Morphological analysis of the vertebral and basilar arteries in the Chinese population provides greater diagnostic accuracy of vertebrobasilar dolichoectasia and reveals gender differences

Purpose

Previous studies suggest that cerebral artery diameter and position differ with both gender and ethnicity, making diagnosis of vertebrobasilar dolichoectasia (VBD) difficult. Thus, the current study investigated the morphology and potential gender differences of the vertebral (VA) and basilar arteries (BA) in the Chinese population. The data collected also enabled some criteria to be suggested for the diagnosis of VBD by MRI.

Methods

A total of 200 healthy participants who underwent magnetic resonance imaging (MRI) were enrolled. The diameters of the BA and VA were measured using high resolution MRI and the height of the basilar artery bifurcation and the position of the basilar artery were also analyzed. The 95?% confident intervals (CI) of vessel diameter were calculated.

Results

The diameters of each artery measured, significantly differed with gender (p?Conclusions There are significant gender differences in the diameter of both the VA and BA, indicating that gender needs to be considered in the diagnosis of VBD. These results also provide much needed quantitative data for the diagnosis of VBD in Chinese people.     

Complex anomalies of type 1 proatlantal intersegmental artery and aortic arch variations

Purpose

We report a case of type 1 proatlantal intersegmental artery (PIA) associated with multiple anomalies of the aortic arch, and discuss the possible embryonic mechanism and clinical importance of the multiple cerebrovascular variants in this patient.

Methods

A 65-year-old woman with dizziness underwent cerebral magnetic resonance (MR) imaging and head and neck MR angiography using a 3-tesla scanner and computed tomography (CT) angiography using a 64-slice multidetector CT scanner.

Results

MR and CT angiography demonstrated an aneurysm of the distal end of the azygos anterior cerebral arteries and hypoplasia of the proximal right vertebral artery (VA) with an anastomotic artery, between the right internal carotid artery (ICA) and distal right VA that passed through the foramen magnum, indicating a type 1 PIA. She also demonstrated an aberrant right subclavian artery (ARSA) with hypoplasia of the right VA, and the left VA arose directly from the aortic arch.

Conclusion

To our knowledge, this is the first report of a type 1 PIA associated with multiple vascular anomalies of the aortic arch, such as ARSA and origin of the left VA from the arch. In cases of persistent anastomoses between the carotid and vertebrobasilar arteries, such as PIAs, imaging examination should include the aortic arch to identify associated vascular variations.     

The Evaluation of Vertebrobasilar Artery System in Neuro‐Behçet and Behçet Disease using Magnetic Resonance Angiography

The aim of this study is the evaluation of the vertebrobasilar artery system in patients with Behçet's and Neuro‐Behçet's disease. For this aim; 20 adults with clinically diagnosed Behcet's disease, 20 adults with Neuro‐Behçet's disease, and 19 age‐ and gender‐matched controls were examined by magnetic resonance angiography (MRA). During MRA, diameters of left vertebral artery (LVA), right vertebral artery (RVA), basilar artery (BA), and proximal segment (P1) of posterior cerebral artery between origin and junction with the posterior communicating artery were measured. In all groups, LVA was dominant than RVA (P < 0.05). The diameters of BA and right P1 of Neuro‐Behçet's disease were larger than the other groups (P < 0.05). In addition, the diameters of left P1 of Neuro‐Behçet's disease were larger but not statistically significant. There is no difference between the groups in terms of gender. Behçet's disease can affect vascular structures; therefore vertebrobasilar artery system should be examined in patients with Behçet's and Neuro‐Behçet's disease. Anat Rec, 297:1302–1305, 2014. © 2014 Wiley Periodicals, Inc.     

