Choroidal Artery Research Articles

Case of a Pure Arterial Malformation and Review of the Literature. (P12-5.029)

<h3>Objective:</h3> NA <h3>Background:</h3> Pure arterial malformations are dilated, overlapping, and tortuous arteries forming a mass of arterial loops without a venous component. These malformations are rare, with limited cases reported in the literature. Affecting any of the intracranial arteries, they are usually found incidentally and often have a benign course. <h3>Design/Methods:</h3> We present a case of a pure arterial malformation in a young female with hyperprolactinemia. Furthermore, we review the literature and provide an updated summary of these malformations. <h3>Results:</h3> A 28-year-old female with a history of infantile hemangiomas, polycystic ovary syndrome, and hyperprolactinemia presented with acne, mild hirsutism, and galactorrhea. Her neurological exam was normal. Magnetic Resonance Imaging (MRI) of the brain with and without contrast ruled out a prolactinoma but revealed a 3 cm vascular malformation at the margin of the left cavernous sinus extending posteriorly into the anterior left perimesencephalic cistern. Initial differentials included a pial arteriovenous malformation or less likely a dural arteriovenous fistula. A diagnostic cerebral angiogram revealed a pure arterial malformation without arteriovenous shunting. This was composed of dysplasia of the left posterior communicating artery and anterior choroidal arteries. Stenosis of the left internal carotid artery distally with collateral support into the left anterior cerebral artery and middle cerebral artery was also noted. Genetic testing for vascular malformation syndromes, including genes known to be associated with hereditary hemorrhagic telangiectasia, was negative. Repeat MRI/MRA done 8 months from the initial scan revealed no abnormal large arterial venous shunting or definite saccular aneurysm formation. <h3>Conclusions:</h3> Although rare, pure arterial malformations should be considered in the differential diagnosis for patients presenting with a cranial vascular malformation. Management of these lesions is usually conservative given their lack of arteriovenous shunting and low risk of rupture, with only a few cases undergoing surgery or endovascular treatment. <b>Disclosure:</b> Dr. Ahmed has nothing to disclose. Dr. Regenhardt has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Rapid Medical. Dr. Regenhardt has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Johnson and Bell Trial Lawyers. The institution of Dr. Regenhardt has received research support from National Institutes of Health. The institution of Dr. Regenhardt has received research support from Society of Vascular and Interventional Neurology. The institution of Dr. Regenhardt has received research support from Heitman Foundation. Dr. Vranic has nothing to disclose. Dr. Dmytriw has nothing to disclose. James D. Rabinov has stock in Pfizer.

Study of the relationships between quantitative measurements of cerebral vascularization obtained by artificial intelligence, cognitive functions, and biomarkers of Alzheimer’s disease (P4-6.005)

<h3>Objective:</h3> Explore the relationship between the diameters and the volumes of the intracranial arteries and i) cognition; ii) Alzheimer’s Disease (AD) biomarkers, specifically hippocampal and cerebral atrophy and PET amyloid burden; iii) cognitive decline. <h3>Background:</h3> With the aging of the world population, approximately 78 million people worldwide will be affected by a major neurocognitive disorder (NCD) in 2030, with up to 80% of cases being of AD type. However, its etiology remains unclear. Given the growing evidence supporting a relationship between vascular factors and AD, we explored this hypothesis using a novel artificial intelligence (AI) algorithm. <h3>Design/Methods:</h3> Of the 409 participants (42–95 years old) selected from the OASIS-3 database, 338 had a normal cognition, 53, a questionable NCD, 16, a mild NCD, and 2, a major NCD. Intracranial arteries were evaluated by time-of-flight magnetic resonance angiography (TOF-MRA) and their measurements were calculated using a newly developed AI system. Cognitive status was assessed by MMSE, CDR, and several neuropsychological tests, including Logical Memory and Trail Making tests. Amyloid burden was visualized by amyloid PET with contrast (Pittsburgh Compound B or Florbetapir) and quantified using the Centiloid scale. Brain and hippocampal volumes were assessed by T1-weighted MRI and the resulting images were processed by the Freesurfer image analysis suite. <h3>Results:</h3> The anterior choroidal arteries (AchA) had the most associations (nonlinear and negative) with cognitive functions and AD markers. Conversely, the anterior cerebral (ACA), basilar, and 1^st segment of the posterior cerebral arteries (PCA-P1) had very little relationship with cognition. Among the statistically significant results, the correlations were of low magnitude. <h3>Conclusions:</h3> Using TOF-MRA imaging and AI, we were able to calculate the quantitative measurements of the intracranial arteries and thus assess their association with certain AD elements. Future research to further explore the vascular hypothesis of AD should be conducted in order to confirm these findings. <b>Disclosure:</b> Miss Ni has nothing to disclose. Dr. Janelle has nothing to disclose. Mr. Dumais has received personal compensation for serving as an employee of Imeka. Dr. Bocti has nothing to disclose. Kevin Whittingstall has nothing to disclose.

