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Xu Y, Mohyeldin A, Nunez MA, Doniz-Gonzalez A, Vigo V, Cohen-Gadol AA, Fernandez-Miranda JC. Microvascular anatomy of the medial temporal region. J Neurosurg 2022; 137:747-759. [PMID: 34952521 DOI: 10.3171/2021.9.jns21390] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 09/08/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors investigated the microvascular anatomy of the hippocampus and its implications for medial temporal tumor surgery. They aimed to reveal the anatomical variability of the arterial supply and venous drainage of the hippocampus, emphasizing its clinical implications for the removal of associated tumors. METHODS Forty-seven silicon-injected cerebral hemispheres were examined using microscopy. The origin, course, irrigation territory, spatial relationships, and anastomosis of the hippocampal arteries and veins were investigated. Illustrative cases of hippocampectomy for medial temporal tumor surgery are also provided. RESULTS The hippocampal arteries can be divided into 3 segments, the anterior (AHA), middle (MHA), and posterior (PHA) hippocampal artery complexes, which correspond to irrigation of the hippocampal head, body, and tail, respectively. The uncal hippocampal and anterior hippocampal-parahippocampal arteries contribute to the AHA complex, the posterior hippocampal-parahippocampal arteries serve as the MHA complex, and the PHA and splenial artery compose the PHA complex. Rich anastomoses between hippocampal arteries were observed, and in 11 (23%) hemispheres, anastomoses between each segment formed a complete vascular arcade at the hippocampal sulcus. Three veins were involved in hippocampal drainage-the anterior hippocampal, anterior longitudinal hippocampal, and posterior longitudinal hippocampal veins-which drain the hippocampal head, body, and tail, respectively, into the basal and internal cerebral veins. CONCLUSIONS An understanding of the vascular variability and network of the hippocampus is essential for medial temporal tumor surgery via anterior temporal lobectomy with amygdalohippocampectomy and transsylvian selective amygdalohippocampectomy. Stereotactic procedures in this region should also consider the anatomy of the vascular arcade at the hippocampal sulcus.
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Affiliation(s)
- Yuanzhi Xu
- 1Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- 2Department of Neurosurgery, Stanford Hospital, Stanford, California
| | - Ahmed Mohyeldin
- 2Department of Neurosurgery, Stanford Hospital, Stanford, California
| | - Maximiliano Alberto Nunez
- 2Department of Neurosurgery, Stanford Hospital, Stanford, California
- 3Department of Neurosurgery, Hospital El Cruce, Buenos Aires, Argentina
| | | | - Vera Vigo
- 2Department of Neurosurgery, Stanford Hospital, Stanford, California
| | - Aaron A Cohen-Gadol
- 4Department of Neurological Surgery, Indiana University, Indianapolis, Indiana; and
- 5The Neurosurgical Atlas, Carmel, Indiana
| | - Juan C Fernandez-Miranda
- 2Department of Neurosurgery, Stanford Hospital, Stanford, California
- 5The Neurosurgical Atlas, Carmel, Indiana
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Jang SH, Lee J, Kim JW, Choi KT. Prognosis prediction of motor outcome in hemiparetic patients with anterior choroidal artery infarction: Radiologic and transcranial magnetic stimulation prognostic validation studies (STROBE). Medicine (Baltimore) 2021; 100:e28397. [PMID: 34941175 PMCID: PMC8702112 DOI: 10.1097/md.0000000000028397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT To investigate prognosis prediction of motor outcome in anterior choroidal artery (AChA) infarction patients using radiologic and transcranial magnetic stimulation (TMS) studies.Twenty six patients with complete weakness of the affected hand were recruited. The Motricity Index (MI), Medical Research Council (MRC) scores for the affected finger extensors, Modified Brunnstrom classification (MBC) and Functional Ambulation Category (FAC) were evaluated twice: at onset and the chronic stage (3-4 months after onset). Patients were assigned according to the presence of infarction at the corona radiata (CR); the CR-positive group (infarct presence at the CR and posterior limb of internal capsule [PLIC], 11 patients) and CR-negative group (infarct presence at the PLIC, 15 patients), and the presence of motor evoked potentials at the affected hand muscle: the TMS-positive group (11 patients) and the TMS-negative group (15 patients).At the second evaluation, the MI scores were significantly different between the CR-positive (45.10 ± 7.06) and CR-negative groups (57.90 ± 11.56), and between the TMS-positive (60.37 ± 11.53) and TMS-negative groups (46.70 ± 7.99) (P < .05). The MRC scores for the finger extensors were also significantly different between the CR-positive (0.95 ± 1.01) and CR-negative (2.57 ± 1.33) groups and between the TMS-positive (3.05 ± 0.88) and TMS-negative (1.03 ± 1.14) groups (P < .05). Fourteen (53.85%) of the 26 patients recovered to have a functional hand score (MBC ≥5) and 19 (73.07%) of the 26 patients recovered to have an independent gait score (FAC ≥3) on their second evaluation.The results show that CR involvement in addition to the presence of a PLIC lesion and a TMS-negative response were related to poor motor outcomes in patients with an AChA infarction. Consequently, radiologic and TMS studies can be considered for motor outcome prognosis prediction in patients with an AChA infarction.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Yeungnam University 317–1, Daemyungdong, Namku, Daegu, Republic of Korea
| | - Jun Lee
- Department of Neurology, College of Medicine, Yeungnam University 317–1, Daemyungdong, Namku, Daegu, Republic of Korea
| | - Jae Woon Kim
- Department of Radiology, College of Medicine, Yeungnam University 317–1, Daemyungdong, Namku, Daegu, Republic of Korea
| | - Kyu Tae Choi
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Yeungnam University 317–1, Daemyungdong, Namku, Daegu, Republic of Korea
