Patterns of reinnervation of denervated cerebral arteries by sympathetic nerve fibers after unilateral ganglionectomy in rats

Summary In order to clarify the manner in which previously denervated cerebral arteries become reinnervated after unilateral excision of the superior cervical ganglion (SCG), we observed directly the reinnervating sympathetic nerve fibers originating in the contralateral SCG by using anterograde labeling with wheat germ aggulutinin-horseradish peroxidase in rats. The nerve fibers sprouted from the nerve fibers in the contralateral anterior cerebral artery and reinnervated the arterial wall of the anterior cerebral artery of the denervated side as early as one week after ganglionectomy. In addition to this sprouting route, three other reinnervating nerve fiber routes were observed in the circle of Willis of the denervated side two weeks after ganglionectomy: the proximal portion of the internal carotid artery, the route passing between bilateral ethmodial arteries, and the posterior communicating artery. Eight weeks after ganglionectomy, these reinnervating nerve fibers formed a fairly dense plexus in a circular pattern in the circle of Willis. However, the reinnervation could not be observed in the arterial branches derived from the circle of Willis (middle cerebral artery and posterior cerebral artery) even 16 weeks after ganglionectomy. The present results clearly demonstrated the time course, distribution pattern and limitation of the reinnervation from the contralateral SCG following unilateral ganglionectomy. The fact that reinnervation could be observed only in the main cerebral arteries of the circle of Willis, in which the nerve plexus appeared to have a circular pattern, suggests a difference between the qualities of sympathetic innervation controlling the cerebral circulation in these arteries and the other arterial branches related to these differences in reinnervation capacity.     

脉络丛前动脉显微解剖结构的临床应用研究

目的研究脉络丛前动脉显微解剖结构的临床应用及其意义。方法用体视显微镜和手术显微镜对21例（42侧）成人脑标本进行观察,研究脉络丛前动脉显微解剖结构特点。结果脉络丛前动脉来源于颈内动脉者37侧（88.1%）;来源于大脑中动脉者3侧（7.2%）;来源于后交通动脉者2侧（4.8%）。左侧脉络丛前动脉比右侧粗大者占78.9%。脉络丛前动脉的起始处管径变异较大,平均（0.79±0.27）mm。管径从起始部发出随行程延伸越来越细,中段管径0.35~0.71 mm;末段管径0.16~0.33 mm。脉络丛前动脉主干长（2.88±0.48）cm。海马旁回钩前沟定位与交点的距离右侧为（11.17±1.78）mm,左侧为（10.93±2.13）mm。结论双侧脉络丛前动脉管径无明显差异,发生痉挛易导致视束的供血障碍。相关颞叶内侧附近手术时,海马旁回钩前沟定位比较准确,手术时要注意在以海马旁回钩前沟为标志的交点处保护脉络丛前动脉。     

视束血供形态学研究及其临床意义

目的：研究视束动脉起源、数量、分布以及相关动脉的病理变化，为视束因缺血所致视野缺损提供形态学依据。方法：在体视显微镜和手术显微镜下，对45例90侧成人脑标本进行观察，研究视束动脉的起源、数量、分布，对其中50—70岁年龄的60侧脑标本的视束相关动脉做病理切片观察。结果：视束的血供主要来自颈内动脉、大脑中动脉、大脑前动脉、后交通动脉、和脉络丛前动脉的分支，呈节段性分布，上述动脉有动脉粥样硬化改变者占88．3％，动脉粥样硬化斑块引起视束动脉完全阻塞的占6．7％(4侧)，部分阻塞的占5．0％(3侧)。结论：50岁以上者出现一过性或持续性不同程度的视野缺损，若除外其他疾患则可能是脑底动脉粥样硬化引起视束血供障碍所致。     