Uveal vascular bed in health and disease: lesions produced by occlusion of the uveal vascular bed and acute uveal ischaemic lesions seen clinically. Paper 2 of 2.

From studies on postmortem anatomical descriptions of the uveal vascular bed, it was generally concluded that occlusion of PCA or its branches should not produce an ischemic lesion. However, in vivo studies have recorded that the PCAs and their branches, right down to the terminal choroidal arterioles, and the choriocapillaris, have a segmental distribution in the choroid, and that PCAs and choroidal arteries function as end-arteries. This explains the basis of the occurrence of isolated inflammatory, ischemic, metastatic, and degenerative choroidal lesions, which are usually localized. Thus, in vivo studies have completely revolutionized our concept of the uveal vascular bed in disease.

Teaching NeuroImages: Persistent anterograde amnesia due to sequential, bilateral vascular damage to the Papez circuit

A 62-year-old previously cognitively intact man presented to the emergency department with acute impairment of anterograde memory (ability to form new memories).1 Head CT did not show acute changes; however, amnesia persisted. MRI disclosed an acute infarct in the left posterior hippocampus and a nonacute lacunar stroke in the right anterior thalamus (figure). Memory testing showed severe deficits in verbal and visual memory, persisting after 2 months. Bilateral lesions located anywhere in the Papez circuit (hippocampal formations, mammillary bodies, anterior thalamic nuclei, cingulate and parahippocampal cortices, and their connections via fornix and mammillothalamic tracts) may be implicated in marked, persistent anterograde memory deficits.1,2 The hippocampus receives its blood supply from collateral branches of the posterior cerebral artery and the anterior choroidal artery.3 The anterior thalamus is supplied by the tuberothalamic artery.4

Elevated neutrophil-related immune-inflammatory biomarkers in acute anterior choroidal artery territory infarction with early progression

ObjectiveThe anterior choroidal artery territory (AChA) infarction has a high rate of progression and poor functional prognosis. The aim of the study is to search for fast and convenient biomarkers to forecast the early progression of acute AChA infarction. MethodsWe respectively collected 51 acute AChA infarction patients, and compared the laboratorial index between early progressive and non-progressive acute AChA infarction patients. The receiver-operating characteristics curve (ROC) analysis was used to determine the discriminant efficacy of indicators that had statistical significance. ResultsThe white blood cell, neutrophil, monocyte, white blood cell to high-density lipoprotein cholesterol ratio, neutrophil to high-density lipoprotein cholesterol ratio (NHR), monocyte to high-density lipoprotein cholesterol ratio, monocyte to lymphocyte ratio, neutrophil to lymphocyte ratio (NLR), and hypersensitive C-reaction protein in acute AChA infarction are significantly higher than healthy controls (P < 0.05). The NHR (P = 0.020) and NLR (P = 0.006) are remarkably higher in acute AChA infarction patients with early progression than non-progression. The area under the ROC curve of NHR, NLR, the combine of NHR and NLR are 0.689 (P = 0.011), 0.723 (P = 0.003), 0.751 (P < 0.001), respectively. But there are no significant differences in efficiency between NHR and NLR and their combined marker in predicting progression (P > 0.05). ConclusionNHR and NLR may be significant predictors of early progressive patients with acute AChA infarction, and the combination of NHR and NLR could be a preferable prognostic marker for AChA infarction with early progressive course in acute stage.