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Ha SY, Kim SE, Shin KJ, Park J, Park KM, Kim SE, Park S, Lee DA, Liebeskind DS. Existence and Significance of Internal Border Zone Infarcts with Accessory Lesions Located in the Anteromedial Temporal Lobe. J Stroke Cerebrovasc Dis 2021; 30:106004. [PMID: 34325272 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106004] [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: 04/16/2021] [Revised: 06/29/2021] [Accepted: 07/09/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To examine the existence and significance of internal border zone (IBZ) infarcts with accessory lesions in the anteromedial temporal lobe (ATL). MATERIALS AND METHODS IBZ infarcts located at the corona radiata were selected based on diffusion-weighted imaging of 2535 consecutive patients with ischemic stroke and the presence of lesions in the ATL was identified. The Mann-Whitney U test, Student t-test, Pearson χ2 test, or Fisher exact test was used to analyze differences between the IBZ infarct groups with and without accessory lesions in the ATL. RESULTS Thirty-six of 2535 patients (1.4%) had IBZ infarcts. The IBZ group with accessory lesions in the ATL (17 cases, 47.2%) showed a higher portion of occluded middle cerebral arteries than the IBZ group without accessory lesions in the ATL (p = 0.02). The initial National Institutes of Health Stroke Scale score (odds ratio, 2.03; 95% confidence interval, 1.04-3.99; = 0.039) and progression after admission (odds ratio, 25.43; 95% confidence interval, 2.47-261.99; p = 0.007) were independently associated with poor prognosis in patients with IBZ infarcts. There were no differences in the progression rate and clinical outcomes, regardless of the presence of lesions in the ATL. CONCLUSIONS Our study suggests the existence of a distinct type of IBZ infarct characterized by accessory lesions in the ATL, which is associated with different arterial features but has a similar clinical course to IBZ infarcts without accessory lesions in the ATL.
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Affiliation(s)
- Sam Yeol Ha
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Sung Eun Kim
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, South Korea
| | - Kyong Jin Shin
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, South Korea
| | - JinSe Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, South Korea
| | - Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, South Korea
| | - Si Eun Kim
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, South Korea
| | - Seongho Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, South Korea
| | - Dong Ah Lee
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, South Korea
| | - David S Liebeskind
- Department of Neurology, UCLA Stroke Center, University of California, 635 Charles E. Young Drive South, Suite 225, Los Angeles, CA 90095, USA.
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Yamamoto Y, Nagakane Y, Tomii Y. [Cerebral deep vascular architectures and subcortical infarcts]. Rinsho Shinkeigaku 2020; 60:397-406. [PMID: 32435049 DOI: 10.5692/clinicalneurol.60.cn-001408] [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] [Indexed: 11/05/2022]
Abstract
The lenticulostriate arteries (LSA) supply the lateral half of the head of the caudate nucleus, entire putamen, anterior limb, genu and the superior part of the internal capsule (IC) and a part of the corona radiata. The LSA consists with medial, intermediate and lateral branches. The medial branches perfuse the lateral segment of the globus pallidus, the head of the caudate nucleus and the anterior limb of the IC. The intermediate branches supply the anterior half of the LSA territory, while the lateral branches supply the posterior half. The anterior cerebral artery (ACA) perforators, predominantly Heubner's artery, perfuse the inferomedial part of the caudate head, the anteromedial part of putamen, the anterior part of the lateral segment of the globus pallidus and anterior limb of the internal capsule. Such territories can be represented by the anterior and ventral basal ganglions. The anterior choroidal artery (AChA) gives off three main groups of branches including the lateral branches that supply the medial temporal lobe, the medial branches that supply the cerebral peduncle and the superior branches that supply the internal capsule and the basal ganglia. The superior branches are further discriminated into proximal branches that supply the anterior one third of the posterior limb of internal capsule (PLIC) and the medial segment of the globus pallidus and distal branches that supply the posterior two-third of PLIC, retro-lenticular part of the internal capsule and the lateral thalamic nuclei. The superficial penetrating arteries, i.e. medullary arteries, arise from the cortical branches of the middle cerebral artery (MCA) and supply the deep white matter. Infarcts caused by the medullary artery occlusion are located in the centrum-semiovale and half of them were caused by embolic mechanism. The centrum-semiovale corresponds to cortical border-zone (BZ) while the corona radiate corresponds to internal BZ.
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Turk Y, Kuskun A. Anterior choroidal artery aneurysms could have different symptoms, and outcomes: a report of 3 cases treated endovascularly. Clin Imaging 2020; 61:11-14. [DOI: 10.1016/j.clinimag.2020.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 12/20/2019] [Accepted: 01/07/2020] [Indexed: 11/16/2022]
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Perosa V, Priester A, Ziegler G, Cardenas-Blanco A, Dobisch L, Spallazzi M, Assmann A, Maass A, Speck O, Oltmer J, Heinze HJ, Schreiber S, Düzel E. Hippocampal vascular reserve associated with cognitive performance and hippocampal volume. Brain 2020; 143:622-634. [PMID: 31994699 PMCID: PMC7009470 DOI: 10.1093/brain/awz383] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 09/12/2019] [Accepted: 10/07/2019] [Indexed: 01/14/2023] Open
Abstract
Medial temporal lobe dependent cognitive functions are highly vulnerable to hypoxia in the hippocampal region, yet little is known about the relationship between the richness of hippocampal vascular supply and cognition. Hippocampal vascularization patterns have been categorized into a mixed supply from both the posterior cerebral artery and the anterior choroidal artery or a single supply by the posterior cerebral artery only. Hippocampal arteries are small and affected by pathological changes when cerebral small vessel disease is present. We hypothesized, that hippocampal vascularization patterns may be important trait markers for vascular reserve and modulate (i) cognitive performance; (ii) structural hippocampal integrity; and (iii) the effect of cerebral small vessel disease on cognition. Using high-resolution 7 T time-of-flight angiography we manually classified hippocampal vascularization patterns in older adults with and without cerebral small vessel disease in vivo. The presence of a mixed supplied hippocampus was an advantage in several cognitive domains, including verbal list learning and global cognition. A mixed supplied hippocampus also was an advantage for verbal memory performance in cerebral small vessel disease. Voxel-based morphometry showed higher anterior hippocampal grey matter volume in mixed, compared to single supply. We discuss that a mixed hippocampal supply, as opposed to a single one, may increase the reliability of hippocampal blood supply and thereby provide a hippocampal vascular reserve that protects against cognitive impairment.
