Bilateral aplasia of the anterior cerebral artery in the presence of its vascular source: a case report.

PURPOSE: Our goal was to investigate the cases of bilateral aplasia of the anterior cerebral artery (ACA). METHODS: The macro- and microdissection of the target human brain arteries of 388 cadaveric cases was applied under the magnifying glass. Each case was photographed and diagrammatically represented in the workbook. The length and the outer diameter of the corresponding arteries on the photos were measured using a computer software program. RESULTS: There was only one case (1/388 or 0.25%) of bilateral ACA aplasia that belonged to a male adult cadaver. Except for the variations of the posterior communicating artery on one side and the basilar artery, the instance of cerebral pathology was not recorded in this case. We compared the recent case with available literature cases. CONCLUSION: Summarizing small number of literature cases, the recent case of bilateral ACA aplasia as the fifth case discovered so far, represents a true morphological rarity.

Congenital absence of the bilateral internal carotid artery: a review of the associated (ab)normalities from a newborn status to the eighth decade of life.

PURPOSE: Due to the fact that the internal carotid artery (ICA) is responsible for nourishing two thirds of the brain volume, our aim was to inspect the morphofunctional consequences of the bilateral lack of this artery. METHODS: In order to examine this condition, we referred to both the library archive of our Faculty of Medicine and electronic databases of anatomical and clinical reports that included the following keywords: "absence," "aplasia," or "agenesis" in combination with "internal carotid artery," "common carotid artery," or only "carotid artery." RESULT: We found 60 recorded cases of the bilateral ICA absence in the subjects of newborn status to the eighth decade of life, which had been discovered in 20 countries. The following ten parameters were described: the embryological base, terminology, history, incidence, general data, differential diagnosis, collateral circulation, the associated vascular aplasia and/or other variants, pathophysiology, and the importance in praxis. CONCLUSION: This review noted all the cases of the bilateral ICA aplasia published for the past 104 years. Although there were 11.6% of cases of the associated cerebral aneurysms and 1-4 cases of 16 other diseases, approximately one quarter of the cases was without any pathology.

Variation of some arteries of the vertebrobasilar system: case report.

A specificity of the vertebrobasilar system (VBS) is a convergent junction of paired vertebral arteries (VAs) in the basilar artery (BA) usually at the level of bulbopontine sulcus on the ventral side of the rhombencephalon. We revealed multiple VBS variations (a high junction of both VAs, absence of posterior inferior cerebellar arteries, short and ectatic BA, hypoplasia and initial duplication of the left anterior inferior cerebellar artery, and bilateral common trunks of the posterior cerebral and superior cerebellar arteries) in a 52-year-old male that routinely autopsied at the Institute of Forensic Medicine. Embryological base and morphological status of presented VBS variations is highlighted according to the literature data. Summarized variations of VBS can be classified as morphological rarity, and may be of clinical importance during angiographic studies or neurosurgical procedures.

Fenestrations of the human posterior cerebral artery.

BACKGROUND: The posterior cerebral artery (PCA), as a paired terminal branch of the basilar artery, runs through four segments (P1 to P4) to the inferior and medial surfaces of the occipital and a part of the temporal lobes. There are many PCA variants in its course. The literature data indicated that a fenestration of the PCA was very rare and that its clinical significance is unknown. The purpose of this investigation was to present the frequency, location, and some morphological features of PCA fenestration in the prenatal and postnatal period. METHOD: Using brain bases of 468 (200 fetal and 268 adult) cadavers, we applied macroscopic and microscopic investigation. RESULTS: We found four (0.85 %) cases of PCA fenestrations-two at the left and right P1 segment of fetuses, respectively, then one adult at the left P2 segment, as well as one adult at one right PCA of the two existing arteries. There were associated multiple vascular abnormalities in one adult case. We did not find any case of PCA aneurysm originating from fenestration, as well as from PCA without fenestration. CONCLUSION: The frequency, segment, and side location, as well as the size and shape of PCA fenestrations in specimens of our population did not significantly differ from the same in other populations. PCA fenestrations in our adult specimens were not the bases of aneurysms.

