Parietal Branch Research Articles

Drainage of the scalp by the superficial temporal vein: surgical implications

The arrangement of the veins of the scalp is not well-known. The drainage of the scalp by the superficial temporal v. was studied in 68 specimens dissected from unembalmed cadavers. After prolonged contraflow irrigation, the whole of the venous network drained by the trunk of the superficial temporal v. was injected from either side with latex. Depending on the method chosen to demonstrate the venous network, whether by direct observation or corrosion, the latex was stained with Evans' blue or with Latexol. The superficial temporal a. was also prepared by injection-corrosion in 16 cases. The diameter of the trunk of the superficial temporal v. in its preauricular portion was estimated as between 1.1 and 1.6 mm. Nine different types, classified by frequency, were recognised in the arrangement of the affluents of the superficial temporal v. In every case there was a main parietotemporal collector continued as the trunk of the superficial temporal v. The affluents joining the main collector varied in number (from 8 to 1) and in arrangement. Their anastomoses with the veins adjacent to the superficial temporal v. were numerous. The density of the secondary branches varied greatly with individuals. They were sometimes totally absent, particularly in the fronto-temporal region. Usually, the main collector was of sufficient caliber for microsurgical use and its course followed that of the parietal branch of the superficial temporal a., but in 4% of cases the main collector was too narrow to be so used and in 8% of cases its course did not follow that of the parietal branch of the superficial temporal a.(ABSTRACT TRUNCATED AT 250 WORDS)

Late Bleeding after Rhytidectomy from Injury to the Superficial Temporal Vessels

Five healthy, normotensive women, whose mean age was 49.8 years, developed expanding hematomas between 8 and 10 days (average 9 days) after rhytidectomy. In each patient, the bleeding vessel could be identified: In two, it was the parietal branch of the superficial temporal artery; in two, it was the parietal branch of the superficial temporal vein; and in one, it was the superficial temporal artery immediately before its branching. Contributing factors may have been sudden physical exertion in four of the five patients and in another salicylate ingestion. Several measures can help avoid late bleeding from the superficial temporal vessels or their branches; not using a too potent vasoconstrictive agent (epinephrine) in the local anesthetic so that the vessels will be easier to visualize; not injecting the local anesthetic too deeply or incising to deeply; dividing and ligating the superficial temporal vessel and its major branches if injured; using bipolar coagulation on small branches; and instructing patients repeatedly not to engage in strenuous activity or to ingest salicylates for at least 2 weeks after operation.

Modification of acute focal ischemia in rabbits by poloxamer 188.

We studied the effect of a synthetic copolymer surfactant, poloxamer 188, on cerebral blood flow in a rabbit model of focal cerebral ischemia. Following retro-orbital craniectomy, the parietal branch of the middle cerebral artery was occluded with bipolar current. Cerebral blood flow was measured by the hydrogen clearance technique using platinum-iridium electrodes placed within the parietal cortex. Ten rabbits were infused with 50 mg/kg poloxamer 188 in saline beginning 30 minutes after occlusion; 12 control rabbits received an equal volume of saline. Poloxamer 188 increased blood flow significantly in areas of severe or moderate ischemia but had little effect in areas with mild or no ischemia. The improvement in blood flow could not be accounted for by hemodilution, and the copolymer did not affect blood viscosity at any shear rate from 1 to 100 sec-1. We hypothesize that poloxamer 188 increases circulation in ischemic tissue by inhibiting adhesive interactions among proteins (fibrin and fibrinogen) and cells in the microcirculation.

Ischemic cortical lesions after permanent occlusion of individual middle cerebral artery branches in rats.

Our study describes the anatomy of the middle cerebral artery (MCA) in 65 Sprague-Dawley rats and the spatial distribution of ischemic cortical lesions caused by occluding major MCA branches. The rats characteristically had at least two major MCA branches, frontal and parietal. Many rats had additional branches supplying the pyriform and temporal cortexes. Permanent occlusion of the frontal or parietal branches combined with 30 minutes of bilateral carotid artery occlusion produced visible Evans blue dye uptake by ischemic cortical areas after 24 hours. No lesions distal to the occlusion were apparent in 38% and 43% of rats with frontal and parietal branch occlusions, respectively; small lesions contiguous with the occlusion site were observed in 38% and 32% of the rats. Only 6% of the frontal and 7% of the parietal branch occlusions produced isolated distal infarcts as expected if these branches were end-arteries. Blood flow was reversed in arteries distal to the occlusion. We conclude that extensive collateral connections of the frontal and parietal MCA branches with other arterial systems protect the anterior and posterior cortical regions. In contrast, occlusions of the pyriform branch of the MCA invariably caused infarcts in the frontopyriform region. In about one third of the rats, frontal or parietal branch occlusions produced lesions involving much of the proximal MCA territory; the frontopyriform region was most consistently affected. Combined, these data suggest that the pyriform MCA branch is an end-artery and that the cortical region it supplies is prone to ischemic damage resulting from any reduction of blood flow through the main MCA trunk.(ABSTRACT TRUNCATED AT 250 WORDS)

Anatomical study of the superficial temporal artery.

