scholarly journals Microsurgical Anatomy of the Anterior Circulation of the Brain Adjusted to the Neurosurgeon’s Daily Practice

2021 ◽  
Vol 11 (4) ◽  
pp. 519
Author(s):  
Tomas Poblete ◽  
Daniel Casanova ◽  
Miguel Soto ◽  
Alvaro Campero ◽  
Jorge Mura
Keyword(s):  
Daily Practice ◽  
Computed Tomographic Angiography ◽  
Poor Quality ◽  
Surgical Anatomy ◽  
Microsurgical Anatomy ◽  
Anterior Circulation ◽  
Computed Tomographic ◽  
Intrinsic Complexity ◽  
Tomographic Angiography

The study of cerebrovascular anatomy can be difficult and may take time due to its intrinsic complexity. However, it can also be difficult for the following reasons: the excessive description of neuroanatomy making articles hard to read, the unclear clinical application of what is written, the use of simplified or intricate schematic drawings that are not always appropriate for effective teaching, the poor quality of neuroanatomy dissections and the use of unusual views of figures that are not strictly related to the most frequent neuroimages to be interpreted in daily practice. Because of this, we designed an article that incorporates original and accurate anatomical dissections in an attempt to improve its comprehensibility. Five formalin-fixed adult cadaveric heads, whose vessels were injected with a colored silicone mixture (red for arteries and blue for veins), were dissected and examined under a microscope with magnifications from 3× to 40×. Special emphasis has been placed on correlating topographic anatomy with routine neuroimaging studies from computed tomographic angiography (CTA) and digital subtraction angiography (DSA). The essential surgical anatomy in a neurosurgeon’s daily practice is also described. The cadaveric dissections included in this study contribute to the understanding of the cerebrovascular anatomy necessary for the neurosurgeon’s daily practice.

scholarly journals Comparison between ultra-high-resolution computed tomographic angiography and conventional computed tomographic angiography in the visualization of the subcallosal artery

2021 ◽  
Vol 12 ◽  
pp. 528
Author(s):  
Yoshimichi Sato ◽  
Toshiki Endo ◽  
Shingo Kayano ◽  
Hitoshi Nemoto ◽  
Kazuki Shimada ◽  
...  
Keyword(s):  
High Resolution ◽  
Evaluation Method ◽  
Computed Tomographic Angiography ◽  
Anterior Communicating Artery ◽  
Exact Test ◽  
Computed Tomographic ◽  
Small X ◽  
Tomographic Angiography ◽  
Better Than

Background: The subcallosal artery (ScA) is a single dominant artery arising from the anterior communicating artery. Its injury causes amnesia and cognitive disturbance. The conventional computed tomographic angiography (C-CTA) is a common evaluation method of the intracranial artery. However, to image tinny perforating arteries such as the ScA is technically demanding for C-CTA. The purpose of this study is to investigate whether the ultra-high-resolution CTA (UHR-CTA) could image the ScA better than C-CTA. UHR-CTA became available in clinical practice in 2017. Its novel features are the improvement of the detector system and a small X-ray focus. Methods: Between April 2019 and May 2020, 77 and 49 patients who underwent intracranial UHR-CTA and C-CTA, respectively, were enrolled in this study. Two board-certified neurosurgeons participated as observers to identify the ScA based on UHR-CTA and C-CTA images. Results: UHR-CTA and C-CTA detected the ScA in 56–58% and 30–40% of the patients, respectively. In visualization of the ScA, UHR-CTA was better than C-CTA (P < 0.05, Fisher’s exact test). Between the two observers, the Cohen’s kappa coefficient was 0.77 for UHR-CTA and 0.78 for C-CTA. Conclusions: UHR-CTA is a simple and accessible method to evaluate intracranial vasculature. Visualization of the ScA with UHR-CTA was better than that with C-CTA. The high quality of UHR-CTA could provide useful information in the neurosurgery field.

scholarly journals Appropriateness of pediatric CT utilization in clinical practice

2019 ◽  
pp. 4-17
Author(s):  
Panruethai Trinavarat ◽  
Nisanard Pisuchpen ◽  
Sasitorn Petcharunpaisan ◽  
Darintr Sosothikul ◽  
Jitladda Deerojanawong ◽  
...  
Keyword(s):  
Arterial Occlusion ◽  
Intravenous Thrombolysis ◽  
Computed Tomographic Angiography ◽  
P Value ◽  
Anterior Circulation ◽  
Independent Predictive Factor ◽  
Middle Cerebral Artery Infarction ◽  
Clinical Criteria ◽  
Computed Tomographic ◽  
Tomographic Angiography

