Abstract
We have investigated establishment of collateral circulation in patients with cerebral circulation disorder. Thirty angiograms of patients treated at Neurological Department of Hospital Centre in Sarajevo suffering from arteriae cerebri mediae occlusion were used for this study. Cerebral anastomoses that included connections between arteriae cerebri anterior and arteriae cerebri mediae over leptomeningeal anastomoses occurred in some patients suffering from occlusion of this arteriae. It was concluded that the majority of anastomoses existed between big leptomeningeal branches of postcommunicant segment of a. cerebri anterior and branches of cerebri mediae. These collaterals are of great significance as their functional ability is sometimes of a high degree in cases of occlusion of one or the other artery. It can be concluded that anastomosing of the blood vessels increases their volume in the whole and therefore more blood can be provided, although physiological factors should not be neglected, as functional effectiveness of collateral circulation in postocclusive states depends also on the state of the whole cerebrovascular system, then on the speed of creation of occlusion (thrombosis or embolism), systemic arterial pressure, volume and viscosity of the blood.
Highlights
Functional effectiveness of collateral circulation in postocclusive states depends on many factors: on the number of anastomoses and their calibres, on the state of the whole cerebrovascular system, vascular variations and anomalies, on the speed of creation of occlusion, on the systemic arterial pressure, on volume and viscosity of the blood
The analysed cases were the angiograms of patients who survived the occlusion of arteriae cerebri mediae owing to the well developed leptomeningeal anastomoses between the blood vessels inserted into pia mater and flowing over the brain cortex
Having analysed such cases with arteriae cerebri mediae occlusion through its early, mid and late phases of filling, we discovered the creation of collateral circulation between the front and mid arteries of the brain
Summary
Functional effectiveness of collateral circulation in postocclusive states depends on many factors: on the number of anastomoses and their calibres, on the state of the whole cerebrovascular system, vascular variations and anomalies, on the speed of creation of occlusion (thrombosis or embolism), on the systemic arterial pressure, on volume and viscosity of the blood. Most of them are lodged in subarachnoid space near pia mater, and a smaller number of anastomoses, usually of bigger calibre, in the cisterns of that space In his comprehensive study, the author reports that pial anastomoses are placed mostly within pial arterial and arteriolar nets. Besides small anastomoses of 10-μm diameter, there are big ones whose calibre ranges between 25 and 90 μm These anastomoses are present in the field of arborisation of one leptomeningeal branch or its rami of the same cerebral arteries, or they connect leptomeningeal branches of adjacent arteries of the brain. Krayenbuhl et Yasargil (5) and Fields (4) report that arteriography became one of the most efficacious methods in diagnosing occlusive cerebrovascular disease This technique has been used for gathering all other information that could not have been collected in any other way. This is reliable in respect to the implication of two separate, but connected aspects of cerebral ischemia various clinical manifestations of vascular occlusion and variable recovery after functionally neurological deficiency
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