Fifty consecutive human autopsy specimens were studied to determine the suitability of the superficial temporal artery (STA) for use in microvascular anastomoses. Ten variations of the STA were found. The STA at the zygoma averaged 2.2 mm in outside diameter. The STA averaged 31.7 mm from the zygoma to its bifurcation, where the average outside diameter was 1.9 mm. Eight per cent of the specimens had no bifurcation, and 92% had at least one branch in a frontal or parietal distribution that was greater than or equal to 1 mm. A suitable frontal branch (i.e., greater than or equal to 1 mm in diameter and greater than or equal to 70 mm in length) was found in 90% of the specimens, and a suitable parietal branch was found in 71%. Six specimens (12%) had an additional branch, all of which were of suitable length and diameter. Eight per cent of the specimens lacked a vessel suitable for microvascular anastomosis.

Vasomotor nerve control of isolated arteries and veins.

In order to compare neuro-effector function in different blood vessels, frequency-response relationships were determined for the following preparations: 1)Isolated rings of the proximal saphenous, distal saphenous and ear arteries, the parietal branch of the internal iliac vein and the small saphenous vein from the rabbit, 2) spiral strips of the rabbit pulmonary artery and 3) longitudinal preparations of the rat portal vein. In each rabbit tissue only one low (less than or equal to 4 Hz) and one high (larger than or equal to 8 Hz) transmural nerve stimulation frequency was applied until steady state responses were obtained and these were expressed as a percentage of a maximum response to exogenous noradrenaline (NA) applied in each experiment. The general shape of the frequency-response curves was similar, but differences in steepness and amplitude of the maximum neurogenic response relative to exogenous NA were found. The steepness of the frequency-response relationships of the veins tended to be greater than those of the arteries. It appears that factors such as close neuro-muscular contacts, presence of terminal nerve fibres within the media and the operation of mechanisms for myogenic propagation of activity contribute to the effectiveness of neurogenic vascular control as revealed by frequency-response curves. In vivo, geometrical factors can greatly augment the hemodynamic significance of the observed differences.

The effect of "ouabain" on the ultrastructure of cerebral arterioles and surrounding tissue, studied by a cannulation of a cerebral artery.

A technique for cannulation of a parietal branch of the middle cerebral artery is described by which high but local concentrations of substances can be achieved in cortical vessels. Using this technique it was shown that ouabain, a specific inhibitor of the Na+-K+-ATPase enzyme system, can produce alterations in the blood brain barrier (BBB) permeability as seen by the passage of Evans Blue into cortical tissue. Electron microscopy revealed changes in the endothelium of cerebral arterioles ranging from an increase in the number of vesicles and vacuoles to complete breakdown of cytoplasm and membranes. Swelling of the peri-arteriolar end feet of protoplasmic astroglia and of dendrites was characteristic of tissue surrounding affected arterioles. Swollen fibrous astrocytes, oligodendrocytes and microglia were not seen even in areas of vasogenic edema. These results are discussed in terms of current ideas of the BBB and astroglial function.

Warfarin-induced hypoprothrombinemia. Potentiation by hyperthyroidism

HYPERTHYROIDISM has been reported to enhance the anticoagulant response to warfarin sodium.^1,2We believe that the following case of increased sensitivity to warfarin was caused primarily by the patient's hyperthyroid state. <h3>Report of a Case</h3> A 53-year-old diabetic woman was admitted to the City of Memphis Hospitals in March 1974 for right hemiparesis and aphasia that had occurred the day before admission. She had a palpable 3×5-cm nodule in the right lobe of the thyroid. On the first hospital day, the patient went into atrial fibrillation with a rapid ventricular rate for which she was digitalized. Cerebral arteriogram showed occlusion of the posterior parietal branch of the left middle cerebral artery. Heparin sodium therapy was begun on the second hospital day. On the sixth hospital day, warfarin sodium therapy, 7.5 mg daily, was started, and after three days, prothrombin time (PT) increased from 13.7 seconds (control, 11.0) to 35.2