Background: Cerebral collateral circulation is necessary to maintain cerebral blood flow and penumbra when arterial insufficiency occurred. Only a few studies about collateral status on development of malignant middle cerebral artery infarction (mMCAi) have been documented. Objective: To determine whether collateral status evaluated by single phase computed tomographic angiography (CTA) help prediction of mMCAi in patients with large arterial occlusion whom not received endovascular treatment. Material and Methods: We retrospectively reviewed patients with acute ischemic stroke in anterior circulation in our institute during January 2015 to December 2015. We analyzed clinical data, baseline National Institutes of Health Stroke Scale (NIHSS), Alberta Stroke Program Early CT Score (ASPECTS) on baseline nonenhanced computed tomography of the brain (NECT brain), and CTA collateral status. Malignant MCA infarction was defined according to clinical criteria. Results: Thirty-five patients were included. Mean age was 68.8±15.56 years. Mean baseline NIHSS and baseline ASPECTS were 17(±5) and 6(±3), respectively. All patients received intravenous thrombolysis. CTA collateral status and baseline NECT ASPECTS significantly correlated with development of mMCAi (P-value = 0.007 and 0.001). Only baseline NECT ASPECTS was an independent predictive factor for mMCAi (OR 0.63, 95%CI 0.46-0.86, P-value =0.004). Patients with baseline NECT ASPECTS ≤ 7 were more likely develop mMCAi (OR 14.29 95%CI 1.57-129.94, P-value 0.018). Conclusion: In acute stroke patients with proximal MCA or ICA occlusion received intravenous thrombolysis alone, baseline NECT ASPECTS and CTA collateral status were significantly correlate with development of mMCAi. However, only baseline ASPECTS ≤ 7 was an independent predictor for mMCAi.

Intraoperative Computed Tomographic Angiography in Cerebral Aneurysm Surgery

Neurosurgery ◽  
2010 ◽  
Vol 66 (2) ◽  
pp. 349-353 ◽  
Author(s):  
Shree Kumar Dinesh ◽  
John Thomas ◽  
Ivan Ng
Keyword(s):  
Cerebral Aneurysm ◽  
Arterial Occlusion ◽  
Computed Tomographic Angiography ◽  
Artery Occlusion ◽  
Aneurysm Surgery ◽  
Anterior Circulation ◽  
Computed Tomographic ◽  
Scale Scores ◽  
Tomographic Angiography ◽  
Cerebral Artery Occlusion

Abstract OBJECTIVE To assess the feasibility and potential utility of intraoperative computed tomographic angiography (iCTA) in identifying unexpected residual aneurysms and major cerebral artery occlusion after cerebral aneurysm surgery. METHODS We prospectively studied 6 consecutive patients with ruptured anterior circulation aneurysms who underwent craniotomy and clipping. iCTA was performed in all cases after the surgeon was satisfied that the aneurysm was completely obliterated and the clip did not occlude a major artery. We analyzed the iCTA images with regard to residual aneurysm and major arterial occlusion and compared them with the postoperatively acquired angiographic images, which served as a control. Patient age and sex, aneurysm location and size, clinical presentation after rupture, and postoperative course, as well as postoperative modified Rankin Scale scores, were also recorded. RESULTS One of the 6 patients had a residual aneurysm detected on the iCTA images, and it was confirmed on the immediate postoperative digital subtraction angiography. There were no cases of major arterial occlusion on iCTA imaging or postoperatively acquired angiographic imaging. CONCLUSION iCTA is both feasible and potentially useful in identifying unexpected residual aneurysms and major arterial occlusion after surgical clipping of aneurysms.

scholarly journals Collateral Status on Baseline Computed Tomographic Angiography and Intra-Arterial Treatment Effect in Patients With Proximal Anterior Circulation Stroke

Stroke ◽  
2016 ◽  
Vol 47 (3) ◽  
pp. 768-776 ◽  
Author(s):  
Olvert A. Berkhemer ◽  
Ivo G.H. Jansen ◽  
Debbie Beumer ◽  
Puck S.S. Fransen ◽  
Lucie A. van den Berg ◽  
...  
Keyword(s):  
Treatment Effect ◽  
Computed Tomographic Angiography ◽  
Anterior Circulation ◽  
Computed Tomographic ◽  
Tomographic Angiography

Acute Pontine Ischemic Stroke in a Healthy Child With Intracranial Vasculopathy

2019 ◽  
Vol 34 (13) ◽  
pp. 820-823
Author(s):  
Youssef A. Kousa ◽  
Jonathan Murnick ◽  
Justin Burton ◽  
Marc DiSabella ◽  
Paola Pergami
Keyword(s):  
Altered Mental Status ◽  
Filling Defect ◽  
Computed Tomographic Angiography ◽  
School Age Children ◽  
Minor Trauma ◽  
Anterior Circulation ◽  
Computed Tomographic ◽  
Perforating Artery ◽  
A Minor ◽  
Tomographic Angiography

Here we report the case of a previously healthy 8-year-old boy who presented with altered mental status, right facial droop and right-sided hemiplegia the day after playing in an inflatable bouncer. No head trauma was reported by the patient nor witnessed by the parents. Urgent magnetic resonance imaging (MRI) demonstrated acute ischemic infarction in the left pons; computed tomographic angiography excluded arterial dissection but identified a small hyperdense filling defect in the basilar artery, later confirmed to be a calcification at the origin of a perforating artery. Pediatric National Institutes of Health (PedNIH) Stroke Scale score was 15. Infectious, inflammatory, hypercoagulable and additional vascular causes were excluded. Although the cause of the calcification remains obscure, we speculate that, similarly to mineralizing microangiopathy, a minor trauma led to stroke in this child. To our knowledge, mineralizing microangiopathy, the well-described entity affecting perforating arteries of the anterior circulation in young children leading to basal ganglia stroke following minor head traumas has not been described in the posterior circulation or in previously healthy school-age children.

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