Long-term hemodynamic changes in cerebral proliferative angiopathy presenting with intracranial hemorrhage: illustrative case.

Cerebral proliferative angiopathy (CPA) is a rare vascular proliferative disease; however, long-term follow-up reports are scarce. The authors report a rare case and document a patient's medical history over 20 years. A 5-year-old girl developed left frontal lobe hemorrhage, presenting with headache. At 8 years of age, angiography showed diffuse capillary ectasia without an arteriovenous shunt. Single-photon emission computed tomography (SPECT) showed normal cerebral blood flow (CBF). She had normal growth without systemic disease. At 25 years of age, an intraventricular hemorrhage occurred, presenting with sudden headache. Angiography revealed vascular lesion enlargement, increased feeding arteries, dural supply to the nidus and peri-nidal lesion, and flow-related aneurysm. SPECT showed remarkable decreases in CBF in the nidus and peri-nidal lesion. Cerebral proliferative angiopathy (CPA) was diagnosed, and the aneurysm arising at the lateral posterior choroidal artery caused the hemorrhage. Coil embolization of the aneurysm was performed with a flow-guide catheter and extremely soft platinum coils. New aneurysms were not noted 1.5 years after the procedure. This is the first report to demonstrate hemodynamic changes in CPA on angiography and SPECT over 17 years. The development of endovascular devices has enabled the embolization of ruptured aneurysms at the peripheral cerebral artery.

Aphasia with No Apparent Paralysis in Progressive Stroke of the Anterior Choroidal Artery.

Some anterior choroidal artery (AChA) infarctions in the posterior limbs of the internal capsule (plIC) have been reported to cause aphasia, typically with apparent paralysis. We herein report an 84-year-old woman with AChA infarction. Although her dysarthria remained mild with no apparent paralysis, we overlooked progression to branch atheromatous disease-related infarct with exacerbation of her anomia, which delayed the initiation of more intense therapy. Even in AChA infarction, especially when the lesion is located mainly in the anterior part of the plIC, as in our case, it is possible to encounter progressive stroke predominantly with aphasia.

A rare variant of accessory posterior cerebral artery.

The posterior cerebral artery (PCA) leaves from the distal end of the basilar artery (BA) and is joined to the internal carotid artery (ICA) by the posterior communicating artery (PComA). The archived computed tomography angiogram of a 67 y.o. male patient was studied anatomically. Anatomically normal PCAs left the BA. Both anterior choroidal arteries were found but the right one was hyperplastic. As the latter distributed parieto-occipital and calcarine branches, it was regarded as an accessory PCA. It was laterally to the normal one, inferior to the vein of Rosenthal. The terms "accessory PCA" and "hyperplastic anterior choroidal artery" describe the same morphology. Rare anatomical variants could benefit from a homogenous terminology.

Extremely long posterior cerebral artery P1 segment.

Excluding aplasia and hypoplasia of the P1 segment of the posterior cerebral artery (PCA), anatomical variations in the PCA are rare. To our best knowledge, there are few reports of an extremely long P1 segment of the PCA. Herein, we report a rare case of an extremely long P1 segment of the PCA, which was diagnosed by 1.5-T magnetic resonance angiography (MRA). A 96-year-old woman was transferred by ambulance to our hospital with impaired consciousness. Her symptom improved, and magnetic resonance imaging showed no significant findings. MRA revealed an extremely long P1 segment of the left PCA. The length of the P1 segment of the left PCA was 27.3mm. The left posterior communicating artery (PCoA) was 20.9mm, which is not considered long. The left anterior choroidal artery branched from the internal carotid artery distal to the PCoA branching position. Basilar artery fenestration was also incidentally identified. Careful imaging assessment was important for identifying the extremely long P1 segment of the PCA in the present case. This rare anatomical variation can also be confirmed by 1.5-T MRA.