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Affiliation(s)
- Valentina Perosa
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke-University, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Anastasia Priester
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Gabriel Ziegler
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke-University, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Arturo Cardenas-Blanco
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke-University, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Laura Dobisch
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke-University, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Marco Spallazzi
- Department of Neurology, Azienda Ospedaliero-Universitaria, Parma, Italy
| | - Anne Assmann
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Anne Maass
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Oliver Speck
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
- Leibniz-Institute for Neurobiology (LIN), Magdeburg, Germany
- Institute of Physics, Otto-von-Guericke University, Magdeburg, Germany
| | - Jan Oltmer
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Hans-Jochen Heinze
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
- Leibniz-Institute for Neurobiology (LIN), Magdeburg, Germany
| | - Stefanie Schreiber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
| | - Emrah Düzel
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke-University, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
- Institute of Cognitive Neuroscience, University College London, London, UK
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The anterior one third of the posterior limb of the internal capsule is also supplied by the anterior choroidal artery. J Neurol Sci 2019; 406:116455. [PMID: 31634717 DOI: 10.1016/j.jns.2019.116455] [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: 07/19/2019] [Revised: 08/30/2019] [Accepted: 09/09/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE It is universally recognized that the anterior choroidal artery (AChA) supplies the posterior two-third of the posterior limb of internal capsule (PLIC). On the other hand, the blood supply to the anterior one third of the PLIC has remained undetermined. We posit the anterior one third of the PLIC is also supplied by the AChA referring the previous microsurgical descriptions. METHODS Ninety consecutive patients with isolated acute infarction in the PLIC were studied. We classified patients into 4 groups. 1. The anterior type that involved the anterior one-third part of the PLIC. 2. The posterior type that involved the caudal two-third part of the PLIC, 3. The combined type that located in the full length of the PLIC, 4. The dot type that restricted within PLIC up to10mm in diameter. RESULTS Patient numbers in groups 1 through 4 were 7 (7.7%), 46 (51.1%), 9 (10.6%) and 28 (31.1%). The anterior type involved the medial part of pallidum (MPP) in 5 patients (71.4%) and none in the lateral thalamus (LT), while the posterior type involved MPP only in 6 patients (13.0%) and LT in 33 patients (71.7%). CONCLUSION Corresponding to previous microsurgical descriptions, an occlusion of the proximal branches may cause anterior type infarct and that of the distal branches may cause posterior type infarcts. The anterior one third of the PLIC is also supplied by the branches of the AChA, albeit the low prevalence.
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Cooke J, Maingard J, Chandra RV, Slater LA, Brooks M, Asadi H. Acute middle cerebral artery stroke in a patient with a patent middle cerebral artery. Neurol Clin Pract 2019; 9:250-255. [PMID: 31341713 DOI: 10.1212/cpj.0000000000000605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 12/17/2018] [Indexed: 11/15/2022]
Abstract
Purpose of review Knowledge of cerebrovascular anatomical variants is vital for clinicians working with patients presenting with signs and symptoms of cerebral infarction, particularly in the era of endovascular clot retrieval. Recent findings We provide an overview of a cerebrovascular anatomical variation and detail a patient presenting with cerebral infarction secondary to occlusion of their anomalous vessel who underwent successful endovascular clot retrieval with excellent functional outcome. We also include technical descriptions. Summary Given the clinical importance of the areas supplied by the accessory middle cerebral artery, knowledge of this vessel is not only important for diagnosis but also for neurosurgical or endovascular management of patients with this variant.