Posterior right diagonal artery

Background: There is general confusion about a branch of the posterior segment of the right coronary artery that has been referred to as 1) the lower trunk of a divided right coronary artery; 2) a posterior reflection of the right marginal artery; 3) the ramus lateralis; and 4) a posterolateral branch or a posterior descending artery. Materials: Three hundred human hearts were studied by direct observation, X-ray films, and corrosion casting. Results: This branch of the right coronary artery arises either after the right marginal artery (in 84% of hearts) or it constitutes the continuation of this artery in the remaining 16%. We named it the posterior right diagonal artery (PRDA). It was found in 14% of 266 hearts of right dominant type. It was present in 39% when the length of the posterior descending artery (PDA) was shorter than half of the length of the posterior interventricular sulcus (PIS) and in 6% when it was longer. When the PRDA originated directly from the RCA, the RMA appeared underdeveloped; the PRDA always occupied the inferior part of the PIS and appears either as continuation of a short PDA or as a replacement for a long PDA from the point where this artery leaves the PIS to enter the posterior wall of the left ventricle. The PDRA when present serves as a bridge between the RCA and the left anterior descending artery. Conclusions: These findings are of practical importance for the correct interpretation of coronary arteriographies and in the field of coronary artery surgery. © 1994 Wiley-Liss, Inc.     

The course of the posterior inferior cerebellar artery may be related to its level of origin

The course of the posterior inferior cerebellar artery (PICA) was analyzed with reference to its origin and relationships with the medullary and cerebellar surfaces and the adjacent cranial nerves in 40 brains after the injection with acrylic resins of the vertebrobasilar system. In 42.5% of instances, the PICA originated from the lateral medullary segment of the vertebral artery (VA), in 32.5% from its premedullary segment, in 22.5% from the basilar artery (BA), and in 2.5% it was absent. With reference to the level of origin, three patterns of course for the lateral medullary segment of the PICA can be outlined. (1) When it arises from the lateral medullary segment of the VA, it passes below the hypoglossal nerve, and the lateral medullary segment may form a loop with an anterosuperior convexity towards the pontomedullary sulcus (41%), or it may follow a rectilinear course (41%). It passes at the level of the accessory nerve. The tonsillomedullary (TM) segment shows a caudal loop and the telovelotonsillary (TVT) has a cranial loop. (2) When the PICA arises from the BA, it passes above the hypoglossal nerve. The lateral medullary segment forms a loop with lateral convexity (78%) and passes above or through the glossopharyngeal nerve, frequently showing a recurrent course among the roots of the IX, X, or XI cranial nerve. The TM and the TVT segments do not have loops. (3) When the PICA arises from the premedullary segment of the VA, it passes above, below, or through the rootlets of the hypoglossal nerve. In the lateral medullary segment, it follows a rectilinear course (54%) and passes the plane formed by the IX, X, and XI cranial nerves at an intermediate level with respect to the other two patterns. The TM and the TVT segments show caudal and cranial loops. The different origins and courses of the PICA derive from the selection of different branches of the primitive vertebrobasilar plexus during the development of the cerebellum. The existence of an embryologic correlation between the course of the PICA and its level of origin may be useful in the evaluation of its angiographic anatomy.     

Rare case of right accessory renal artery originating as a common trunk with the inferior mesenteric artery: a case report

Dissection of a male cadaver revealed several vascular abnormalities in the abdominal cavity, notably of the renal circulation. In particular, three renal arteries were observed on the right side and two on the left. On the right side, one accessory renal artery originated as a common trunk with the inferior mesenteric artery. Additional variations included a left inferior phrenic artery originating from the celiac trunk, bilateral testicular veins emptying into renal veins, and the left testicular artery arising from the left renal artery. The possible embryonic development of these branching patterns and their clinical significance are discussed briefly.     

Pathologic Reappraisal of Wallenberg Syndrome: A Pathologic Distribution Study and Analysis of Literature

Background

Wallenberg syndrome was first reported by Adolf Wallenberg as arising due to the obstruction of the posterior inferior cerebellar artery (PICA), which caused an infarct in the lateral medulla oblongata (MO).

Method

This study was carried out on brain tissue from 2 patients with typical Wallenberg syndrome and 10 autopsy cases without central nervous system disturbances.