大脑动脉环的解剖及在磁共振血管成像上的应用

目的探讨运用三维时间飞跃法(3D-TOF)磁共振血管成像显示大脑动脉环,为构建大脑基底动脉环三维可视化动脉图谱提供形态学资料。方法对10例尸体的大脑动脉环进行动脉间角度及距离的测量。同时,对30例正常人的头颅进行3D-TOF磁共振血管成像检查,图像经西门子Syngo B17工作站后处理,从影像学分析大脑动脉环。结果大脑前动脉显示率为100!,均表现为双支型。动脉环内的均值距离为(1.06±0.23)cm,其与颈内动脉间的均值夹角为(63.13±9.72)°,与前交通动脉的均值夹角为(107.95±57.70)°;颈内动脉环内段显示率为100!,其与大脑前动脉的均值夹角为(63.13±9.72)°,与后交通动脉的均值夹角为(123.20±10.37)°;大脑后动脉显示率为100!,动脉环内的均值距离为(0.56±0.12)cm,其与后交通动脉的均值夹角为(70.00±8.87)°,与基底动脉的均值夹角为(123.95±11.43)°;后交通动脉显示率为100%,动脉环内的均值距离(1.06±0.17)cm,其与颈内动脉的均值夹角为(123.20±10.37)°,与大脑后动脉的均值夹角为(70.00±8.87)°,与大脑中动脉的均值夹角为(131.15±15.21)°;前交通动脉的显示率为80%,动脉环内的均值距离为(0.23±0.16)cm,其与大脑前动脉的均值夹角为(107.95±57.70)°。结论明确了大脑动脉环的解剖组成,测量了动脉间的距离及动脉环内各动脉间的角度,3D-TOF法磁共振血管成像可清晰显示大脑动脉环的组成,三维重建技术可以从各个角度显示大脑动脉环。     

The hemodynamic effect of bilateral carotid artery ligation and the morphometry of the main communicating circuit in normotensive and spontaneously hypertensive rats

After reducing the number of patent conduit arteries to the brain by bilateral ligation of the carotid artery, the percentage decrease in blood pressure from the aorta to the internal carotid artery distal to the ligation was larger in spontaneously hypertensive rats than in normotensive rats. The pressure drop corresponded to the degree of hypertension as well as to morphometrically determined structural arterial alteration in the main communicating circuit, i.e. larger media to internal radius ratio and smaller internal radius in the posterior communicating arteries, the proximal part of the posterior cerebral arteries, the basilar artery and the vertebral arteries. The discrepancy between the sum of the luminal cross sectional areas of the communicating circuit and the luminal areas of the ligated conduit arteries was larger in the hypertensive than in the normotensive rats. It is to be expected that occlusion of conduit arteries to the brain will have a larger impact on the cerebral arterial perfusion pressure head in the presence of such hypertensive structural alterations known to increase flow resistance.     

大鼠前脑动脉的形态学研究

目的观察大鼠前脑动脉的分布、形态和结构,为进一步研究脑血管疾病提供依据。方法通过颈总动脉注射红色乳胶和多种染色方法对大鼠前脑动脉的大体形态和微细结构进行观察。结果大鼠脑基底动脉环完整,颈内动脉和基底动脉在前脑的主要分支有大脑前动脉、大脑中动脉和大脑后动脉。其中,大脑前动脉位于大脑纵裂底部,几何形态学指标稳定,镜下脑动脉管壁形态结构典型。结论大鼠前脑动脉大体形态学和微细结构与人端脑动脉相似,大脑前动脉由于其位置恒定和结构典型在研究脑血管改变方面具有一定价值。     

后交通动脉池的显微解剖研究

目的 :探讨后交通动脉池的显微解剖特点及其手术意义。方法 :在手术显微镜下 ,观测 1 5例后交通动脉池的构成及其结构特点。结果 :后交通动脉池出现率为 86.7% ,其长、宽、高均约 1cm ,外侧壁为颞叶内侧面 ;顶壁几乎均为视束及视交叉下面 ;外上壁是脚池底壁 ,多呈网膜样 ;底壁主要是动眼神经和Liliequist膜的间 /中脑膜 ;内下壁是liliequist膜的下丘膜。主要含有后交通动脉及其几乎所有分支。结论 :后交通动脉池是由颈内动脉外侧间隙达到脚间窝的必经之路 ,需沿后交通动脉下面切开liliequist膜的下丘膜。若见后交通动脉外上面有网膜样结构 ,不可轻易打开 ,因为其外上面几乎总有脉络膜前动脉行走     

Monolateral type I proatlantal artery with bilateral absence of vertebral arteries: description of a case and review of the literature

