - Çağrı Canbolat
- Neurosurgery Clinic, Liv Hospital Vadi İstanbul Hospital, İstanbul, Türkiye
| | - Emrah Çeltikçi
- Department of Neurosurgery, Gazi Universtiy Faculty of Medicine, Ankara, Türkiye
| | - Harun Demirci
- Department of Neurosurgery, Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara, Türkiye
| | - Pınar Özışık
- Department of Neurosurgery, Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara, Türkiye
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - M Necmettin Pamir
- Department of Neurosurgery, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Türkiye
| | - Abuzer Güngör
- Department of Neurosurgery, Yeditepe University Faculty of Medicine, İstanbul, Türkiye.,Department of Neurosurgery, Bakırköy Research and Training Hospital for Psyhiatry, Neurology and Neurosurgery, İstanbul, Türkiye
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Khatri R, Qureshi MA, Chaudhry MRA, Maud A, Vellipuram AR, Cruz-Flores S, Rodriguez GJ. The Angiographic Anatomy of the Sphenoidal Segment of the Middle Cerebral Artery and Its Relevance in Mechanical Thrombectomy. INTERVENTIONAL NEUROLOGY 2020; 8:231-241. [PMID: 32508905 DOI: 10.1159/000502545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 08/01/2019] [Indexed: 11/19/2022]
Abstract
Objective The middle cerebral artery (MCA) is the most commonly treated artery in mechanical thrombectomy stroke trials; however, there is no pragmatic agreement about the segmental anatomy and nomenclature utilized. It results in significant clinical-radiological dissociation and introduces bias in research trials. The purpose of the study is to review and compare angiographic anatomy with microsurgical anatomy literature of the MCA with emphasis on the discrepancy. Methodology Consecutive cerebral angiograms between January 2011 and March 2014 were retrospectively reviewed by endovascular surgical neuroradiologists. Information about the anatomy of the sphenoidal segment of the MCA classified as classic and non-classic pattern, the lenticulostriate artery takeoff pattern, and the course angulation of the sphenoidal segment were studied. Results A total of 500 patients, 886 cerebral angiograms, were reviewed. We found the classic pattern of the main trunk MCA bifurcation and a straight angulation course in less than half of the cases. The lenticulostriate arteries arose not only from the main trunk but also from its divisions in more than half of the cases. Conclusion It is important to corroborate our findings and to develop a pragmatic classification to accurately assess MCA occlusions from the radiological and clinical perspective.
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Affiliation(s)
- Rakesh Khatri
- Department of Neurology, Texas Tech University of Health Sciences Center, El Paso, Texas, USA
| | | | | | - Alberto Maud
- Department of Neurology, Texas Tech University of Health Sciences Center, El Paso, Texas, USA
| | | | - Salvador Cruz-Flores
- Department of Neurology, Texas Tech University of Health Sciences Center, El Paso, Texas, USA
| | - Gustavo Jose Rodriguez
- Department of Neurology, Texas Tech University of Health Sciences Center, El Paso, Texas, USA
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Tabani H, Tayebi Meybodi A, Benet A. Venous anatomy of the supratentorial compartment. HANDBOOK OF CLINICAL NEUROLOGY 2020; 169:55-71. [PMID: 32553298 DOI: 10.1016/b978-0-12-804280-9.00003-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The cerebral venous drainage system in humans has several unique characteristics that set it apart from its arterial counterpart. The intracranial drainage system can be broadly divided into supra- and infratentorial components. The supratentorial venous drainage is further subclassified into superficial and deep systems, each with a unique set of features. A thorough knowledge of the normal and variant venous drainage pathways is important to understand the different pathologic processes involving the venous vasculature, to identify and anticipate the different venous channels encountered during surgery and also to predict the possible sequelae of intentional or inadvertent venous sacrifice during surgery. This chapter summarizes the anatomic and radiologic characteristics of the venous supply of the supratentorial compartment of the brain, reviews its general characteristics, sheds light on the different classifications and nomenclature used for its descriptions, and briefly discusses its embryologic development.
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Affiliation(s)
- Halima Tabani
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Ali Tayebi Meybodi
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Arnau Benet
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, United States.