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Affiliation(s)
- Jamie Cooke
- Anatomy and Neuroscience (JC), School of Biomedical Sciences, University of Melbourne, Parkville; Department of Surgery (JC), Alfred Hospital, Melbourne, Victoria; Interventional Radiology Service (JM, MB, HA), Department of Radiology, Austin Hospital, Melbourne; School of Medicine (JM, MB, HA), Faculty of Health, Deakin University, Waurn Ponds; Stroke Division (JM, MB, HA), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria; Interventional Neuroradiology Service (HA), Department of Radiology, St Vincent's Hospital; Interventional Neuroradiology Unit (RVC, L-AS, HA), Monash Imaging, Monash Health; and Faculty of Medicine (RVC, HA), Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Julian Maingard
- Anatomy and Neuroscience (JC), School of Biomedical Sciences, University of Melbourne, Parkville; Department of Surgery (JC), Alfred Hospital, Melbourne, Victoria; Interventional Radiology Service (JM, MB, HA), Department of Radiology, Austin Hospital, Melbourne; School of Medicine (JM, MB, HA), Faculty of Health, Deakin University, Waurn Ponds; Stroke Division (JM, MB, HA), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria; Interventional Neuroradiology Service (HA), Department of Radiology, St Vincent's Hospital; Interventional Neuroradiology Unit (RVC, L-AS, HA), Monash Imaging, Monash Health; and Faculty of Medicine (RVC, HA), Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Ronil V Chandra
- Anatomy and Neuroscience (JC), School of Biomedical Sciences, University of Melbourne, Parkville; Department of Surgery (JC), Alfred Hospital, Melbourne, Victoria; Interventional Radiology Service (JM, MB, HA), Department of Radiology, Austin Hospital, Melbourne; School of Medicine (JM, MB, HA), Faculty of Health, Deakin University, Waurn Ponds; Stroke Division (JM, MB, HA), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria; Interventional Neuroradiology Service (HA), Department of Radiology, St Vincent's Hospital; Interventional Neuroradiology Unit (RVC, L-AS, HA), Monash Imaging, Monash Health; and Faculty of Medicine (RVC, HA), Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Lee-Anne Slater
- Anatomy and Neuroscience (JC), School of Biomedical Sciences, University of Melbourne, Parkville; Department of Surgery (JC), Alfred Hospital, Melbourne, Victoria; Interventional Radiology Service (JM, MB, HA), Department of Radiology, Austin Hospital, Melbourne; School of Medicine (JM, MB, HA), Faculty of Health, Deakin University, Waurn Ponds; Stroke Division (JM, MB, HA), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria; Interventional Neuroradiology Service (HA), Department of Radiology, St Vincent's Hospital; Interventional Neuroradiology Unit (RVC, L-AS, HA), Monash Imaging, Monash Health; and Faculty of Medicine (RVC, HA), Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Mark Brooks
- Anatomy and Neuroscience (JC), School of Biomedical Sciences, University of Melbourne, Parkville; Department of Surgery (JC), Alfred Hospital, Melbourne, Victoria; Interventional Radiology Service (JM, MB, HA), Department of Radiology, Austin Hospital, Melbourne; School of Medicine (JM, MB, HA), Faculty of Health, Deakin University, Waurn Ponds; Stroke Division (JM, MB, HA), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria; Interventional Neuroradiology Service (HA), Department of Radiology, St Vincent's Hospital; Interventional Neuroradiology Unit (RVC, L-AS, HA), Monash Imaging, Monash Health; and Faculty of Medicine (RVC, HA), Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Hamed Asadi
- Anatomy and Neuroscience (JC), School of Biomedical Sciences, University of Melbourne, Parkville; Department of Surgery (JC), Alfred Hospital, Melbourne, Victoria; Interventional Radiology Service (JM, MB, HA), Department of Radiology, Austin Hospital, Melbourne; School of Medicine (JM, MB, HA), Faculty of Health, Deakin University, Waurn Ponds; Stroke Division (JM, MB, HA), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria; Interventional Neuroradiology Service (HA), Department of Radiology, St Vincent's Hospital; Interventional Neuroradiology Unit (RVC, L-AS, HA), Monash Imaging, Monash Health; and Faculty of Medicine (RVC, HA), Nursing and Health Sciences, Monash University, Melbourne, Australia
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Abstract
In this review, our intension is to present imaging features of several categories of uncommon cases of brain infarctions including infarctions associated with neurovascular variants, infarctions along small arterial territories, and brainstem stroke syndromes. Infarctions associated with neurovascular variants include azygos anterior cerebral artery territory infarction and artery of Percheron infarction. In the second group, we discuss anterior choroidal artery infarction and artery of Heubner infarction. The third group highlights brainstem stroke syndromes, including Claude and Benedikt syndromes due to midbrain infarction; Foville, Marie Foix, and locked-in syndromes due to pontine infarction; and Dejerine (medial medullary), bilateral medial medullary, and Wallenberg (lateral medullary) syndromes.
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Liu LX, Zhang CW, Xie XD, Wang CH. Application of the Willis Covered Stent in the Treatment of Blood Blister-Like Aneurysms: A Single-Center Experience and Systematic Literature Review. World Neurosurg 2019; 123:e652-e660. [DOI: 10.1016/j.wneu.2018.11.245] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/29/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
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11
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Liu LX, Zhang CW, Lin S, Wu C, Wang T, Zhou LX, Wang CH, Xie XD. Application of the Willis Covered Stent in the Treatment of Ophthalmic Artery Segment Aneurysms: A Single-Center Experience. World Neurosurg 2019; 122:e546-e552. [DOI: 10.1016/j.wneu.2018.10.098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/14/2018] [Accepted: 10/16/2018] [Indexed: 11/26/2022]
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Bhogal P, Ganslandt O, Bäzner H, Henkes H, Aguilar Perez M. Treatment of Unruptured, Saccular, Anterior Choroidal Artery Aneurysms with Flow Diversion : A Single Centre Experience. Clin Neuroradiol 2018. [PMID: 29516113 PMCID: PMC6710236 DOI: 10.1007/s00062-018-0677-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background The region of the brain supplied by the anterior choroidal artery (AChoA) is exquisitely eloquent. Aneurysms arising at or close to the origin of the vessel are not uncommon and damage or occlusion to the vessel can result in devastating consequences. The optimal treatment strategy is yet to be determined. Objective We sought to determine the efficacy of flow diversion for the treatment of unruptured AChoA aneurysms. Method A retrospective review of our prospectively maintained database was performed to identify all patients with unruptured aneurysms of the AChoA between March 2009 and May 2017. The fundus size, number and type of flow-diverting stent (FD), complications and follow-up data were recorded. Results We identified 30 patients (60% female), average age 52.8 ± 10.8 years (range 27–73), with 30 aneurysms. The aneurysms were generally small with a mean fundus diameter of 3.4 mm (range 1–7 mm). Early angiographic follow-up data were available for all patients at which point 15 aneurysms were completely occluded (50%). Delayed angiographic follow-up was available in 24 patients and occlusion was seen in 21 patients (87.5%). Of the patients one developed transient ischemic symptoms after interruption of the antiplatelet medication and another patient had a small embolic infarct with transient symptoms in the periprocedural period. Conclusion Flow diversion can be used to successfully treat aneurysms of the AChoA. The treatment carries a high rate of technical and radiological success with a good safety profile.