Abstract Number ‐ 199: Acute Treatment of Aneurysmal Subarachnoid Patients with Flowdiversion: A Single Center Real World Experience

Introduction Subarachnoid hemorrhage patients presenting with complex morphology, and those with dissecting /fusiform aneurysms, blister aneurysms have historically posed a challenge for acute endovascular treatment. Flow diversion as a treatment for ruptured intracranial aneurysms is a last resort given the need for dual antiplatelet therapy in the acute setting. Methods We present our single center experience, real world experience in the acute treatment of patients with subarachnoid hemorrhage with pipeline flow diversion device. Results 6 patients presented acutely with a subarachnoid hemorrhage. Two of those had saccular intracranial aneurysms, 1 with a blister aneurysm, and 3 with dissecting aneurysms. 1 patient presented with a ruptured anterior choroidal artery location dissecting aneurysm, 1 with PCA blister aneurysm, 1 with intradural vertebral artery dissecting aneurysm, 1 saccular posterior communicating artery aneurysm, and another with a ruptured complex morphology anterior choroidal artery aneurysm, and 1 with dissecting PCA aneurysm. All patients were emergently loaded with dual antiplatelet therapy consisting of either aspirin and clopidogrel, or aspirin and ticagrelor or pletal and ticagrelor. 1 patient was treated with surface modified pipeline device with shield technology. Technical success was achieved in 100% of these patients. No acute in stent thrombosis was seen in this cohort. Four patients had no residual filling or recurrence at the 1st follow‐up at a median interval of 2–12 months. 1 patient died from fulminant vaso spasm. Follow‐up is pending in 1 patient. Conclusions In carefully selected patients, flow diversion in the acute setting is tolerated and can be an alternative treatment strategy with an acceptable safety profile.

Abstract Number ‐ 236: Pure Arterial Malformations: A Case Report

Introduction Pure arterial malformations are dilated, overlapping, and tortuous arteries forming a mass of arterial loops without a venous component. These malformations are rare, with limited cases reported in the literature. Affecting any of the intracranial arteries, they are usually found incidentally and often have a benign course. Methods We present a case of a pure arterial malformation in a young female with hyperprolactinemia. Furthermore, we review the literature and provide an updated summary of these malformations. Results A 28‐year‐old female with a history of infantile hemangiomas, polycystic ovary syndrome, and hyperprolactinemia presented with acne, mild hirsutism, and galactorrhea. Her neurological exam was normal. Magnetic Resonance Imaging (MRI) of the brain with and without contrast ruled out a prolactinoma but revealed a 3 cm vascular malformation at the margin of the left cavernous sinus extending posteriorly into the anterior left perimesencephalic cistern. Initial differentials included a pial arteriovenous malformation or less likely a dural arteriovenous fistula. She underwent a diagnostic cerebral angiogram which revealed a pure arterial malformation without arteriovenous shunting. This was composed of dysplasia of the left posterior communicating artery and anterior choroidal arteries. Stenosis of the left internal carotid artery distally with collateral support into the left anterior cerebral artery and middle cerebral artery was also noted. Lesser changes were noted in the right side with reconstitution of the right anterior cerebral artery from collaterals. Genetic testing for vascular malformation syndromes, including genes known to be associated with hereditary hemorrhagic telangiectasia, was negative. Repeat MRI/MRA done 8 months from the initial scan was stable with no abnormal large arterial venous shunting or definite saccular aneurysm formation noted. Conclusions Although rare, pure arterial malformations should be considered in the differential diagnosis for patients presenting with a cranial vascular malformation. Management of these lesions is usually conservative given their lack of arteriovenous shunting and low risk of rupture, with only a few cases undergoing surgery or endovascular treatment.