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de Souza JS, Laureano-Melo R, Herai RH, da Conceição RR, Oliveira KC, da Silva IDCG, Dias-da-Silva MR, Romano RM, Romano MA, Maciel RMDB, Chiamolera MI, Giannocco G. Maternal glyphosate-based herbicide exposure alters antioxidant-related genes in the brain and serum metabolites of male rat offspring. Neurotoxicology 2019; 74:121-131. [PMID: 31226268 DOI: 10.1016/j.neuro.2019.06.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/31/2019] [Accepted: 06/14/2019] [Indexed: 01/09/2023]
Abstract
In response to the rapid development of genetically engineered glyphosate-tolerant crops, the use of glyphosate-based herbicides (GBHs), in agriculture, has increased substantially. Currently, it is estimated that 747 million kg of GBHs are applied per year. Although several epidemiological studies have demonstrated that there are health risks associated with GBH exposure, the effects these chemicals have on the oxidative and inflammatory response in the brain are still unclear. In fact, alterations in these processes could contribute to the development of neurological diseases, such as Alzheimer's disease and autism spectrum disorders. The present study exposed pregnant rats to GBH and evaluated changes in the expression of genes related to oxidnte defense and inflammation response and monitored the serum metabolome in the adult male offspring. Pregnant Wistar rats were administered distilled water or Roundup®, at either 5 and 50 mg/kg/day, (p.o.) from gestational day (GD) 18 to postnatal day (PND) 5. There was a significant increase in the gene expression levels of Neuroglobin (Ngb - oxygen storage and tissue protection) (105%, p = 0.031), Glutathione Peroxidase 1 (Gpx1 - oxidative stress) (95%, p = 0.005), Prostaglandin-Endoperoxidase Synthase 1 (Ptgs1 - inflammation) (109%, p = 0.033) and Hypoxia inducible factor 1 subunit alpha (Hif1α - oxygen sensor) (73%, p = 0.017), in the cerebellum of PND90 rats perinatally exposed to 50 mg GBH/kg/day. Moreover, both GBH-exposed groups displayed a significant decrease in the expression of Catalase (Cat - oxidative stress) (49%, p = 0.003; and 31% p = 0.050, respectively) expression, in the cortex. Serum metabolites analyses, from the same animals of each group, demonstrated that there were significant changes in the concentrations of lysophosphatidylcholine and phosphatidylcholine, which have been associated with neurodegenerative diseases. The results of the present study suggest GBH exposure during pregnancy alters the expression of genes associated with oxidant defense, inflammation and lipid metabolism. It is plausible that maternal GBH exposure could have lasting neuronal effects on the offspring later in life.
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Affiliation(s)
- Janaina Sena de Souza
- Universidade Federal de São Paulo, UNIFESP/EPM, Departamento de Medicina, Disciplina de Endocrinologia Clínica, São Paulo, São Paulo, 04039-032, Brazil.
| | - Roberto Laureano-Melo
- Universidade Federal de São Paulo, UNIFESP/EPM, Departamento de Medicina, Disciplina de Endocrinologia Clínica, São Paulo, São Paulo, 04039-032, Brazil
| | - Roberto Hirochi Herai
- Pontifícia Universidade Católica do Paraná, School of Medicine, Graduate Program in Health Sciences (PUCPR/PPGCS), Curitiba, Paraná, 80215-901, Brazil; Instituto Lico Kaesemodel (ILK), Curitiba, Paraná, 80240-000, Brazil
| | - Rodrigo Rodrigues da Conceição
- Universidade Federal de São Paulo, UNIFESP/EPM, Departamento de Medicina, Disciplina de Endocrinologia Clínica, São Paulo, São Paulo, 04039-032, Brazil
| | - Kelen Carneiro Oliveira
- Universidade Federal de São Paulo, UNIFESP/EPM, Departamento de Medicina, Disciplina de Endocrinologia Clínica, São Paulo, São Paulo, 04039-032, Brazil
| | | | - Magnus Régios Dias-da-Silva
- Universidade Federal de São Paulo, UNIFESP/EPM, Departamento de Medicina, Disciplina de Endocrinologia Clínica, São Paulo, São Paulo, 04039-032, Brazil
| | - Renata Marino Romano
- Universidade Estadual do Centro-Oeste, Departamento de Farmácia, Guarapuava, Paraná, Brazil
| | - Marco Aurélio Romano
- Universidade Estadual do Centro-Oeste, Departamento de Farmácia, Guarapuava, Paraná, Brazil
| | - Rui Monteiro de Barros Maciel
- Universidade Federal de São Paulo, UNIFESP/EPM, Departamento de Medicina, Disciplina de Endocrinologia Clínica, São Paulo, São Paulo, 04039-032, Brazil
| | - Maria Izabel Chiamolera
- Universidade Federal de São Paulo, UNIFESP/EPM, Departamento de Medicina, Disciplina de Endocrinologia Clínica, São Paulo, São Paulo, 04039-032, Brazil
| | - Gisele Giannocco
- Universidade Federal de São Paulo, UNIFESP/EPM, Departamento de Medicina, Disciplina de Endocrinologia Clínica, São Paulo, São Paulo, 04039-032, Brazil; Universidade Federal de São Paulo, Departamento de Ciências Biológicas, Diadema, São Paulo, 09972-270, Brazil.
