Abstract
Background: The perforating arteries in the dorsolateral zone of the midbrain play a crucial role in the functions of the brain stem. Their damage due to herniation, pathological lesions, or surgery, favored by the narrow tentorial incisura, can lead to hemorrhages or ischemia and subsequently to severe consequences for the patient.Objective: In literature, not much attention has been directed to the perforating arteries in the lemniscus; in fact, no reports on the perforators of this anatomical region are available. The present study aims to a detailed analysis of the microanatomy and the clinical implications of these perforators, in relation to the parent vessels. We focused on the small vessels that penetrate the midbrain's dorsolateral surface, known as lemniscal trigone, to understand better their microanatomy and their functional importance in the clinical practice during the microsurgical approach to this area.Methods: Eighty-seven alcohol-fixed cadaveric hemispheres (44 brains) without any pathological lesions provided the material for studying the perforating vessels and their origin around the dorsolateral midbrain using an operating microscope (OPMI 1 FC, Zeiss). Measurements of the perforators' distances, in relation to the parent vessels, were taken using a digital caliper.Results: An origin from the SCA could be found in 70.11% (61) and from the PCA in 27.58% (24) of the hemispheres. In one hemisphere, an origin from the posterior choroidal artery was found (4.54%). No perforating branches were discovered in 8.04% of specimens (7).Conclusion: The perforating arteries of the lemniscal trigone stem not only from the superior cerebellar artery (SCA), as described in the few studies available in literature, but also from the posterior cerebral artery (PCA). Therefore, special attention should be paid during surgery to spare those vessels and associated perforators. A comprehensive understanding of the lemniscal trigone's perforating arteries is vital to avoid infarction of the brainstem when treating midbrain tumors or vascular malformations.
Highlights
IntroductionThis study aims to provide a microsurgical anatomical definition of the perforating vessels and to name their parent vessels, which stem from the dorsolateral midbrain perforation zone’s arterial capillary network
The dorsolateral surface is just this small triangular area known as lemniscal trigone or Reil’s Trigone (Testut and Latarjet, 1949), delimited posterosuperiorly by the inferior colliculus and its brachium, posteroinferiorly by the superior cerebellar peduncle, and anteriorly by the lateral mesencephalic sulcus, which is recognized by the lateral mesencephalic vein (LMV), a constant landmark (Ardeshiri et al, 2006, 2007)
In one (1.14%) of the 87 hemispheres, we found an origin from the medial posterior choroidal artery and, in another hemisphere (1.14%), branches emanating from the medial posterior choroidal artery, posterior cerebral artery (PCA), medial superior cerebellar artery (MSCA), and lateral superior cerebellar artery (LSCA)
Summary
This study aims to provide a microsurgical anatomical definition of the perforating vessels and to name their parent vessels, which stem from the dorsolateral midbrain perforation zone’s arterial capillary network. The mesencephalon consists of the cerebral peduncles, the tegmentum, and the tectum. The lateral mesencephalic sulcus separates the cerebral peduncles from the tegmentum. The perforating arteries in the dorsolateral zone of the midbrain play a crucial role in the functions of the brain stem. Their damage due to herniation, pathological lesions, or surgery, favored by the narrow tentorial incisura, can lead to hemorrhages or ischemia and subsequently to severe consequences for the patient
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