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Affiliation(s)
- P Bhogal
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany.
| | - O Ganslandt
- Neurosurgical Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany
| | - H Bäzner
- Neurological Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany
| | - H Henkes
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany.,Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - M Aguilar Perez
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
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Hasegawa T, Ogiwara T, Nagm A, Goto T, Aoyama T, Hongo K. Risks of Endoscopic Temporal Ventriculocisternostomy for Isolated Lateral Ventricle: Anatomic Surgical Nuances. World Neurosurg 2017; 110:189-192. [PMID: 29155114 DOI: 10.1016/j.wneu.2017.11.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Entrapment of the temporal horn, known as isolated lateral ventricle (ILV), is a rare type of noncommunicating focal hydrocephalus, and standard treatment has not been established. We report 2 cases of endoscopic surgery for ILV and highlight the anatomic surgical nuances to avoid associated surgical risks. CASE DESCRIPTION The first patient presented with recurrent ILV following initial shunt placement for ILV, owing to shunt malfunction. In the second patient, ILV recurred secondary to choroid plexus inflammation caused by cryptococcal infection. Endoscopic temporal ventriculocisternostomy was effective in both cases. However, in the second case, the choroidal fissure was fenestrated, which led to cerebral infarction in the territory of the choroidal artery zone, attributed to damage of the branches of the choroidal segment of the anterior choroidal artery. CONCLUSIONS Although endoscopic temporal ventriculocisternostomy is considered a safe and less invasive procedure for treatment of symptomatic ILV, the technique is still associated with risks. To avoid complications, it is necessary to be familiar with the anatomy of the choroidal arteries and the pertinent endoscopic intraventricular orientation. Additionally, sufficient experience is required before it can be recommended as the treatment of choice.
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Affiliation(s)
- Takatoshi Hasegawa
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Toshihiro Ogiwara
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
| | - Alhusain Nagm
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Department of Neurosurgery, Al-Azhar University Faculty of Medicine, Nasr city, Cairo, Egypt
| | - Tetsuya Goto
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tatsuro Aoyama
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kazuhiro Hongo
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
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14
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Alqahtani SA, Luby M, Nadareishvili Z, Benson RT, Hsia AW, Leigh R, Lynch JK. Perfusion Deficits and Association with Clinical Outcome in Patients with Anterior Choroidal Artery Stroke. J Stroke Cerebrovasc Dis 2017; 26:1755-1759. [PMID: 28457620 DOI: 10.1016/j.jstrokecerebrovasdis.2017.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 04/02/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Anterior choroidal artery (AChA) strokes have a varied pattern of tissue injury, prognosis, and clinical outcome. It is unclear whether perfusion deficit in AChA stroke is associated with the clinical outcome. This study aims to determine the frequency of perfusion abnormalities in AChA stroke and association with clinical outcome. METHODS The study cohort was derived from ischemic stroke patients admitted to 2 stroke centers between July 2001 and July 2014. All patients received an acute magnetic resonance imaging (MRI) scan. Patients with ischemic stroke restricted to the AChA territory were included in the study. Lesion size was measured as the largest diameter on diffusion-weighted imaging (DWI) or apparent diffusion coefficient and divided into 2 groups (<20 mm or ≥20 mm). Group comparisons were performed among patients with and without perfusion abnormalities and based on diffusion diameter. Favorable clinical outcome was defined as discharge to home. RESULTS A total of 120 patients were included in the study. Perfusion deficits were identified in 67% of patients. The admission National Institutes of Health Stroke Scale (NIHSS) was higher in patients with perfusion abnormalities (P = .027). Diameter lesion size on DWI was larger among patients with a perfusion deficit median [interquartile range], 1.63 [1.3-2.0], as compared with those without, 1.18 [1.0-1.7], P < .0001. Patients with a perfusion deficit were less likely to be discharged to home than those without (36% versus 60%, P = .013). CONCLUSIONS Two thirds of patients with an AChA stroke have a perfusion deficit on MRI, higher admission NIHSS, and larger DWI lesion size at presentation.
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Affiliation(s)
- Saeed A Alqahtani
- Stroke Diagnostics and Therapeutics Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, Maryland.