Abstract Number ‐ 197: A Single‐Center, 23‐Year Experience with the MAGIC Catheter for Pediatric AVM

Introduction The MAGIC Catheter (Balt, Montmorency, France) is a commonly used flow‐directed microcatheter for neuro‐interventions. Despite the MAGIC catheter not having FDA approval for use in pediatric and neonatal populations, our institution has used this catheter off‐label for numerous cases of pediatric arteriovenous malformation (AVM), vein of Galen malformation (VOGM), dural arteriovenous fistula (dAVF), and pial AVF (pAVF). Herein, we outline our practice’s experience with the MAGIC catheter for pediatrics. Methods We reviewed our institutional, quality‐control database for all cases of pediatric, vascular malformation that utilized the MAGIC catheter since its original use in pediatrics at our practice (March 1999) and July 2022. We describe the disease and demographic characteristics of this cohort, frequency of MAGIC catheter use, adjunct supplies, complications, smallest vessels catheterized, and clinical outcomes. Results Over the review period, 99 pediatric patients with AVM(45), VOGM(49), dAVF(3), and pAVF(2) were identified for detailed review. This cohort has collectively undergone 194 procedures. The average age at first procedure with the MAGIC catheter was 4.42 years with a wide variation (SD: 4.56; Range: 0–17.64). The majority of cases using the MAGIC catheter were cerebral angiograms with embolization (190 – 97.9%), though occasionally it was employed for angiography alone (4 – 2.1%). A 4‐Fr Berenstein Catheter was the most common adjunct catheter used during the study period (156/194; 80.4%), though the 5‐Fr Envoy appeared often as well (30/194; 15.5%). Every embolization in the series led to interval‐decrease or cure of the malformation, though five intraprocedural complications were noted in the form of transient decrease neuromonitoring evoked potentials, epidural hematoma due to vessel perforation, and three cases of vessel perforation without long‐term consequence. Periprocedural complications occurred in one patient involving an intraventricular hemorrhage requiring a ventriculoperitoneal shunt. The most common liquid embolic agent used with the MAGIC catheter was nBCA (179/190; 94.2%) with occasional use of Onyx 18, Fibered Coils, Surgi‐Flo, STS, and Ethanol. Of the 67 patients who had a follow‐up available for review, 30 (44.8%) are neurologically intact and clinically well, 19(28.4%) are clinically well with mild symptoms (mild autism spectrum disorder, mild hemiparesis, headaches, mild weakness, post‐hemorrhage/stroke excellent recovery), 9 (13.4%)have experienced moderate to severe symptoms (limb weakness, cranial neuropathies, cognitive delay/deficit, inability to ambulate, seizures), 3 (4.5%) have passed away, and 6 (9.0%) have been lost to follow‐up. Selective catheterization of small vessels was performed among the anterior choroidal, thalamoperforator, posterior choroidal, middle meningeal arteries and superior cerebellar, posterior cerebral, and deep external/internal carotid artery branches, and many others by the MAGIC microcatheter for contrast injection or delivery of embolic agents. Conclusions Flow‐directed microcatheters are a quintessential tool used in the endovascular treatment of cerebrovascular diseases, but few have regulatory approval for use in pediatric populations. The off‐label use of the MAGIC microcatheter has been shown to be safe and effective in pediatric embolization procedures. However, there still remains a technology gap in the development of flow‐directed catheters specifically designed and proportioned for use in pediatric patients.