Morphology of the cerebral arterial circle in the prenatal and postnatal period of Serbian population.

BACKGROUND: In the literature, there are descriptions of morphological types of the cerebral arterial circle (CAC) of different human populations around the world, but not the Serbian population. This additionally inspired the authors to present the results of previous and current researches of CAC's configuration in the prenatal, as well as in the postnatal period. METHOD: The study was performed on CACs of 190 human fetuses and 143 adult cadavers. The caliber and configuration of fetal vessels were examined under the operating microscope, while the same of adults were studied using the ImageJ. Statistical analysis of CACs vessels' calibers was performed. Classification into one of CAC morphological types was based on the presence of hypoplasia of corresponding vessel(s). RESULTS: There was not only significant difference of the three communicating arteries calibers before and beyond the 16th week of gestation. Calibers of the right pre-communicating part of the posterior cerebral artery and right cerebral part of the internal carotid artery were significantly higher in male than in female adults. There were 13 morphological types of CACs from the prenatal to the postnatal period. Most frequent CAC types were the type I (normal CAC) prenatally and type IV (unilateral hypoplasia of the posterior communicating artery) in the postnatal period. There were not relationships between the cerebral cause of death and a presence of aneurysm. CONCLUSION: Results of this study will be the basis for future investigation of CACs according to the same or different ages and causes of disease and/or death.

Hypoplastic arteries of the cerebral arterial ring in the blind spot of computed tomography angiography.

BACKGROUND: Some variations of the cerebral arterial circle (CAC) are associated with an increased risk for the development of various pathological conditions. This paper aimed to determine the prevalence of hypoplastic arteries of CAC and to emphasize the limited possibility of their visualization by computed tomography angiography (CTA). MATERIALS AND METHODS: The research was performed on 400 adult cadavers by macro- and microdissection of the cerebral arteries. Each case was photographed and the diameter of the arteries was measured digitally, by analyzing photographs of the bases of the brain in the ImageJ program. RESULTS: The largest prevalence of artery diameter <1mm (<0.6mm) in CAC had the posterior communicating artery (PCoA). PCoA on the left side was hypoplastic in 44.9% (11.4%) of cases, while the same artery on the right side was hypoplastic in 44.3% (6.6%) of cases. The posterior cerebral artery was hypoplastic on the left side in 3% (0.6%) and on the right side in 4.2% (0.6%) of cases. The anterior cerebral artery had a hypoplastic caliber only on the right side in 2.4% (0.6%) of the cases, while the internal carotid arteries did not have a diameter <1mm in any case. The anterior communicating artery showed the greatest variability in morphology. Studies on CTA describe the occurrence of aplasia in a statistically significantly higher percentage, and the occurrence of hypoplastic arteries in a statistically significantly lower percentage compared to studies on cadavers. CONCLUSIONS: Due to significant differences between cadaveric and radiological studies, it is necessary to analyze their results regarding arterial hypoplasia and aplasia separately. A diameter of less than 1 mm has been suggested as a criterion for arterial hypoplasia.

Vertebral and/or basilar dolichoectasia in human adult cadavers.