We report a case of a patient with right type I proatlantal intersegmental artery associated with right fetal posterior cerebral artery and absence of both vertebral arteries and of the left posterior communicating artery. We also describe the clinical relevance of these findings for this patient. A 56-year-old woman with vertigo and tinnitus underwent contrast enhanced Magnetic Resonance Angiography (MRA) of the supra-aortic arteries using a 1.5 Tesla scanner. Maximum intensity projection and volume rendering reconstructions were obtained. MRA demonstrated the persistence of an anastomotic artery between the right internal carotid artery and basilar artery, passing through the foramen magnum, suggesting a type I proatlantal intersegmental artery. The examination also showed the absence of both vertebral arteries and the presence of a right fetal-type posterior cerebral artery. To our knowledge, this is the first report of a type I proatlantal intersegmental artery associated with an omolateral fetal-type posterior cerebral artery and the absence of both vertebral arteries and of the left posterior communicating artery. This condition requires a watchful monitoring of the patient and has to be considered in case of surgical procedures of the carotid arteries.     

视交叉前间隙有关结构的解剖观察及其临床意义

目的为经额入路行蝶鞍区手术提供外科解剖学依据。方法对30个经福尔马林固定的成年人尸头标本的视交叉前间隙及有关结构在肉眼和SXQ鄄Ⅱ型手术显微镜下进行观察,对视交叉前间隙的面积进行测算。结果①视交叉前间隙之间的面积为(28.4±6.2)mm2。两侧视神经颅内段越长,夹角越小,视交叉前间隙越大;两侧视神经颅内段越短,夹角越大,视交叉前间隙越小。②视交叉前缘至鞍结节之间的距离为(4.1±0.8)mm,两侧视神经于视交叉前之间的夹角为63.2°±5.8°。③颈内动脉自前床突内侧向上穿过硬脑膜之后,先向前、内、上方行至视神经下面,再弯向后、外、上方行于视神经外侧。④分布于视交叉上后面的视交叉上动脉来源于两侧大脑前动脉水平部段和前交通动脉。分布于视交叉下前面的视交叉下动脉来源于两侧颈内动脉和后交通动脉。结论经额入路蝶鞍区手术主要是通过视交叉前间隙,在颈内动脉之间的间隙操作,手术中应注意保护好视神经和视交叉的营养动脉,以减少并发症的发生。     

Some observations on the cerebral arterial circles of mink (Mustela vison)

With the exception of a brief allusion to an unidentified species of Mustela with regard to cerebral vascular studies by de Vriese ('05), major information concerning the circle of Willis in mink was nonexistent until the present investigation. Brains of mink in which the cerebral arterial circles were injected with latex and subsequently hardened in formalin, revealed the primary cerebral arterial anastomosis to be ring-like in form; all of the component vessels were patent and well formed, none was attenuated or string-like. Some of the more prominent findings included: (1) a predominance of asymmetric divergence of the posterior communicating arteries separating from the bifurcating basilar artery; (2) the presence of a posterior intercommunicating artery in all of the specimens; (3) the occasional doubling of the superior cerebellar and the posterior cerebral arteries; (4) deeply placed internal cerebral loops forming secondary arterial anastomoses between some penetrating vessels in the caudal region of the circle; other loops interconnected other penetrating vessels in the rostral region of the circle; (5) blood channels forming an intercarotid anastomosis traversed the pia mater; (6) the presence of a penetrating artery adjunctive to the recurrent artery of Heubner; (7) anastomoses between the internal and the external ophthalmic arteries, and between the internal and the external olfactory arteries forming collateral channels of communication between the intracranial and the extracranial circulations; (8) the occasional presence of an anterior communicating artery supplementing the commonly occurring azygos anterior cerebral artery which continued as a single vessel throughout its extent; (9) unjoined anterior cerebral arteries in one animal which was exceptional.     

人外侧膝状体的血液供应及其临床意义

目的：为外侧膝状体（LGB）缺血所致的视野缺损提供形态学依据。方法：手术显微镜下观察成人和胎儿脑的LGB动脉的来源和微血管构筑,部分脑标本用组织切片方法观察营养LGB动脉的粥样硬化病理改变。结果：LGB营养动脉第一级来自颈内动脉和大脑后动脉,二级为脉络丛前动脉、脉络丛后外动脉和丘脑膝状体动脉,三级构成LGB的小动脉。50岁以上的标本,LGB的一、二级动脉有硬化改变的占88％,二级小动脉被阻塞占10％。结论：二级动脉在LGB内有各自的供血区,脉络丛前动脉是供应LGB前部和外侧部的唯一动脉,大脑后动脉营养LGB的其余部分。不同动脉的阻塞可导致不同种类的视野改变,是视野缺损的原因之一。     