Warfarin-Induced Hypoprothrombinemia

HYPERTHYROIDISM has been reported to enhance the anticoagulant response to warfarin sodium.^1,2We believe that the following case of increased sensitivity to warfarin was caused primarily by the patient's hyperthyroid state. <h3>Report of a Case</h3> A 53-year-old diabetic woman was admitted to the City of Memphis Hospitals in March 1974 for right hemiparesis and aphasia that had occurred the day before admission. She had a palpable 3×5-cm nodule in the right lobe of the thyroid. On the first hospital day, the patient went into atrial fibrillation with a rapid ventricular rate for which she was digitalized. Cerebral arteriogram showed occlusion of the posterior parietal branch of the left middle cerebral artery. Heparin sodium therapy was begun on the second hospital day. On the sixth hospital day, warfarin sodium therapy, 7.5 mg daily, was started, and after three days, prothrombin time (PT) increased from 13.7 seconds (control, 11.0) to 35.2

Norepinephrine uptake, smooth muscle sensitivity, and metabolizing enzyme activity in rabbit veins.

Some parameters of the adrenergic neuroeffector mechanism were measured in vitro in the central ear (near the base of the ear), common jugular, pulmonary, brachial, femoral, renal, superficial cervical, cephalic, and small saphenous veins, a branch of the deep circumflex iliac vein, the parietal branch of the internal iliac vein, branches of the anterior mesenteric vein, the inferior vena cava (immediately distal to the left renal vein), and a subcutaneous vein of the back. Although extraneuronal uptake of 3 H-norepinephrine was the same in all of the veins except the mesenteric, the neuronal uptake of norepinephrine varied widely. A number of veins, including the femoral and superficial cervical veins, showed no neuronal uptake, and the uptake of others, including the cephalic and mesenteric veins, was greater than that measured in any previously studied vascular tissue. The median effective dose for the contractile effect of norepinephrine on the veins was on the same order of magnitude as that for the aorta and the ear artery. Catechol-O-methyl transferase, but not monoamine oxidase, activity appeared to be related to innervation density. It is concluded that veins show a remarkable variation in the dimensions of their adrenergic parameters, particularly those related to innervation density.

Innervation pattern and neurogenic response of rabbit veins.

The adrenergic neuroeffector mechanism has been assessed in 14 different veins of the rabbit chosen to represent vessels of different, function and regional location. The pattern, distribution and density of the adrenergic innervation were assessed by fluorescence histochemistry. The magnitude of the neurogenic contractile response of isolated segments was studied &lt;i&gt;in vitro&lt;/i&gt; in relation to the maximum response to &lt;i&gt;1&lt;/i&gt;-norepinephrine. The diameter and wall thickness of the veins was determined. The amount of adrenergic innervation determined histochemically was related to the size of the contractile response. Both fluorescence and response were absent in the superficial cervical, femoral, subcutaneous from back, brachial and deep circumflex iliac branch veins. The amount of adrenergic innervation increased in order in the renal, inferior vena cava, pulmonary, jugular, parietal branch of internal iliac, mesenteric, central ear, cephalic and small saphenous veins. In the latter two veins, innervation was not restricted to the adventitio-medial junction but entered the media. The pattern of innervation and contractile response may be related to the functional need for active venoconstriction in the various parts of the capacitance section of the vascular system.

Postnatal development of coronary arteries in the rat.

135 successful injections of the coronary arteries in the rat (Wistar-stains, Konarovice and Zurich-breeds) were examined over the period from pn 2 (pn = day of development after birth—post natum) to adult. 1. From pn 4 on the branches supplying that part of the atrial wall close to the atrioventricular sulcus were observed. At the same time the branch of the right coronary artery supplying the interactrial septum was found to be developed. 2. In the adult rat the branches for the conus pulmonalis come regularly (in 100% of cases) from the right coronary artery; sometimes (in 66%) an additional branch derives from the left coronary artery. 3. From pn 1 anastomoses between the septal branches and from pn 2 anastomoses between the parietal branches are developed. Beginning in the upper part of the interventricular septum, then coming to the heart bulbus and down to the apex region and at last in the dorsal wall of the heart. 4. The development of the coronary bed in the rat is in general closed at stage pn 12.

Blood Sampling From Scalp Arteries in Infants

Frequent measurements of arterial blood oxygen tension are necessary in order to regulate the amount of environmental oxygen needed by infants with cardiopulmonary disease.1 In 1964, Thomsen2 described a technique for intermittent sampling of arterial blood from the temporal artery of small infants. Since we have successfully used a modification of her method during the past 6½ years, we thought it useful to describe our procedure and our experience with it. Technique For sampling, we insert a needle into the lumen of the frontal or parietal branch of the superficial temporal artery which we located by palpation. We try to perform the puncture when the infant is in a "steady state," by which we mean that breathing is regular, the infant is not agitated, and the concentration of inspired oxygen has been constant for at least 15 minutes.