BACKGROUND: Intracranial arterial dolichoectasia is a condition in which arteries demonstrate an increase in length and diameter, with the vertebrobasilar system being the most commonly affected segment. Because the criteria for and degree of vertebrobasilar dolichoectasia are usually established on three-dimensional time-of-flight MR angiography, we presented the results of an anatomic study of vertebrobasilar dolichoectasia cadaveric specimens. METHOD: Examination was carried out on the brains of human adult cadavers, routinely dissected at the Institute of Forensic Medicine. Measurement of the outer diameter and length of vertebral and/or basilar arteries was performed using the ImageJ processing program. RESULTS: There were 14 cases (14/216) of vertebral and/or basilar (dolicho)ectasia. Their classification into special (sub)types is made according to the basilar and/or vertebral diameter. The basilar length ranged from 32.91-59.37 mm, and the basilar outer diameter ranged from 3.51-8.92 mm in relation to the corresponding point of its measurement. The outer diameter of the vertebral arteries ranged from 0.67-5.91 mm. The Games-Howell post hoc test additionally showed that a basilar outer diameter of grade III and IV was significantly larger than in grade II (p < 0.05). CONCLUSIONS: We noted a predisposition of males older than 40 years to arterial dolichoectasia in the vertebrobasilar system, independently from population group, as well as its asymptomatic appearance, independently from the presence of atherosclerotic plaques.

Specifies of the fetal median callosal artery.

BACKGROUND: A variable artery in the anterior cerebral circulation, named median callosal artery (MdCA) belongs to one of the three groups of anteromedial central branches of the anterior communicating artery (ACoA). The lack of information on MdCA in human fetuses inspired the authors to explore and present its morphological features. METHODS: The arteries of the brain base were analyzed and measured on 193 specimens of human fetuses, whose values are preserved from the time of preparation of PhD thesis. RESULTS: The median callosal artery was observed in 45% (87/193) of fetuses from 12.5 to 25 weeks of gestation. The MdCA originating from the single ACoA was found in 4.66% cases. MdCAs originating from the so-called anterior communicating rete (16.58%), as well from the partially duplicated (5.69%) and total duplicated ACoA (10.88%) were also found. A statistically significant difference of the artery OD between male and female fetuses was not found. There was a non-significant positive correlation between fetal age presented in gestational weeks and the artery OD (r = 0.214). The OD of the MdCA did not correlate with the diameters of the anterior cerebral artery (ACA). An unusual convergent union of initial ACA medial vessels and partial duplication at MdCA beginning and its trunk fenestrations were shown, along with bilateral distribution of MdCA branches. CONCLUSIONS: The wide range of variability of the median callosal artery in human fetuses, presented in this paper, contributes to anatomical knowledge on the anterior part of cerebral circulation.

Platelet-rich fibrin: Basics of biological actions and protocol modifications.

Platelet-rich fibrin (PRF) represents second generation of platelet concentrates, which has gained increasing awareness in recent years for regenerative procedures. This biologic additive is completely autologous, easy to prepare, has minimal expense, and possesses prolonged growth factor release, together with several other advantages over traditionally prepared platelet concentrates. Since its introduction, various protocols for PRF preparation have been proposed with different amounts of growth factors and other biomolecules necessary for wound healing. However, reference data about potential effect of some PRF components on hard and soft tissue healing are still conflicting. The current article intends to clarify the relevant advances about physiological role of certain PRF components and to provide insight into the new developmental approach. Also, this review summarizes the evolution of platelet concentrates and biologic properties of different modifications of PRF procedure.

Human anterior pituitary's ACTH cells during the aging process: immunohistochemic and morphometric study.

Corticotrophs produce a hormone that stimulates the adrenal gland cortex to secrete glucocorticoids, which in turn have effects on carbohydrate and protein metabolism. Quantification, morphological characteristics, and distribution of corticotrophs in the anterior pituitary and changes in the number and shape of the cells during aging have been examined using immunohistochemical and morphometric methods. The material consisted of 14 anterior pituitaries taken from cadavers at routine autopsy. The tissue was processed by standard histological procedure and the obtained slices were stained by the monoclonal anti-ACTH antibody for corticotrophs identification. Digital images of stained histological sections were analyzed using the morphometric method with the Image J system. The volume density of ACTH positive cells was determined. The cases were classified into three age groups. One-way ANOVA showed that the volume density of the corticotrophs was significantly higher in the second and third group in relation to the first group. The difference in the volume densities of the corticotrophs between the genders was not significant. Morphometric and statistical analyses demonstrated a significant positive correlation between the corticotrophs volume densities and the age of the evaluated cases. Linear regression showed that age significantly predicts corticotrophs volume density. Corticotrophs significantly increase during the life span.