Unilateral agenesis of the internal carotid artery presented as transient ischaemic attack: a case report

Dysgenesis of the internal carotid artery (ICA) is a rare vascular disorder with a variety of different grades (agenesis, aplasia, and hypoplasia). The left internal carotid artery is reported to be affected by dysgenesis three times more often than the right one. Most of the patients with dysgenesis of the internal carotid artery are asymptomatic. We report a case of a patient with right internal carotid artery agenesis presented to our hospital as transient ischaemic attack. CT scans at skull base level with bone settings showed absence of the right carotid canal, consistent with congenital agenesis of the internal carotid artery. MR imaging of the brain revealed signal void of the intracranial portion of right internal carotid artery. Maximum intensity projection reconstruction confirmed the agenesis of the right ICA, with the right middle cerebral artery fed through a dilated posterior communicating artery and the right anterior cerebral artery supplied by the anterior communicating artery (fetal type of collateral flow). In patients with agenesis of the internal carotid artery non-invasive imaging techniques are currently the mainstay of diagnosis.     

应用MRA研究大脑前动脉A1段发育与交通动脉开放之间的关系

目的　探讨大脑前动脉A1段发育与前后交通动脉开放情况之间的关系。方法 回顾性分析了107例3.0T磁共振血管成像（MRA）无脑血管病的检查者和体检者。观察双侧大脑前动脉A1段发育、前交通动脉和双侧后交通动脉开放情况,测量双侧大脑前动脉A1段、前交通动脉及后交通动脉的管径,分析二者的相关性。  结果　①右侧大脑前动脉A1段发育不良占22.43%（24/107）,缺如占0.93%（1/107）,左侧大脑前动脉A1段发育不良占16.82%（18/107）,缺如占1.87%（2/107）。②前交通动脉开放占47.66%（51/107）。③单侧或双侧后交通动脉开放共有39例,其中双侧同时开放占21例,仅左侧开放占7例,仅右侧开放占11例。④大脑前动脉A1段发育不良与交通动脉开放相关（r=0.654,P＜0.01）。  结论 大脑前动脉A1段发育不良可引起交通动脉代偿性开放。     

大鼠脑血管颈内动脉系神经肽Y能神经纤维的来源

应用免疫组织化学技术 ABC法和神经节切除术 ,观察了 3 0只 Sprague-Dawley大鼠 (分正常组和四个手术组 )颈内动脉系脑底血管主要分支神经肽 Y( NPY)能神经纤维的起源。正常组大鼠脑底血管大脑前动脉、大脑中动脉和大脑后动脉均可见棕褐色的 NPY能免疫反应阳性纤维 ,呈细线状 ,攀附于血管壁上。手术 组做左侧颈上神经节切除术 ,术后存活 7～ 10 d,发现左侧大脑前动脉、大脑中动脉和大脑后动脉阳性纤维明显减少 ,右侧同名动脉阳性纤维亦有减少 ,但不如同侧明显 ;手术 组做双侧颈上神经节切除术 ,术后存活 7～ 10 d,双侧大脑前动脉、大脑中动脉和大脑后动脉阳性纤维基本消失 ;手术 组做左侧星状神经节切除术 ;手术 组做双侧星状神经节切除术 ,上述各动脉阳性纤维密度都未减少。将手术 、 组各组阳性纤维密度数据与正常组进行对比 ,经统计学分析 ,有显著差异。结果提示 :大鼠一侧颈内动脉系各主要动脉分支的 NPY能神经纤维都起源于双侧颈上神经节 ,但以同侧为主     

The cerebral basal arterial network: morphometry of inflow and outflow components

The aim of this project was to study how the morphology of the incoming and outgoing arterial components of the cerebral basal arterial network influence the blood flow to the brain. The cerebral basal arterial network consists of the circulus arteriosus cerebri anteriorly and the basilar artery posteriorly. Diameters of inflow vessels (bilateral vertebral and internal carotid arteries), connecting vessels (anterior communicating, basilar and bilateral posterior communicating arteries) and outflow vessels (anterior, middle and posterior cerebral arteries) were measured and cross‐sectional areas calculated in 51 cadaveric brain specimens. The individual and the average cross‐sectional areas of inflow arteries (51.43 mm²) were significantly bigger than the major outflow arteries (37.76 mm²) but smaller than the combined cross‐sectional areas of outflow (37.76 mm²) and connecting (25.33 mm²) arteries. The difference in the size of arterial cross‐sectional area and the presence of the connecting arteries in the cerebral basal arterial network provides a mechanism for lowering peaks in pressure, and demonstrates a function of the cerebral basal arterial network.     