| | - Marie Luby
- Stroke Diagnostics and Therapeutics Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, Maryland
| | - Zurab Nadareishvili
- Stroke Diagnostics and Therapeutics Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, Maryland; Stroke Program, Suburban Hospital, Bethesda, Maryland
| | - Richard T Benson
- Stroke Diagnostics and Therapeutics Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, Maryland; Stroke Center, MedStar Washington Hospital Center, Washington, DC, Washington
| | - Amie W Hsia
- Stroke Diagnostics and Therapeutics Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, Maryland; Stroke Center, MedStar Washington Hospital Center, Washington, DC, Washington
| | - Richard Leigh
- Stroke Diagnostics and Therapeutics Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, Maryland
| | - John K Lynch
- Stroke Diagnostics and Therapeutics Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, Maryland
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15
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Chandra A, Li WA, Stone CR, Geng X, Ding Y. The cerebral circulation and cerebrovascular disease I: Anatomy. Brain Circ 2017; 3:45-56. [PMID: 30276305 PMCID: PMC6126264 DOI: 10.4103/bc.bc_10_17] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/28/2017] [Accepted: 06/07/2017] [Indexed: 11/28/2022] Open
Abstract
In this paper, which is the first in a three-part series that reviews cerebrovascular anatomy, pathogenesis, and stroke, we lay the anatomical foundation for the rest of the series. Beginning with its origin in the branches of the aorta, we start by describing the arterial system. This system is partitioned into two major divisions (anterior and posterior circulations) that differ significantly in features and pathogenic potential. The systems, and the major branches that comprise them, are described. Description of the arterial system proceeds to the point of the fulfillment of its function. This function, the exchange of gases and nutrients with the cerebral parenchyma, is the subject of a subsequent section on the microcirculation and blood-brain barrier. Finally, the cerebral venous system, which is composed of cerebral veins and dural venous sinuses, is described. Thus, an anatomical context is supplied for the discussion of cerebrovascular disease pathogenesis provided by our second paper.
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Affiliation(s)
- Ankush Chandra
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - William A Li
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Christopher R Stone
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xiaokun Geng
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
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16
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Neki H, Caroff J, Jittapiromsak P, Benachour N, Mihalea C, Ikka L, Moret J, Spelle L. Patency of the anterior choroidal artery covered with a flow-diverter stent. J Neurosurg 2015; 123:1540-5. [PMID: 26047410 DOI: 10.3171/2014.11.jns141603] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
The concept of the flow-diverter stent (FDS) is to induce aneurysmal thrombosis while preserving the patency of the parent vessel and any covered branches. In some circumstances, it is impossible to avoid dangerously covering small branches, such as the anterior choroidal artery (AChA), with the stent. In this paper, the authors describe the clinical and angiographic effects of covering the AChA with an FDS.
METHODS
Between April 2011 and July 2013, 92 patients with intracranial aneurysms were treated with the use of FDSs in the authors’ institution. For 20 consecutive patients (21.7%) retrospectively included in this study, this involved the unavoidable covering of the AChA with a single FDS during endovascular therapy. AChAs feeding the choroid plexus were classified as the long-course group (14 cases), and those not feeding the choroid plexus were classified as the short-course group (6 cases). Clinical symptoms and the angiographic aspect of the AChA were evaluated immediately after stent delivery and during follow-up. Neurological examinations were performed to rule out hemiparesis, hemihypesthesia, hemianopsia, and other cortical signs.
RESULTS
FDS placement had no immediate effect on AChA blood flow. Data were obtained from 1-month clinical follow-up in all patients and from midterm angiographic follow-up in 17 patients (85.0%), with a mean length of 9.8 ± 5.4 months. No patient in either group complained of transient or permanent symptoms related to an AChA occlusion. In all cases, the AChA remained patent without any flow changes.
CONCLUSIONS
The results of this study suggest that when impossible to avoid, the AChA may be safely covered with a single FDS during intracranial aneurysm treatment, irrespective of anatomy and anastomoses.
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Affiliation(s)
- Hiroaki Neki
- Interventional Neuroradiology NEURI Center, Beaujon Hospital, Paris Diderot University, Clichy, France
| | - Jildaz Caroff
- Interventional Neuroradiology NEURI Center, Beaujon Hospital, Paris Diderot University, Clichy, France
| | - Pakrit Jittapiromsak
- Interventional Neuroradiology NEURI Center, Beaujon Hospital, Paris Diderot University, Clichy, France
| | - Nidhal Benachour
- Interventional Neuroradiology NEURI Center, Beaujon Hospital, Paris Diderot University, Clichy, France
| | - Cristian Mihalea
- Interventional Neuroradiology NEURI Center, Beaujon Hospital, Paris Diderot University, Clichy, France
| | - Leon Ikka
- Interventional Neuroradiology NEURI Center, Beaujon Hospital, Paris Diderot University, Clichy, France
| | - Jacques Moret
- Interventional Neuroradiology NEURI Center, Beaujon Hospital, Paris Diderot University, Clichy, France
| | - Laurent Spelle
- Interventional Neuroradiology NEURI Center, Beaujon Hospital, Paris Diderot University, Clichy, France
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17
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Internal capsule stroke in the common marmoset. Neuroscience 2015; 284:400-411. [DOI: 10.1016/j.neuroscience.2014.10.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 09/28/2014] [Accepted: 10/01/2014] [Indexed: 12/27/2022]
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18
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Chausson N, Joux J, Saint-Vil M, Edimonana M, Jeannin S, Aveillan M, Cabre P, Olindo S, Smadja D. Infarction in the anterior choroidal artery territory: clinical progression and prognosis factors. J Stroke Cerebrovasc Dis 2014; 23:2012-2017. [PMID: 25088169 DOI: 10.1016/j.jstrokecerebrovasdis.2014.02.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 01/23/2014] [Accepted: 02/18/2014] [Indexed: 11/24/2022] Open
Abstract
This study was undertaken to describe the still poorly known evolving profile of anterior choroidal artery (AChA) infarctions, identify their prognosis factors, and evaluate responses to intravenous (IV) thrombolysis. During 42 months, we prospectively enrolled patients with an isolated AChA stroke. Clinical and radiologic parameters were compared between patients with or without progression, defined as any clinical worsening. Factors associated with poor outcome (dependence or death) were tested, and IV thrombolysis responses were assessed. For the 100 of 1234 (8.1%) analyzed patients with AChA stroke (predominantly lacunar syndrome [88%]), mean admission and maximum National Institutes of Health Stroke Scale (NIHSS) scores were 4.4 and 5.2, respectively. Arterial hypertension (78%) and diabetes (30%) were the main vascular risk factors. Despite low 3-month mortality (3%), 26% of the patients were dependent; 46 patients with progressive stroke (over 56 ± 56 hours, 1.6 mean successive plateaus) had higher risks of dependence (P < .0001). An acute-phase NIHSS score of 6 or more significantly increased the risk of poor outcome (P < .0001). Maximum NIHSS score and progression were independently associated with poor outcome. Among 21 patients given IV thrombolysis, 12 AChA strokes continued to progress, leaving 8 disabled at 3 months. Almost half of AChA strokes progress during the first 2 to 3 days. Maximum acute-phase NIHSS scores and progression were independently associated with poor outcome, also strongly predicted by an NIHSS score of 6 or more at any time. Our unconvincing experience with IV thrombolysis means new therapeutic options and trials are needed, especially for patients with clinical progression and/or NIHSS score of 6 or more.