Results

Patient 1 exhibited the 3 major neurological symptoms of right crossed sensory disturbance, right cerebellar ataxia and bulbar palsy. There was the pathological obstruction of the right vertebral artery (VA). Regarding the histopathlogical distribution, the infarct extended on the right side to the lateral spinothalamic tract, nucleus of the spinal tract of the trigeminal nerve, spinal tract of the trigeminal nerve, inferior cerebellar peduncle, spinocerebellar tract and nucleus ambiguous. Moreover, a clear infarct in the left lateral MO was pathologically identified, but pathological obstruction of the left PICA or left VA could not be found. The left cerebellar ataxia and bulbar palsy were observed among these 3 major symptoms. Patient 2 showed the 3 major symptoms of right crossed sensory disturbance, right cerebellar ataxia and bulbar palsy. A pathological luminal occlusion was identified in the right PICA. Regarding the histopathological lesion, the infarct disturbed on the right side the lateral spinothalamic tract, nucleus of the spinal tract of the trigeminal nerve, spinal tract of the trigeminal nerve, spinocerebellar tract, inferior cerebellar peduncle and nucleus ambiguus.

Conclusion

Based on our investigation of pathological lesions using our 2 autopsies, we suggest calling the cases that satisfy the following 3 criteria “definite pathologic Wallenberg syndrome”: i) identifiable pathological obstruction of the PICA or VA; ii) infarction in the lateral MO based on PICA or VA obstruction; and iii) a 1-to-1 correspondence between clinical symptoms and neuropathological lesions.     

A vermian artery originating from the posterior cerebral artery: an anatomical case report

During the dissection of a posterior fossa in a cadaveric head, we found a solitary superior vermian artery (VA) originating from the posterior cerebral artery (PCA). On the right side, the VA arose from the precommunicating segment of the PCA. The VA distributed by giving off some branches to the interpeduncular fossa, cerebral peduncle, midbrain, cerebellar cortex, inferior colliculus, lingula, vermis and superior medullary velum. The right superior cerebellar artery (SCA) had a normal origin from the basilar artery (BA) and supplied the righ tentorial surface of the cerebellum by means of bifurcating into two major trunks. The left SCA had duplicated origin from the BA.     

Systematization,description, and territory of arteries that promote vascularization of the midbrain and rhombencephalon in the ostrich (Struthio camelus)

Brain specimens from 30 ostriches were injected with red-dyed latex via the internal carotid arteries (Aa.). The ventral tectal mesencephalic artery (a.), invariably a medium-sized single vessel, was, on the right side, a collateral branch of the caudal branch of the carotid artery (53.4%), a direct branch of the carotid artery (43.3%) and a direct branch of the basilar artery (3.3%) and on the left side, a collateral branch of the caudal branch of the carotid artery (66.7%), a direct branch of the carotid artery (30%), and a direct branch of the basilar artery (3.3%). It vascularized only the ventral half of the optic lobe, with no involvement in cerebellar vascularization on the right (93.3%) and left (80%) sides, extending to the ventrorostral-most cerebellar lobules, which were vascularized on the right (6.7%) and left (20%) sides. The caudal ventral cerebellar arteries were a single vessel on the right (96.7%) and left (93.3%) sides. Its first branch was a common trunk: dorsal spinal—caudal cerebellar on the right (60%) and left (56.6%) sides. Its second branch was the caudal cerebellar artery on the right (76.7%) and left (86.7%) sides. Its third branch was the second component of the caudal cerebellar artery on the right (6.7%) and left (3.3%) sides. The midbrain was vascularized by dorsal and ventral tectal mesencephalic arteries. The cerebellum was vascularized by branches of the caudal ventral cerebellar artery and by the dorsal cerebellar artery.     

Anatomy and prevalence of atlas vertebrae bridges in a Kenyan population: An osteological study

Atlas bridges are bony outgrowths over the third segment of the vertebral artery. They may exist as incipient, incomplete, or complete bridges, converting the groove into a deep sulcus, incomplete, or complete foramen respectively. These bridges and their associated foramina display bilateral and sex differences in their prevalence and type. Occurrence of these bridges may predispose to vertebrobasilar insufficiency and Barre–Lieou syndrome. The coexistence of lateral and posterior bridges as well as side predilection is not clear in either sex. Their relative occurrence may also point to some evolutionary patterns. We studied the prevalence, side predilection, coexistence, and anatomical features of atlas bridges using 102 dry atlases (49 males and 53 females) obtained from the osteology department of the National Museums of Kenya. Complete posterior bridges occurred in 14.7% and 13.7% on the right and left sides, respectively. A lateral bridge was found in 3.9% of cases on the right side only. There was positive correlation in the coexistence of the bridges. A retrotransverse foramen was found in 13% of cases. This study has found that posterior and lateral atlas bridges occur in association especially on the right side. Complete bridges were more prevalent in females and were more often present on the right side. This pattern seems to mirror the sexual predilection of vertebral artery compression syndromes. Gender roles may have an influence on the occurrence of these bridges and therefore the syndromes as well. Clin. Anat. 23:649–653, 2010. © 2010 Wiley‐Liss, Inc.     