Delayed arterial spasm and thrombosis as a cause of post-traumatic hemiplegia (spate thrombosis).

The case of a Marine in whom a vertex epidural hematoma developed, depressing the superior sagittal sinus as a result of a fracture of the vertex of the skull, is presented. The hematoma was removed, and the patient did well until signs of progressive right hemiparesis suddenly developed two days after the hematoma removal. Serial carotid angiography demonstrated the interval development of spaism of the left internal carotid, anterior cerebral and middle cerebral arteries, and occlusion of the posterior parietal branch of the left middle cerebral artery. Prior to the development of the arterial spasm an earlier angiogram had shown these vessels to be of normal diameter. This delayed or "spate" spasm and thrombosis of major intracranial vessels is a rare but serious complication of head injuries. In addition to the usual causes of post-traumatic hemiplegias, this vascular spasm or thrombosis should be suspected in patients in whom progressive neurological signs develop after head injuries.

Occlusion of Small Intracranial Arteries as a Cause of Stroke

A patient with an acute stroke had Gerstmann's syndrome. Cerebral angiography disclosed occlusion of the posterior parietal branch of the middle cerebral artery. The patient has remained physically well over a three-year period with only slight residual impairment in the intellectual spheres. Intracranial occlusions of smaller arterial branches can be diagnosed by cerebral angiography and occlusions of isolated branches give rise to characteristic clinical findings.

Unilateral suppression of vertex sharp waves in the sleep electroencephalogram (case report)

A 15-year-old boy suffered a cerebrovascular accident with left-sided hemiplegia. The EEG showed right-sided suppression of vertex sharp waves during sleep. The posterior parietal and angular gyrus branches of the right middle cerebral artery were shown to be occluded by carotid arteriography.

Continuous intra-arterial infusion of the pelvis via the superior gluteal artery

A method of insertion of a catheter into the hypogastric artery from one of its parietal branches (superior gluteal artery) is described. The advantages of this approach are listed.

Roentgen Manifestations of Arteriosclerosis of the Branches of the Abdominal Aorta

MUCH has been written about calcification of the walls of the abdominal aorta and every roentgenologist has numerous opportunities to see calcified plaques in this location. Calcification of individual arterial branches of the aorta has been described less frequently and there have been occasional reports of aneurysms of the splenic and renal arteries with calcified walls. Practically nothing appears in the current roentgen literature, however, concerning mass calcification of a group of arteries, such as the branches of the coeliac axis, with the production of confusing shadows overlying the left upper quadrant. The distinction between simple arteriosclerotic calcification of the arterial wall and aneurysm is usually not clear. It is the purpose of the present paper to show how varied the roentgen picture may be, and to suggest the means by which a correct diagnosis may be made. The visceral branches of the abdominal aorta are as follows: (1) a single coeliac axis arising at the level of the dorsolumbar junction immediately below the aortic hiatus of the diaphragm: this trunk is very short, 1.0–1.5 em. in length, dividing to form the left gastric, the hepatic, and the splenic arteries; (2) superior mesenteric, a single vessel arising 1.2 ern. below the coeliac axis, serving all the small intestine and the proximal half of the colon; (3) inferior mesenteric, a single vessel arising from the aorta anteriorly at the level of L-3, serving the rest of the colon and most of the rectum; (4) paired suprarenal arteries arising at the same level as the superior mesenteric; (5) paired renal arteries with short trunks which lie directly below the superior mesenteric, arising at the level of L-1, or L-2; (6) internal spermatic (or ovarian) arteries, paired slender vessels arising a short distance below the renal arteries, midway between the origin of the superior and inferior mesenteries, passing obliquely downward, resting on the psoas muscles, to reach the abdominal inguinal ring. There are also parietal branches, such as the four pairs of lumbars, and occasionally additional branches such as the paired inferior phrenics and a single middle sacral, but as calcification is not commonly observed in these, they will not be discussed further. Calcification has been observed most frequently in the branches of the coeliac axis. The shadows cast are diverse in character and are best shown by illustrative cases. In the following case presentations the plan has been to proceed from the most easily recognized examples to the more difficult, rather than to follow a chronological order. For convenience, the cases have been divided as follows: (1) Cases showing multiple ring or tubular shadows; (2) cases showing multiple crescentic or curvilinear shadows; (3) cases showing single ring, tubular, crescentic, or curvilinear shadows.