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Affiliation(s)
- Nicolas Chausson
- Stroke Unit, Hôpital Universitaire de Fort-de-France, Martinique, French West Indies, France
| | - Julien Joux
- Stroke Unit, Hôpital Universitaire de Fort-de-France, Martinique, French West Indies, France
| | - Martine Saint-Vil
- Stroke Unit, Hôpital Universitaire de Fort-de-France, Martinique, French West Indies, France
| | - Mireille Edimonana
- Stroke Unit, Hôpital Universitaire de Fort-de-France, Martinique, French West Indies, France
| | - Séverine Jeannin
- Stroke Unit, Hôpital Universitaire de Fort-de-France, Martinique, French West Indies, France
| | - Mathieu Aveillan
- Stroke Unit, Hôpital Universitaire de Fort-de-France, Martinique, French West Indies, France
| | - Philippe Cabre
- Stroke Unit, Hôpital Universitaire de Fort-de-France, Martinique, French West Indies, France
| | - Stéphane Olindo
- Stroke Unit, Hôpital Universitaire de Fort-de-France, Martinique, French West Indies, France
| | - Didier Smadja
- Stroke Unit, Hôpital Universitaire de Fort-de-France, Martinique, French West Indies, France.
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19
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Tanriover N, Kucukyuruk B, Ulu MO, Isler C, Sam B, Abuzayed B, Uzan M, Ak H, Tuzgen S. Microsurgical anatomy of the cisternal anterior choroidal artery with special emphasis on the preoptic and postoptic subdivisions. J Neurosurg 2014; 120:1217-28. [DOI: 10.3171/2014.1.jns131325] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The object of this study was to delineate the microsurgical anatomy of the cisternal segment of the anterior choroidal artery (AChA). The authors also propose a new classification of this segment on the basis of its complicated course within the carotid and crural cisterns in relation to important neurovascular structures, and the site of origin, course, and areas of supply of perforating arteries.
Methods
Thirty cadaveric cerebral hemispheres injected with colored latex were dissected under surgical magnification to view the cisternal segment of the AChA and its perforators. Fiber dissections using the Klingler technique were performed in two additional latex injected hemispheres to follow the penetration points, courses, and terminal areas of supply of perforating branches that arise from the cisternal segment of the AChA.
Results
The cisternal segment of the AChA was divided into pre- and postoptic parts that meet at the artery's genu, the most medial extension point of the cisternal segment where the artery makes an abrupt turn after passing under the optic tract. The preoptic part of the AChA extended from its origin at the inferomedial side of the internal carotid artery to the artery's genu, which is commonly located just inferomedial to the initial part of the optic tract. The postoptic part coursed within the crural cistern and extended from the genu to the inferior choroidal point. The genu of the AChA was 8 mm medial to the artery's origin and was located medial to the optic tract in 13% of the hemispheres. The postoptic part was longer than the preoptic part in all hemispheres and had more perforating arteries supplying critical deep structures (preoptic 3.4 per hemisphere vs postoptic 4.6 per hemisphere), and these results were statistically significant (p = 0.01). At the preoptic part, perforating arteries arose from the superolateral portion of the artery and coursed laterally; at the postoptic part, perforators arose from the inferomedial portion of the artery and coursed medially. Perforating arteries from both segments passed most commonly to the optic tract, followed by the anterior segment and apex of uncus in the preoptic part and the cerebral peduncle in the postoptic part.
Conclusions
Both parts of the cisternal segment of the AChA come into surgical view during surgeries for different pathologies in and around the perimesencephalic cisterns. However, attending to the artery's genu and defining pre- and postoptic parts during surgery may help the surgeon locate the origin and eventual course of these perforators, and even estimate the terminal areas of supply of most of the perforating arteries. The proposed classification system can prove helpful in planning any operative procedure along the crural cistern and may reduce the probability of inadvertent injury to perforating branches of the cisternal segment.