The bulbocerebellar circumolivary bundle

During the course of a systematic study on the human vertebrobasilar arterial system (De Caro et al. 1995), our attention was drawn in one case to a strange morphology of the ventrolateral aspect of one side of the medulla. While initially our impression was that we were facing an actual malformation, review of the structure of the brainstem as described in most standard anatomical texts showed that it could correspond to the circumolivary fasciculus (Williams et al. 1995). The subject was a 63-y-old man who had died from rupture of an atherosclerotic aneurysm of the abdominal aorta. The medical history was negative for neuropsychiatric pathology. Brain examination showed severe atherosclerosis of the cerebral arteries and hypoplasia of the initial segment of the right posterior cerebral artery. A recent infarct was found in the white matter of the right occipital lobe. After removal of the vertebrobasilar arterial system, the right pyramid showed a superficial groove extending from about 2 mm lateral to the foramen caecum obliquely downwards to the right anterolateral sulcus of the medulla, at the level of the superior margin of the inferior root of the hypoglossal nerve (Fig. 1a). Due to this groove, the lateral part of the pyramid formed a ridge that crossed the anterolateral sulcus of the medulla passing between the 2 main roots of the hypoglossal nerve and then continued, below the inferior pole of the olive, over the lateral region of the medulla ending at the level of the posterolateral sulcus (Fig. 1b). The general appearance was that of a small cord forming a loop around the anterior margin and the inferior pole of the olive, with a descending part (8 mm long), a horizontal part (6 mm long) and with a transverse diameter of 3 mm. After formalin fixation, the brainstem was cut in 8 transverse sections. At the level of the medulla the right pyramid appeared larger than the contralateral and the small lateral cord was separated from the main part of the pyramid by a thin whitish transverse stria (Fig. 1c). Macroscopic examination of the cerebellum showed nothing of relevance.     

Extrinsic risk factors for compromised blood flow in the vertebral artery: anatomical observations of the transverse foramina from C3 to C7

The vertebral artery (VA) is often involved in the occurrence of complications after spinal manipulative therapy. Due to osteophytes compressing the VA anteriorly from the uncinate process or posteriorly from the facet complex, the VAs are susceptible to trauma in the transverse foramina. Such altered anatomical configurations are of major clinical significance, as spinal manipulations may result in dissection of the VA with serious consequences for the blood supply to the vertebrobasilar region. The purpose of this study is to describe numerous structural features of the third to seventh cervical vertebrae in order to contribute to the understanding of pathological conditions related to the VA. The minimal and maximal diameter of 111 transverse foramina in dry cervical vertebrae were studied. The presence of osteophytes and their influence on the VA were evaluated at the vertebral body and at the superior and inferior articular facets. The diameter of the transverse foramina increased from C3 to C6, while the transverse foramina of C7 had the smallest diameter. At all levels the mean dimensions of the left foramina were greater than those of the right side. Osteophytes from the uncinate process of C5 and C6 vertebrae were found in over 60% of dry vertebrae. Osteophytes from the zygapophyseal joints were more frequent at C3 and C4 vertebrae. About half of the osteophytes of the uncinate and of the superior articular process partially covered the transverse foramina. This was less common with those of the inferior articular facets. Osteophytes covering the transverse foramen force the VAs to meander around these obstructions, causing narrowing through external compression and are potential sites of trauma to the VAs potentially even leading to dissection. We strongly advocate that screening protocols for vertebrobasilar insufficiency (VBI) be used prior to any manipulation of the cervical spine and should include not only extension and rotation but any starting position from which the planned manipulation will be performed.     