Abstract Number ‐ 85: Distal Anterior Choroidal Artery Fusiform Aneurysm Successfully Treated with Flow Diversion

Introduction Anterior choroidal artery (AChA) aneurysms account for 3–5% of intracranial aneurysms, and are often saccular, arising at or near the origin of the AChA, with distal lesions being exceedingly rare. Contrary to saccular aneurysms, fusiform aneurysms are associated with a higher risk of rebleeding and mortality due to their formidable anatomy requiring advanced techniques including bypass, stent‐assisted coiling, and, more recently, flow diversion. While flow diverters are becoming more popular, they are currently only approved forinternal carotid artery segment aneurysms. However, many institutions areexpanding their use to more distal and smaller caliber vessels. Herein we present a novel pathology of a dissecting distal AChA fusiform pseudoaneurysm with a small vessel caliber treated successfully with flow diversion. Methods Case presentation and surgical technique. Results We describe a 40‐year‐old woman with monoclonal gammopathy of unknown significance (MGUS), lichen sclerosis, and an unspecified connective tissue disease presenting with diffuse subarachnoid hemorrhage (SAH) (World Federation of Neurosurgical Societies 1; Hunt &amp; Hess scale 2; Modified Fisher Scale 3). A digital subtraction cerebral angiogram revealed a dissecting (5×3 mm) left AChA pseudoaneurysm, 4mm distal to the origin (Figure 1). Flow Redirection Endoluminal Device (FRED Jr, Microvention, CA) (2.5mm 8/13 working/total length) was deployed within the vessel proximal to the aneurysm, preceded by an infusion of 5mg of verapamil to facilitate stent placement (Figure 2). Post procedure, she remained neurologically intact and was discharged on dual antiplatelet therapy (aspirin/ticagrelor). Repeat cerebral angiogram at six months showed patent flow diversion device and no pseudoaneurysm remnant (Figure 3) with a nonfocal physical examination. Conclusions Flow diversion may be a successful, and safe, therapeutic intervention for challenging distal intracranial aneurysms with smaller caliber vessels.

Parent artery occlusion for ruptured aneurysms in moyamoya vessels or on collaterals.

Aneurysms in moyamoya vessels or on collaterals are difficult to treat. Parent artery occlusion (PAO) via endovascular treatment (EVT) is often the last resort, but the safety and efficacy of this approach need to be evaluated. A retrospective study was performed on patients admitted to our hospital who were diagnosed with unilateral or bilateral moyamoya disease (MMD) associated with ruptured aneurysms in moyamoya vessels or on collaterals. These aneurysms were treated with PAO, and the clinical outcome was recorded. Eleven patients were aged 54.7 ± 10.4 years, and six patients were male (54.5%, 6/11). The aneurysms in 11 patients were single and ruptured, and the average size was 2.7 ± 0.6 mm. Three (27.3%, 3/11) aneurysms were located at the distal anterior choroidal artery, 3 (27.3%, 3/11) were at the distal lenticulostriate artery, 3 (27.3%, 3/11) were at the P2-3 segment of the posterior cerebral artery, 1 (9.1%, 1/11) was at the P4-5 segment of the posterior cerebral artery, and 1 was at the transdural location of the middle meningeal artery. Among the 11 aneurysms, PAO by coiling was performed on 7 (63.6%, 7/11), and Onyx casting was performed on 4 (36.4%, 4/11). Of 11 patients, 2 (18.2%, 2/11) suffered intraoperative hemorrhagic complications. During follow-up, all patients had good outcomes with a modified Rankin scale score of 0-2. As a last resort, the application of PAO with coiling or casting Onyx for ruptured aneurysms in moyamoya vessels or on collaterals may be safe with an acceptable clinical outcome. However, patients with MMD may not always achieve expected health outcomes, and PAO for the aneurysm can bring only temporary relief.

Efficacy of intraoperative neuromonitoring (IONM) and intraoperative indocyanine green videoangiography (ICG-VA) during unruptured anterior choroidal artery aneurysm clipping surgery.