An excess vessel in the posterior part of the human cerebral arterial circle (CAC): a case series.

BACKGROUND: As a continuation of the previous findings in human fetuses, accidental finding of an accessory vascular component in the posterior part of CAC of human adult cadavers inspired the authors to present and compare its posterior part configuration. CASE PRESENTATION: Examination was carried out on brains of 48 human adult cadavers, routinely dissected at the Institute of Forensic Medicine. The aberrant vessel in the posterior part of four CACs was discovered.Vascular components of the posterior segment of CAC or of the whole CAC were described and photographed. A comparison between fetal and adult cases was also presented. CONCLUSIONS: Based on the fact that the age of the four presented cases ranged from 73 to 84 and based on the causes of their death, we concluded that the angioarchitecture of the posterior part of the CAC is a consequence of the embryonic or primitive arterial stabilization and interaction with normal adult vessels.

Association of Two Primitive Carotid-Basilar Anastomoses and Cerebrovascular Abnormalities on the Brain Base: A Case Report.

Simultaneous presence of the persistent primitive trigeminal artery and so-called intermediate communicating artery was discovered in a 77-year-old cadaver autopsied due to the myocardial infarction. Many vascular variants and abnormalities such as aplasia of the right vertebral artery (VA), presence of two right posterior cerebral arteries (PCAs), partial duplication of the right superior cerebellar artery, hypoplasia of the pre-communicating part (A1) of the right anterior cerebral artery and the right PCA of basilar origin, a special configuration of the anterior communicating artery (ACoA), and a small aneurysm at the right A1-ACoA junction were associated. The finding of an incipient cerebral aneurysm at the junction of the hypoplastic A1 and embryonal configuration of the ACoA in the eight decade of life indicates that its development was caused by long-term pressure of blood flow at branching points of this artery independent from its caliber. However, it is not yet clear whether the persistence of the first and/or the second carotid-basilar anastomoses in this case was the condition for an aplasia of one VA or vice versa.

Variations in Foramen Transversarium in Typical Cervical Vertebra / Variaciones del Foramen transverso en una Vértebra Cervical Típica

SUMMARY: In literature were described variations in foramen transversarium in cervical vertebrae, as well as their clinical importance, and the information about them boils down to the individual case reports or population morphological studies. The aim of this paper is to contribute to the knowledge of morphological characteristics of the transverse openings on vertebrae of the cervical region. The study was performed on 60 typical vertebrae that are part of the collection of the Department of Anatomy in Nis. The characteristics of permanent openings were measured and accessory foramina were recorded. It was found that the diameter of the openings on the left side was 5.595±0.92 x 5.390±1.507 mm, and on the right 5.766±1.201 x 6.101±1.401 mm. Unilateral completely separated accessory foramina were recorded in 10.17 % of cases, dominant on the left side, and incompletely separated cases in 5.09 %. The research has demonstrated a relatively high incidence of accessory foramina and deviations from circular shaped openings.

En la literatura se describen variaciones en el foramen transverso de las vértebras cervicales, así como su importancia clínica, y la información sobre ellas se reduce a informes de casos individuales o estudios morfológicos poblacionales. El objetivo de este trabajo fue contribuir al conocimiento de las características morfológicas de los forámenes transversos de las vértebras cervicales. El estudio se realizó en 60 vértebras típicas que forman parte de la colección del Departamento de Anatomía de Nis. Se midieron las características de los forámenes constantes y se registraron los forámenes accesorios. Se encontró que el diámetro de los forámenes del lado izquierdo era de 5,595±0,92 x 5,390±1,507 mm, y del derecho de 5,766±1,201 x 6,101±1,401 mm. Se registraron forámenes accesorios unilaterales completamente separados en el 10,17 % de los casos, dominantes en el lado izquierdo y casos incompletamente separados en el 5,09 %. La investigación ha demostrado una incidencia relativamente alta de forámenes accesorios y desviaciones de forma circular.