Anatomical study of a left single coronary artery with special reference to the various distribution patterns of bilateral coronary arteries

A left single coronary artery of heart was observed during anatomy practice at Kumamoto University School of Medicine in a 73-year-old female cadaver who died from a thalamic hemorrhage. The left single coronary artery, having a single orifice in the left aortic sinus, bifurcated into the anterior interventricular (IVa) and circumflex (CIR) arteries. No orifice of the right coronary artery was found on the aortic wall. Giving off a branch which traversed the upper part of the infundibulum to supply the anterior upper region of the right ventricle, the IVa descended in the anterior interventricular sulcus to supply the apex of the heart. The CIR curved leftwards in the atrioventricular sulcus to reach the posterior surface, after which it continued to emerge again into the anterior surface. The atrial arteries showed no anomalous distribution pattern and histological observation revealed no pathological abnormality other than a slightly thickened tunica intima. Furthermore, we observed the distribution patterns of bilateral coronary arteries in 377 hearts dissected during anatomical practice over 13 years at Kanazawa University (1980–1986) and Kumamoto University (1993–1998). Although the reason why only the right coronary artery was absent is left unexplained, it was concluded that the left single coronary artery in this study, having the developed left conal and circumflex branches, was an extreme case of the left dominant series of coronary arteries. The formation of single coronary arteries can be explained embryologically by the change of flow in the capillary plexus established on the ventricle wall.     

Systemic artery to pulmonary artery aneurysm malformations associated with variants at MCF2L

Arteriovenous malformations (AVM) are characterized by abnormal vessels connecting arteries and veins resulting in a disruption of normal blood flow. Hereditary hemorrhagic telangiectasia (HHT) is the most common cause of pulmonary AVM characterized by a right to left shunt. Here we describe a distinct malformation where the flow of blood was from a systemic artery to the pulmonary artery (PA) resulting in a left to right shunt instead of the right to left shunt seen in individuals with HHT. This distinct malformation was identified in seven probands, one from a multiplex family containing 10 affected individuals from five generations. To identify the molecular basis of this distinct malformation, we performed exome sequencing (ES) on the seven probands and the affected paternal female cousin from the multiplex family. PhenoDB was used to prioritize candidate causative variants along with burden analysis. We describe the clinical and radiological details of the new systemic artery to PA malformation with or without pulmonary artery aneurysm (SA-PA(A)) and recommend distinct treatment techniques. Moreover, ES analysis revealed possible causative variants identified in three families with variants in a novel candidate disease gene, MCF2L. Further functional studies will be necessary to better understand the molecular mechanisms involved on SA-PA(A) malformation, however our findings suggest that MCF2L is a novel disease gene associated with SA-PA(A).     

Studying the imaging features and infarction mechanism of vertebrobasilar dolichoectasia with high-resolution magnetic resonance imaging

The mechanisms underlying ischemic infarction in patients with vertebrobasilar dolichoectasia (VBD) remain unclear. In this study, we retrospectively analyzed the imaging characteristics of high-resolution magnetic resonance imaging (HR-MRI) in patients with VBD to explore the possible mechanisms of ischemic stroke (IS) in patients with VBD. Patients with VBD were recruited from the HR-MRI database between July 2017 and June 2021. HR-MRI was used to evaluate the diameter, bifurcation height, laterality, arterial dissection, and atherosclerotic plaques of the basilar artery (BA). Transcranial Doppler was used to measure the vertebrobasilar mean velocity (Vm), peak systolic velocity (Vs), end-diastolic velocity (Vd), and pulsatile index. Twenty-six patients with VBD were enrolled, of which 15 had IS and 11 did not. The incidence of classical vascular risk factors, including age, sex, hypertension, diabetes, and hypercholesterolemia, did not differ significantly between the two groups. The BA diameters of the stroke group were significantly higher than that of the nonstroke group (6.57 ± 1.00 mm vs. 5.06 ± 0.50 mm, p = 0.000). The height of the BA bifurcation in the stroke and nonstroke groups was statistically significant (p = 0.002). Compared with the nonstroke group, the Vm, Vs, and Vd of the BA in the stroke group were lower, but the difference was not significant. In the 16 patients with atherosclerotic stenosis, 30 atherosclerotic plaques were found in the BA, 18 (60%) in the greater curvature, and 12 (40%) in the lesser curvature. In addition, one artery dissection (on the lesser curvature) and two dissecting aneurysms (on the greater curvature) were found in the BA of three patients, respectively. The BA diameter and bifurcation height are factors related to IS in patients with VBD. The mechanism of stroke in patients with VBD may involve abnormal hemodynamics, artery dissection, and atherosclerosis. HR-MRI is a useful method for evaluating the risk and underlying mechanism of stroke in patients with VBD.     