The aim of this study was to investigate the efficacy of intraoperative indocyanine green videoangiography (ICG-VA) and intraoperative neuromonitoring (IONM) to prevent postoperative ischemic complications during microsurgical clipping of unruptured anterior choroidal artery (AChA) aneurysms. We retrospectively reviewed the clinical and radiological records of all patients who had undergone microsurgical clipping for unruptured AChA aneurysms at our institution between April 2001 and December 2019. We compared the postoperative complication rate of the group for which intraoperative ICG-VA and IONM were utilized (group B; n=324) with that of the group for which intraoperative ICG-VA and IONM were not utilized (group A; n=72). There were no statistically significant differences in demographic data between the two groups. Statistically significant differences were observed in the rate of overall complications (p=0.014) and postoperative ischemic complications related to AChA territory (p=0.039). All the cases (n=4) in group B who had postoperative infarctions related to AChA territory showed false-negative results of intraoperative ICG-VA and IONM. Preserving the patency of the AChA is essential to minimize postoperative complications. Intraoperative monitoring tools including ICG-VA and IONM can greatly contribute to lowering complication rates. However, their pitfalls and false-negative results should always be considered.

Three-Dimensional Maps of the Anterior Choroidal Artery Territory.

HomeStrokeVol. 54, No. 3Three-Dimensional Maps of the Anterior Choroidal Artery Territory No AccessCase ReportRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialNo AccessCase ReportRequest AccessFull TextThree-Dimensional Maps of the Anterior Choroidal Artery Territory Daniel Antoniello, MD, Neil R. Patel, MD and Sally S. Ladsaria, MD Daniel AntonielloDaniel Antoniello Correspondence to: Daniel Antoniello, MD, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E. 210th St, Bronx, New York 10467. Email E-mail Address: [email protected] https://orcid.org/0000-0002-4680-7948 Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY. Search for more papers by this author , Neil R. PatelNeil R. Patel Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY. Search for more papers by this author and Sally S. LadsariaSally S. Ladsaria Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY. Search for more papers by this author Originally published19 Jan 2023https://doi.org/10.1161/STROKEAHA.122.042011Stroke. 2023;54:e73–e74"Three-Dimensional Maps of the Anterior Choroidal Artery Territory." Stroke, 54(3), pp. e73–e74FootnotesSupplemental Material is available at https://www.ahajournals.org/doi/suppl/10.1161/STROKEAHA.122.042011.For Sources of Funding and Disclosures, see page e74.Correspondence to: Daniel Antoniello, MD, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E. 210th St, Bronx, New York 10467. Email [email protected]org

Arterial Supply of the Basal Ganglia: A Fiber Dissection Study.

The basal ganglia, a group of subcortical nuclei located deep in the insular cortex, are responsible for many functions such as motor learning, emotion, and behavior control. Nowadays, because it has been shown that deep brain stimulation and insular tumor surgery can be performed by endovascular treatment, the importance of the vascular anatomy of the basal ganglia is being increasingly recognized. To explain the arterial blood supply of the basal ganglia using white matter dissection. The Klingler protocol was used to prepare 12 silicone-injected human hemispheres. The dissections were performed from lateral to medial with the fiber dissection technique to preserve arteries. The globus pallidus blood supply came from the medial lenticulostriate, lateral lenticulostriate, and anterior choroidal arteries; the substantia nigra and subthalamic nucleus were supplied by the branches of posterior cerebral artery; the putamen was supplied by the lateral and medial lenticulostriate arteries; and the caudate nucleus was supplied by the lateral lenticulostriate and medial lenticulostriate arteries and the recurrent artery of Heubner. Knowledge of the detailed anatomy of the basal ganglia and its vascular supply is essential for avoiding postoperative ischemic complications in surgeries related to the insula. In addition, knowledge of this anatomy and vascular relationship opens the doors to endovascular deep brain stimulation treatment. This study provides a 3-dimensional understanding of the blood supply to the basal ganglia by examining it using the fiber dissection technique. Further studies could use advanced imaging modalities to explore the vascular relationships with critical structures in the brain.

Changes in Anterior Chamber Angle and Choroidal Thickness in Patients with Primary Angle-Closure Glaucoma after Phaco-Goniosynechialysis.

