The perforating branches of the P1 segment of the posterior cerebral artery |
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| Authors: | Ahmet Hilmi Kaya Adnan Dagcinar Mustafa Onur Ulu Arif Topal Yasar Bayri Aykan Ulus Cem Kopuz Bulent Sam |
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| Institution: | 1. Department of Neurosurgery, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey;2. Department of Neurosurgery, Sakarya ToyotaSA State Hospital, TEM Motorway, Adapazari, Sakarya, Turkey;3. Morgue Specialization Department, National Forensic Institute, Ministry of Justice, Istanbul, Turkey;1. Graded Specialist (Radiodiagnosis), Military Hospital Gwalior, India;2. Commandant, Military Hospital Gwalior, India;3. Classified Specialist (Medicine), Military Hospital Gwalior, India;4. Graded Specialist (Obst & Gynae), Military Hospital Gwalior, India;5. Graded Specialist (Anaesthesia), Military Hospital Gwalior, India;1. Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA;2. Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA;3. Department of Neurosurgery, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia;1. Vascular Surgery Unit, Department of Surgery, “San Francesco” Hospital, Nuoro, Italy;2. Vascular Surgery Unit, Department “Paride Stefanini”, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy;1. Department of Clinical Sciences Malmö, Clinical Memory Research Unit, Lund University, Malmö, Sweden;2. Memory Clinic, Skåne University Hospital, Malmö, Sweden;3. Department of Neurology, Skåne University Hospital, Lund, Sweden;4. Department of Clinical Sciences, Neurology, Skåne University Hospital, Lund University, Lund, Sweden;5. Department of Clinical Sciences Lund, Diagnostic radiology, Skåne University Hospital, Lund University, Lund, Sweden;1. Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan;2. Center for Clinical Epidemiology, Internal Medicine, St. Luke’s International Hospital, Tokyo, Japan;3. Department of Radiology, Teishinkai Hospital, Sapporo, Japan |
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| Abstract: | The perforating branches of the P1 segment of the posterior cerebral artery are vulnerable to injury. Because of their close proximity to the basilar artery, the vulnerability occurs especially during surgical interventions for vascular pathologies such as basilar apex aneurysms. Therefore, extensive knowledge of the microsurgical anatomy of this area is mandatory to prevent poor post-operative outcomes. We microscopically examined 28 P1 segments obtained from 14 adult fresh cadaver brains (6 silicone injected, 8 freshly examined). The P1 segments ranged between 2.8 mm and 12.2 mm (mean 6.8 mm) in length with a mean outer diameter of 1.85 mm (range 0.8–4.5 mm). All 94 thalamoperforating branches identified in 27 P1 segments (mean 3.35 branches per segment) arose from the postero-superior aspect of P1 and were the most proximally originating branch in nearly all specimens (96.4%). In addition in 28 P1s, 12 short circumflex arteries (42.8%; mean 0.42 branches per segment), 16 long circumflex arteries (57.1%; mean 0.57 branches per segment) and 10 medial posterior choroidal arteries (35.7%; mean 0.35 branches per segment) were identified and all originated from the posterior or postero-inferior surface of the P1 segment. When the P1 segment had more than one type of branch, it was the short circumflex arteries that were always more proximal in origin than the others. The medial posterior choroidal arteries were always more distal in origin. All three branches were not observed together in any of the P1 segments. The findings in this, and future, anatomical studies may help to reduce the post-surgical morbidity and mortality rates after surgery for posterior circulation aneurysms. |
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