Superficial palmar arch: an arterial diameter study

Although anatomical variations in the arterial pattern of the hand have been the subject of many studies, information on the diameter of the superficial palmar arch contributing vessels and its branches are rarely found in the literature. The objective of the current study was to evaluate these arterial variations, with special attention to the diameter of the superficial palmar arch contributing vessels and its major branches. Forty-six hands from male embalmed human cadavers were evaluated, 21 right hands and 25 left hands. Complete arches were present in 43% on the right and in 52% on the left. Arches were completed by the median artery in two cases. Variations were more common at the radial side of the arch and on left hands. Comparison of vessel diameters revealed the radial artery to be significantly larger than the ulnar artery but the ulnar artery to be larger than the superficial branch of the radial artery. The diameters of the common digital arteries were not different with regard to complete or incomplete arches, or with regard to the presence of the median artery.     

肺动脉切除重建术的应用解剖学

目的:为肺动脉切除与重建提供解剖学基础。方法:选择肺内结节性病灶,直径<3.0cm的周围型肺癌或良性球灶,接受肺叶切除手术的病人,对其肺动脉心包外段的长度、外径、分支及奇静脉各段的长度、外径进行观测。结果:左、右肺动脉出心包返折处至下叶背支动脉起点处的长度分别约为45.7mm、42.8mm;动脉起点处的外径:左侧分别为20.6mm、12.6mm,右侧分别为21.5mm、14.7mm。奇静脉可利用的第1段(奇静脉弓)和第2段的长度分别为44.8mm、46.8mm,第1段两端的外径分别为12.7mm、12.3mm。结论:肿瘤侵犯肺动脉主干及其分支根部,动脉切除后可采用侧壁扩大及袖式吻合重建术。肺动脉侧壁切除缺损较大时,右侧可首选自体奇静脉片;左侧首选心包片进行重建。     

A vertebral artery without atlantic and intradural sections: a case report and a review of the literature.

This report covers a case in which the right vertebral artery (VA) did not participate in the formation of the basilar artery. The artery had an external diameter of about 1 mm. It ran trough the transverse foramina of C6 through C2, then turned backward and entered the spinal canal and the dural envelope between the posterior arch of C1 and the lamina of C2 as a medullary artery to end in the spinal arteries. The basilar artery was a continuation of the left VA only. Only very few cases of non-union of the VA with the basilar artery have been previously described. Cases with extreme reduction of one of the VAs are not exceptional. This variant is clinically important. On arteriography, this extremely rare condition could easily be misdiagnosed as an obstruction. In view of manipulative therapy and in the detection of vertebrobasilar insufficiency, one has to bear in mind that cases of non-union may influence the interpretation of these tests.     

320排螺旋CT三维重建大脑前动脉的临床影像解剖学研究

目的　观测大脑前动脉的起源、走行及分支分布规律,期为脑血管疾病的诊疗提供影像学依据。 方法　随机收集100例无血管疾病的脑部多层螺旋CTA影像资料,利用其自带工作站进行图像后处理,观察大脑前动脉的影像解剖学结构。 结果　（1）测得大脑前动脉各段的数值,大脑前动脉A1段长度、内径及A1-A2夹角左右侧有统计学差异;（2）大脑前动脉走形变异率20%（20/100）,其中左侧A1段优势征9%,右侧A1段优势征5%,左侧A1段缺如1%,双侧大脑前动脉发育不良1%,左侧A4、A5段代偿供血1%,右侧A1段优势征合并同侧A2~A5段狭窄（由左侧A2~A5段代偿供血）1%,A4、A5共干1%,双侧A1段畸形1%;（3）大脑前动脉单干型71%,双干型29%。 结论　多层螺旋CTA能清晰立体地显示大脑前动脉的全长和主要分支及其解剖变异;大脑前动脉的变异复杂,左右差异显著,可为临床病变的早期诊断和治疗提供可靠依据。