Branch Of Superior Cerebellar Artery Research Articles

Collateral circulation pathway in patients with basilar artery occlusion/severe stenosis: a single-center case series

Objective: To investigate the collateral circulation compensation model in patients with favorable prognosis of basilar artery occlusion/severe stenosis treated with drugs or endovascular therapy. Methods: Clinical data of patients with basilar artery occlusion/severe stenosis and good clinical outcome were retrospectively collected in the Department of Neurology, Sixth Medical Center of PLA General Hospital from January 2019 to January 2020. They were divided into intensive drug therapy group and combined endovascular therapy group. The number and ways of collateral compensation pathway described by digital substraction angiography (DSA) were analyzed, and the characteristics of the collateral compensation model were summarized. SPSS22.0 software was used for statistical analysis, and the constituent ratio (%) was used for statistical description of the enumeration data. Results: A total of 32 eligible patients were included, including 27 males and 5 females, with an average age 45-76 (59±10) years. The compensation model included posterior communicating artery-posterior cerebral artery (13 cases, 40.6%), posterior communicating artery-posterior cerebral artery-basilar artery (10 cases, 31.2%), cerebellar artery-anastomotic branches of superior cerebellar artery (8 cases, 25.0%), anterior choroid artery-anastomotic branches of posterior choroid artery (2 cases, 6.2%), collateral circulation not established (11 cases, 34.4%).In drug treatment group, collateral compensation was found in the majority (14/15), with mainly posterior communicating artery (10/14).Most patients in combined treatment group did not develop collateral compensation (10/17), anastomotic branches of PICA-SCA were the main routes (6/7). Conclusion: In patients with basilar artery occlusion/severe stenosis, favorable clinical outcome can be achieved in both groups of patients treated with intensive drug therapy or endovascular therapy.

Dissection‐Based Investigation of Variations in Major Gross Arterial Supply to the Trigeminal Ganglion

Introduction & Objective The trigeminal nerve (CN V) primarily conveys afferent sensory input from the anterolateral aspect of the face and scalp via its three main branches – the ophthalmic nerve (CN V1), maxillary nerve (CN V2), and mandibular nerve (CN V3). The 20,000-35,000 primary afferent pseudounipolar neurons of CN V1-3 converge at the trigeminal ganglion (TG) where the neurons’ cell bodies are positioned. The TG is located in Meckel's cave (cavum trigeminale), an intracranial area along the sphenoid bone deep to the meningeal layer of dura mater just anterior to the petrous apex. Four main arterial sources have been reported to perfuse the TG – the accessory meningeal artery (AMA), a branch of middle meningeal artery (MMA), a branch of internal carotid artery (ICA), and a tentorial branch of the superior cerebellar artery (SCA). The reported rate for each potential arterial supply remains variable. The objective of this study was to identify the arterial source of the TG via human cadaveric dissection and quantify the rate of occurrence. Materials & Methods Right and left trigeminal ganglia were examined on 29 embalmed human cadavers. Origins of gross arterial supply traversing the deep surface of the ganglia were identified and recorded. Arterial supply was photographed (iPad Pro, Apple Inc.) and image color contrast was utilized to aide structure identification (Adobe Photoshop 20.0.9). TG tissue samples including the major vessel(s) were collected, paraffin embedded, sectioned at 5 μm, and stained with hematoxylin and eosin (H&E). Major arteries and normal microvasculature were verified with light microscopy (Zeiss Axioskop, Model 45 14 85) and photographed (AmScope Digital Camera, Model MU1003). Results Blood supply to 28 TG was inconclusive due to compromised vessel integrity from a previous course dissection. Of the remaining 30 TG, 56.6% were supplied by a branch of ICA, 16.7% by AMA, and 10.0% by a branch of MMA. No TG were supplied by the tentorial branch of SCA. Anastomotic connections were discovered between MMA/ICA and AMA/ICA for 10.0% and 6.7% of TG supply, respectively. Three of the five AMAs were noted to course through separate foramen in the basicranium instead of the foramen ovale as expected. H&E histological examination confirmed artery structure and verified expected arteriole and capillary microvasculature throughout the TG. Conclusions & Significance In both exclusive and anastomotic form, the majority of TG arterial supply originated from the ICA. Supply from the AMA, MMA, and SCA occurred less often but still merit significance. The results of this study reflect known rates of TG arterial supply. Gross imaging from this study may supply medical educators with new resources to facilitate TG dissection in gross dissection laboratories and may also provide diagnosticians and cardiovascular surgeons with better understanding of TG arterial supply variations that could benefit diagnosis, surgical approaches, and outcomes. In case of blockage, stenosis, or ligation, anastomotic supply would provide anatomical insurance to the TG but warrants further study.

Lesion Patterns and Etiology of Ischemia in Superior Cerebellar Artery Territory Infarcts

Background and Purpose: Infarcts in the territory of superior cerebellar artery (SCA) are uncommon. The clinical, and etiological mechanisms of different infarct patterns of SCA are not well known. Diffusion-weighted imaging (DWI) is superior to conventional magnetic resonance imaging for detecting acute small and multiple ischemic lesions. Methods: We studied 60 patients with lesions involving SCA territory proved by DWI, which have been selected from 3,800 patients with first ischemic stroke consecutively admitted to our stroke unit over a period of 5 years. Results: There are 7 distinctive SCA lesion patterns: (1) a lesion was found in the medial (m) branch territory of SCA (mSCA) in 14 patients; (2) a lesion in the lateral (l) branch territory of SCA (lSCA) was seen in 9 patients; (3) a coexisting lesion involving mSCA and lSCA was found in 9 patients; (4) a lesion in cortical borderzones between SCA and m/l branches of the posterior inferior cerebellar artery (PICA) was observed in 6 patients; (5) a lesion in deep borderzones between lSCA and mSCA, and lPICA and mPICA was present in 8 patients; (6) a lesion involving the medial rostral cerebellum between the right and left SCA was found in 4 patients; (7) multiple lesions involving SCA and other vertebrobasilar artery territories were present in 10 patients. The main cause was possible artery-to-artery embolism from atherosclerotic vertebrobasilar arteries to distal branches of SCA in 20 patients (33%). Fourteen patients had a source of cardioembolism (23%), and 6 patients (8%) had concomitant atherosclerotic vertebrobasilar artery disease and a source of cardioembolism. Conclusions: An acute ischemic lesion in the SCA territory is mainly multiple. The lSCA territory was the most involved area. Small territorial infarcts were frequently associated with large territorial SCA infarcts. Borderzone SCA infarcts occurred in one third of the patients with transient benign symptoms. Mass effects are unusual despite the large amount of SCA involvement. Our results supported the fact that embolism is the predominant stroke mechanism in the SCA territory infarction.