Persistent carotid-vertebral anastomosis associated with contralateral accessory middle cerebral artery

An exceptional case is reported of a complex anomaly of the brain arteries including low left carotid bifurcation, persistent carotid-vertebral anastomosis on the left and accessory middle cerebral artery on the right; the whole posterior circulation was only filled through the anomalous anastomotic vessel which joined with the vertebral artery because of a contralateral hypoplasic vertebral artery and the absence of both posterior communicating arteries. This association has not been previously reported in the literature. The embryological processes leading to these arterial anomalies are discussed. Risks related to a severe carotid stenosis or occlusion and to surgical or endovascular procedures in patients harboring these arterial anomalies are emphasized.     

自发性高血压鼠脑底动脉降钙素基因相关肽能神经纤维的分布

应用免疫组织化学ABC法和神经交点计数技术,观察了10只自发性高血压大鼠和10只正常血压大鼠脑底动脉降钙素基因相关肽(CGRP)能神经纤维的分布。结果证明:在自发性高血压鼠的大脑前动脉、大脑中动脉、大脑后动脉和基底动脉壁上均可见CGRP免疫反应阳性纤维,纤维呈细曲线状,多呈网状走行;与正常血压鼠脑底血管同名动脉比较,其密度明显减少。正常血压鼠脑底血管CGRP能神经纤维多呈环形走行。高血压鼠的CGRP能神经纤维的分布随着高血压的发生而明显减少,提示CGRP能神经纤维的减少与高血压的发生、发展具有一定的关系。     

Extrinsic and intrinsic blood supply to the optic chiasm

Although there have been many studies of the arterial cerebral blood supply, only seven have described the optic chiasm (OC) blood supply and their results are contradictory. The aim of this study was to analyze the extrinsic and intrinsic OC blood supply on cadaveric specimens using dissections and microcomputer tomography (Micro‐CT). Thirteen human specimens were dissected and the internal or common carotid arteries were injected with red latex, China Ink with gelatin or barium sulfate. Three Micro‐CTs were obtained to reveal the intrinsic blood supply to the OC. The superior hypophyseal arteries (SupHypA) (13/13) and posterior communicating artery (PCoA) (12/13) supplied the pial network on the inferior side of the OC. The first segment of the anterior cerebral artery (ACA) (10/10), SupHypA (7/10), the anterior communicating artery (ACoA) (9/10), and PComA (1/10) supplied the pial network of its superior side. The intrinsic OC blood supply was divided into three networks (two lateral and one central). Capillaries entering the OC originated principally from the inferior pial network. The lateral network capillaries had the same orientation as the visual lateral pathways, but the central network was not correlated with the nasal fibers crossing into the OC. There was no anastomosis in the pial or intrinsic networks. Only SupHypA, PCoA, ACoA, and ACA were involved in the OC blood supply. Because there was no extrinsic or intrinsic anastomosis, all arteries should be preserved. Tumor compression of the inferior intrinsic arterial network could contribute to visual defects. Clin. Anat. 31:432–440, 2018. © 2017 Wiley Periodicals, Inc.     

旁正中穿质及其动脉的显微外科解剖

用手术显微镜观测了４８侧旁正中穿质及其动脉。旁正中穿质是界于乳头体、灰结节、视束与大脑脚之间的三角形区域，穿入此区的动脉为旁正中穿动脉和乳头体前动脉。乳头体前动脉的出现率９７．９２％，主要起自后交通动脉（９４．２３％），其余起自颈内动脉和大脑后动脉的交通后段。乳头体前动脉双支的出现率为１０．４２％。有８０．７７％的乳头体前动脉发支至视束、大脑脚和旁正中穿质。详细观察了穿旁正中穿质的动脉外径、长度及