Arterial abnormalities and associated variations of the vertebrobasilar system on the brain base: apropos of a rare case / Anomalías arteriales y variaciones asociadas del sistema vertebrobasilar en la base del cerebro: un caso raro

SUMMARY: The presented case characterizes an association of primitive and definitive arteries with variations on the cadaveric brain base of a very old man. This case is found by the retrospective review of the data archive obtained during many years of cooperation of the author and co-authors. Fenestration of the (ectatic) basilar artery, partial and total duplication of some cerebellar arteries was associated with other variations of the vertebrobasilar and carotid systems. Although this is a case autopsied because of the myocardial infarction, the peculiarity of the case lies in the absence of the aneurysm based on the fenestration or dissection of one of the cerebral arteries.

RESUMEN: El caso presentado caracteriza una asociación de arterias primitivas y definitivas con variaciones sobre la base cerebral cadavérica de un anciano. Este caso se encuentra mediante la revisión retrospectiva de datos obtenidos durante muchos años de un trabajo de cooperación del autor y coautores. La fenestración de la arteria basilar (ectásica), la duplicación parcial y total de algunas arterias cerebelosas se asoció con otras variaciones de los sistemas vertebrobasilar y carotídeo. Si bien se trata de un caso de autopsia a causa de un infarto del miocardio, la peculiaridad del caso radica en la ausencia del aneurisma en base a la fenestración o disección de una de las arterias cerebrales.

Fenestrations and Various Duplications of the Posterior Communicating Artery in the Prenatal and Postnatal Periods.

BACKGROUND: The 2 paired arteries-the posterior communicating arteries (PCoAs) and the precommunicating parts of the posterior cerebral arteries-form the so-called posterior segment of the cerebral arterial circle on the base of the brain. A number of (ab)normal morphologic features were described in the literature (e.g., unusual kinking, or extreme elongations, hypoplasia, duplications, fenestrations, the infundibular widening, or aplasia of the PCoA in the prenatal and/or postnatal periods). The aim of this study was to analyze an incidence of various fenestrations and duplications of the PCoA, and describe their general features and their association with other vascular abnormalities. METHODS: The research was performed on the brains of 200 human fetuses and 377 adult cadavers of both genders and different ages using microdissection and macrodissection methods. RESULTS: There were 0.34% cases with PCoA fenestrations and 3.12% cases with various PCoA duplications. Their morphologic features were described and compared with the similar PCoA abnormalities recorded in the scientific literature. There was no association between the PCoA and either duplication or aneurysm in adult cases. CONCLUSIONS: After thorough examination, the fenestrations and duplications of the PCoA are distinguished as 2 special forms of vascular abnormalities, and the PCoA duplications are characterized as partial and total. Furthermore, whereas the low incidence of a fenestration of the PCoA suggests it to be a sufficiently rare phenomenon, the duplications of the PCoA trunk are fairly frequent, especially concerning its terminal segment.

Infundibular dilatation of the posterior communicating artery in a defined population.

Unusual widening of the posterior communicating artery (PCoA) at its beginning from the cerebral portion of the internal carotid artery (ICA) was described as its infundibular dilatation (ID). A possibility of ID rupture or progression to aneurysm was the reason for an investigation of its frequency and morphologic features in specimens of the Serbian population. Cerebral arteries on the brain base of 267 adult cadavers of both genders and varying age and causes of death were dissected. The images of the PCoA in 190 fetuses were also reviewed. ID of the PCoA was defined as a funnel shaped beginning of different width from ICA, wherein PCoA continues from ID apex to the posterior cerebral artery. There were no cases of ID in fetuses. ID and aneurysms of the PCoA were found in 6/267 or 2.2% and 3/267 or 1.12% of adults, respectively. Unilaterally, they existed on the left side and, frequently, in male cases aging 70 years and older, that had died without cerebral cause. Bilaterally, ID was found in 2/6 cases. There was only one case of ID and aneurysm of the PCoA, but from the ID. We are of the opinion that ID of the PCoA only develops postnatally and probably is due to the influence of hemodynamic factors or hypertension.