We aimed to observe changes in angle width and choroidal thickness (CT) before and after phacoemulsification intraocular lens implantation (PEI) combined with goniosynechialysis (GSL) in patients with primary angle-closure glaucoma (PACG) complicated by cataracts. This prospective cohort study included 60 patients with PACG complicated by cataracts from the Department of Ophthalmology of Shaoxing People’s Hospital, China. Patients underwent PEI combined with GSL (PEI-GSL group) or laser peripheral iridotomy (LPI) followed by PEI (PEI group). Intraocular pressure (IOP) and endothelial counts were significantly decreased in both groups after surgery, while best-corrected visual acuity and central anterior chamber depth were significantly increased. However, there were no significant differences between the two groups. The opening degrees of room corners at 12, 3, 6, and 9 o’clock were recorded as AA12, AA3, AA6, and AA9, respectively. Anterior chamber depth was significantly increased postoperatively compared to preoperatively in both groups, with no significant between-group differences (all ps > 0.05). At 1, 3, and 6 months postoperatively, the width at AA12, AA3, and AA9 points was higher in the PEI-GSL group than in the PEI group (all ps < 0.05). Significant between-group differences at AA6 were observed preoperatively (p = 0.023) and at 1 (p = 0.027) and 3 (p = 0.033) months postoperatively but not at 6 months postoperatively (p = 0.055). CT was smaller postoperatively than preoperatively (all ps < 0.001). The present study suggests that patients with PACG who underwent PEI with or without GSL had reduced IOP and CT after surgery.

Infundibular Widening of Angiographically Invisible Duplicate Anterior Choroidal Artery Mimicking Typical Anterior Choroidal Artery Aneurysm

A diagnosis of an intracranial aneurysm depends on the angiographic configuration and should be cautiously differentiated from aneurysm mimics. In cases of duplicate anterior choroidal arteries (AChAs), infundibular widening of the distal minor AChA can be an aneurysm mimic. If the minor AChA with a smaller diameter is obscured angiographically due to poor contrast filling, an associated infundibular widening beside the proximal large AChA can misinterpreted as a typical AChA aneurysm in angiograms. The authors report on two such cases of duplicate AChAs with infundibular widening presenting like a typical AChA aneurysm in angiograms. Surgical exploration revealed a perforating artery emitting from the dome of the saccular lesion, confirming infundibular widening of a duplicate AChA. No reparative procedure was applied to the infundibular widening in a 48-year-old man, while two vascular outpouchings from the infundibular widening were clipped preserving the duplicate AChA in a 55-year-old woman.

Microanatomical study of the posterior medial choroidal artery

Introduction/Objective. The aim of this study was a detailed examination of microanatomy of the medial posterior choroidal artery (MPChA). Methods. The microanatomical characteristics of the MPChA were studied in 30 formalin fixed brain hemispheres using 6.3?10 ? magnification of the stereoscopic microscope. The arteries were injected with the mixture of 10% India ink and gelatin. The second group of 10 hemispheres consisted of specimens injected with methyl methacrylate fluid into the cerebral arterial vessels, for the preparation of corrosion casts. Results. The MPChA was present in all 30 hemispheres, always as the single artery. The MPChA were divided into proximal and distal types of vessels. We distinguished two segments of the MPChA: a cisternal and plexal. Proximal MPChA was present in 53.3% of cases, with the caliber of 0.6?1 mm (mean 0.8 mm). ?he point of its origin from the posterior cerebral artery was always before the origin of the first temporal cortical branch. Distal MPChA existed in 46.7% of cases, with the diameter of 0.4?1 (mean 0.74 mm). The cisternal segment the most frequently gave of the origin of fine branches to the cerebral crus, medial geniculate body and thalamus. The plexal segment gave rise arteries to the thalamus, and choroid branches for the supply of the choroid plexus of the third ventricle. Anastomoses in the region of the MPChA were found in all of 20 examined brains, most often among the plexal branches. Conclusion. The results describing the microanatomical characteristics of the MPChA may have diagnostic and microsurgical significance.