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Gogia B, Chavali LS, Lang FF, Hayman LA, Rai P, Prabhu SS, Schomer DF, Kumar VA. MRI venous architecture of insula. J Neurol Sci 2018; 390:156-161. [PMID: 29801878 DOI: 10.1016/j.jns.2018.04.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 04/18/2018] [Accepted: 04/19/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE The purpose of this paper is to describe the venous anatomy of the insula using conventional MR brain imaging and confocal reconstructions in cases with glioma induced venous dilatation (venous gliography). METHODS Routine clinical MRI brain scans that included thin cut (1.5-2 mm) post contrast T1 weighted imaging were retrospectively reviewed to assess the insular venous anatomy in 19 cases (11 males and 8 females) with insular gliomas. Reconstruction techniques (Anatom-e and Osirix) were used to improve understanding of the venous anatomy. RESULTS We identified the following insular and peri-insular veins on MRI: the superficial middle cerebral vein (SMCV), peri-insular sulcus vein, vein of the anterior limiting sulcus, the precentral, central, and posterior sulcus veins of the insula, the communicating veins and deep MCV. CONCLUSIONS We concluded that venous anatomy of insula is complicated and is often overlooked by radiologists on MR brain imaging. Use of confocal imaging in different planes helped us to identify the superficial and deep middle cerebral veins and their relationship to the insula. The understanding of the insular venous architecture is also useful to distinguish these vessels from insular arteries. This knowledge may be helpful for presurgical planning prior to insular glioma resection.
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Affiliation(s)
- Bhanu Gogia
- Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555, United States.
| | - Lakshmi S Chavali
- Department of Diagnositc Radiology, Cancer Center Houston, MD, Anderson 77030, United States
| | - Frederick F Lang
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States.
| | - L A Hayman
- Anatom-e information Sys, Houston, TX 77030, United States.
| | - Prashant Rai
- Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555, United States.
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States.
| | - Donald F Schomer
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States.
| | - Vinodh A Kumar
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States.
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Wysiadecki G, Małkiewicz A, Rożniecki J, Polguj M, Haładaj R, Żytkowski A, Topol M. Anatomical variations of the insular gyri: A morphological study and proposal of unified classification. Clin Anat 2018; 31:347-356. [DOI: 10.1002/ca.23060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 01/31/2018] [Accepted: 02/05/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Grzegorz Wysiadecki
- Department of Normal and Clinical AnatomyInterfaculty Chair of Anatomy and Histology, Medical University of LodzLodz Poland
| | - Adam Małkiewicz
- Department of Normal and Clinical AnatomyInterfaculty Chair of Anatomy and Histology, Medical University of LodzLodz Poland
| | - Jacek Rożniecki
- Department of Neurology, Stroke and NeurorehabilitationMedical University of LodzLodz Poland
| | - Michał Polguj
- Department of Angiology, Interfaculty Chair of Anatomy and HistologyMedical University of LodzLodz Poland
| | - Robert Haładaj
- Department of Normal and Clinical AnatomyInterfaculty Chair of Anatomy and Histology, Medical University of LodzLodz Poland
| | - Andrzej Żytkowski
- Department of Biomechanics and Prosthetic‐Orthopedic SupplyMedical University of LodzLodz Poland
| | - Mirosław Topol
- Department of Normal and Clinical AnatomyInterfaculty Chair of Anatomy and Histology, Medical University of LodzLodz Poland
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