Some features of the developmental uterus in human fetuses.

Proper development of each component of the reproductive tract is imperative for successful natural reproduction. The aim was to investigate some morphological features of the fetal uterus in early phases of its development. The uteruses of 65 fetuses of different gestational age were included and each of them was measured in three dimensions: uterine length (UL), uterine width (BC) and the antero-posterior (sagittal) thickness of the uterine fundus (FT) using ImageJ computer program. It was observed that the most intense fetal uterus growth occurred between seventh and eighth month of gestational age (between week 25 and 31). The most intense rate of uterine growth had UL and it showed steeper growth curve from the fourth month of gestational age. The values of UL, BC, FT showed statistically highly positive Pearson's linear correlation with values of CRL, and GA, and among themselves. The strongest correlation was between UL and gestational age. Contrary to proved rising linear trends of UL/FT and UL/BC, BC/FT performed linear trend of decline. However, two divergent linear trends, one ascending (UL/FT), and other declining (BC/FT) have similar descent in values during the early gestational age, from week 12 to 15. Fetal uteruses did not grow at the same rate by all three measured dimensions, and each of measured dimensions has noticeable standard deviations during gestational periods, even with a resolution of a week, suggesting individuality of each human development/growth even during prenatal life.

Persistent primitive olfactory artery in Serbian population.

The continuation of the cranial branch of the primitive internal carotid artery is called the primitive olfactory artery (POℓA). It takes this name according to the fact that it is mainly concerned with supplying the developing nasal region. We reported two new cases of the persistent POℓA (PPOℓA) in Serbian population after retrospective analysis of digital images of 200 fetal and 269 adult cases. This PPOℓA originated from the precommunicating part (A1) of the right anterior cerebral artery, coursed along the olfactory tract, and turned on the medial cerebral hemisphere in both male adults. Some vascular variations (fenestration of the A1 and the median artery of the corpus callosum) were associated with this persistent vessel. According to the fact that we did not find aneurysm in our previous and two recent cases, we are of the opinion that PPOℓA is usually asymptomatic in Serbian population.

Human basilar artery abnormalities in the prenatal and postnatal period.

OBJECTIVE: Although complex and varied, adult cerebral angioarchitecture has its origins in embryologic development, where normal components, variations, and abnormalities evolve from modifications of primitive vessels. Therefore, the aim of this report was the study of the morphologic features of the basilar fenestrations in prenatal and postnatal period and associated variants and/or pathologies. METHODS: We studied the brain vessels of 120 fetuses microscopically (i.e., with an operative microscope) and 112 adult cadavers macroscopically. RESULTS: We described 10 cases of basilar abnormalities, five fetal and four adult fenestrations, as well as one adult case with a basilar aneurysm. The location of the vertebrobasilar junction on a caudal myelencephalon and a prolongation of the basilar trunk followed both fetal and adult forms of fenestrations. The same caliber values of the basilar and internal carotid arteries, a variation in the number and origin of some of the basilar side branches, and a tendency of fenestrations to be multiple in number, as particular fetal features, were mostly present in adults. CONCLUSION: The fact that basilar fenestrations in adult specimens shared similar features with fetal ones and without aneurysms, as well as the fact that a basilar aneurysm was without fenestration in its base, lead us to hypothesis that the basilar fenestration is a vascular developmental variant related to the maintenance of vascular symmetry in the midline of the human brain base.