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Affiliation(s)
- Necmettin Tanriover
- 1Department of Neurosurgery, Cerrahpaşa Medical Faculty, Istanbul University
| | - Baris Kucukyuruk
- 1Department of Neurosurgery, Cerrahpaşa Medical Faculty, Istanbul University
| | - Mustafa Onur Ulu
- 1Department of Neurosurgery, Cerrahpaşa Medical Faculty, Istanbul University
| | - Cihan Isler
- 1Department of Neurosurgery, Cerrahpaşa Medical Faculty, Istanbul University
| | - Bulent Sam
- 2Istanbul Headquarters of the Forensic Medicine Institute, Ministry of Justice; and
| | - Bashar Abuzayed
- 1Department of Neurosurgery, Cerrahpaşa Medical Faculty, Istanbul University
| | - Mustafa Uzan
- 1Department of Neurosurgery, Cerrahpaşa Medical Faculty, Istanbul University
| | - Halil Ak
- 1Department of Neurosurgery, Cerrahpaşa Medical Faculty, Istanbul University
| | - Saffet Tuzgen
- 3Department of Neurosurgery, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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20
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Middle cerebral and anterior choroidal artery watershed infarction. Acta Neurol Belg 2014; 114:67-8. [PMID: 23417287 DOI: 10.1007/s13760-013-0186-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 02/04/2013] [Indexed: 10/27/2022]
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21
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Pavol M, Goldberg E, Mohr JP, Ruff I, Lazar R. Severe aphasia following infarction in the territory of the left anterior choroidal artery. Cerebrovasc Dis 2011; 32:197-8. [PMID: 21849781 DOI: 10.1159/000328242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Marykay Pavol
- Stroke Division, Department of Neurology, Columbia University Medical Center, 710 W. 168th Street, New York, NY 10032, USA.
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22
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Ois A, Cuadrado-Godia E, Solano A, Perich-Alsina X, Roquer J. Acute ischemic stroke in anterior choroidal artery territory. J Neurol Sci 2009; 281:80-4. [PMID: 19324377 DOI: 10.1016/j.jns.2009.02.323] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2008] [Revised: 01/19/2009] [Accepted: 02/02/2009] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of the study was to describe a series of patients with acute ischemic infarct in the anterior choroidal artery (AChA) territory. Moreover, we analyzed the prevalence of these strokes and compared them with hemispheric and deep infarcts. Finally, we hypothesized that the size of the infarct could be related to aetiology and prognosis. METHODS We studied a prospective series of 1350 patients with acute ischemic stroke. We analyzed the following factors: age, gender, diabetes mellitus, hypertension, hyperlipidaemia, current smoking, ischemic heart disease, previous stroke, peripheral arterial disease, prior antithrombotic treatment, major cardioembolic source, severe arterial stenosis, initial severity, progression, mortality, disability, and recurrence rate at three months. AChA strokes were classified as small (<20 mm) or large (>or=20 mm), as measured by diffusion-weighted MRI, and compared by size in the analysis. RESULTS 112 patients (8.3%) had an ischemic lesion restricted to the AChA territory (large: 42 patients, small: 70 patients). Patients with AChA infarcts were younger, more likely to be diabetic, and predominantly male. We found significant differences in the rate of major embolic sources, recurrence, progression and prognosis. Large AChA strokes were associated with embolic pathologies and had worse prognosis than small AChA strokes. INTERPRETATION Infarcts in the AChA territory have different aetiological mechanisms and outcome than other territories. Large AChA infarcts have a higher association with an embolic source and worse prognosis than small lesions.
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Affiliation(s)
- Angel Ois
- Neurology Department, Hospital del Mar, Universitat de Barcelona, IMIM-Hospital del Mar, Barcelona, Spain.
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23
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Abstract
Visual Imagery is the ability to generate mental images in the absence of perception, that is, We describe a patient, IM, who suffered from an acute ischemic stroke in the right anterior choroidal artery who appeared to demonstrate relatively isolated impairment in visual imagery. Her cognitive function, including her performance on tests of semantic function, was at ceiling, apart from a deficit in visual memory. IM failed in tasks involving degraded stimuli, object decision involving reality judgments on normal animals, and drawings from memory. By contrast, she was able to match objects seen from an unfamiliar viewpoint and to perform tasks of semantic and visual association. We hypothesize that IM has a visual working memory deficit that impairs her ability to generate full visual representations of objects given their names, individual feature, or partial representations. The deficit appears to be the result of damage to connections between the right thalamus and the right temporal lobe. Our findings may help to clarify the role of the thalamus in the cortical selective engagement processes that underlie working memory.
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Palomeras E, Fossas P, Cano AT, Sanz P, Floriach M. Anterior choroidal artery infarction: a clinical, etiologic and prognostic study. Acta Neurol Scand 2008; 118:42-7. [PMID: 18205882 DOI: 10.1111/j.1600-0404.2007.00980.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To analyze the clinical, etiologic and prognostic profile of anterior choroidal artery (AChA) infarcts. METHODS 42 consecutive patients with AChA infarction were included. Symptoms, etiology and scores on neurological and functional scales were analyzed on admission, discharge and at 3-month follow-up. A comparative study was performed between deep (n = 23) and deep + superficial (n = 19) infarcts. RESULTS Lacunar syndrome was present in 83.3% of patients. Etiology was large-vessel disease in 38.1% and cryptogenic in 38.1%. Ten patients had a National Institute of Health Stroke Scale score >7 on admission. At discharge, 45.3% had an modified Rankin Scale >2 (35.7% after 3 months). Infarcts involving superficial territory were more severe at admission (P = 0.034) and were associated with a worse functional status at discharge (P = 0.0008). CONCLUSION AChA infarcts usually present with lacunar syndrome, although they are often not lacunar infarcts. At discharge, almost half of the patients are dependent in their activities of daily living, and most remain so at 3-month follow-up. Infarcts involving superficial territory are associated with worse prognosis.
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Affiliation(s)
- E Palomeras
- Unit of Neurology, Hospital de Mataró, Mataró, Spain.
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25
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Chapter 22 Topographic classification of ischemic stroke. HANDBOOK OF CLINICAL NEUROLOGY 2008; 93:425-52. [DOI: 10.1016/s0072-9752(08)93022-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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