Variation and Anomalies of the Posterior Cerebral Artery: Review and Pilot Study.

Variations and anomalies of the posterior cerebral artery (PCA) have several clinical implications, including assisting in understanding the clinical signs of a stroke. Anomalies have been described previously; however, few reports mention the origins, absence, duplication and triplication of the cortical branches. Furthermore, the PCA branching pattern has not been adequately described. The aim of this study was to describe the anatomy and anomalies of the PCA. Results of a pilot study were additionally included. The quantity, origin, diameter and length of the PCA cortical branches were described in this review, as well as the branching pattern and the anomalies. Accordingly, the pilot study reported on these aspects. In the pilot study it was evident that the description of the branching pattern is not the "normal" pattern, since it was only observed in one case. This pattern was re-evaluated and three groups were described; monofurcation, bifurcation and trifurcation. Furthermore, one case of a fenestration was observed. Aneurysms tend to form at branching points, thus knowledge of the branching pattern can aid in detection of ruptured and unruptured aneurysms in this region. This review outlined several gaps in the literature, and a pilot study was included to fill some of these gaps. Future research should especially focus on the branching pattern of the PCA. Possible sex, age and population differences may also exist.

The anatomical variation of the circulus arteriosus cerebri in a cadaver cohort representing the population dynamics of the Western Cape.

The literature revealed a connection between the variations of the Circulus arteriosus cerebri (CAC) and cerebrovascular disease, ischemia, stroke, aneurysms and atherosclerosis. The diameters of the vessels forming the CAC have been classified into 22 types by previous authors. The aim of this study was to assess the variation of the CAC (diameter, length and anomalies) in a cadaver cohort representing the population of the Western Cape. Thirty-nine subjects (female n = 11, male n = 28) who had died of causes unrelated to brain trauma, were obtained from Stellenbosch University. Additionally, a pilot study was done on 20 specimens. The CAC were removed and fixed for three weeks in 10% buffered formaldehyde. Digital images were taken and the vessels were measured using Adobe Creative Suite 5: Extended edition (Photoshop). The normal diameter (type 1) was observed in 41% of specimens and type 4 (hypoplastic posterior communicating artery) was observed in 23.1%. One case (bilateral hypoplastic posterior communicating arteries and a hypoplastic right posterior cerebral artery) was classified as "other", since it could not be classified into the 22 types. Additional variations included duplication (17.9%) and one point fusion (15.4%) of the anterior communicating artery. Studies have shown that about half of a healthy population have a typical CAC (normal diameter and no anomalies). In the present study the prevalence of a typical CAC was only 15.4%. Studies can only be compared if the same definitions for variations are used. The knowledge of these variations is important in endarterectomy, stenting head and neck surgery and angiography.

Mesenchymal cells are required for epithelial duct cell-to-beta cell maturation and function in an injured adult pancreas in the rat.

The islet, the endocrine portion of the pancreas - develops from an invagination of the pancreatic duct epithelial cells (PDECs) into the surrounding tissue. The contact of the PDECs with mesenchymal cells (MSCs) may be an essential drive for endocrine cell fate. During pancreatic development, cells that express Neurogenin-3 (Ngn3) biomarker are precursors of insulin- producing beta cells. These precursors have been reported in the neogenesis of islets from adult tissues following the surgical ligation of the main pancreatic duct (PDL). But the capacity of these precursors to induce the appropriate signals to complete the entire neogenesis program has been questioned. We studied the fate of co-culture of PDECs and MSCs from the ligated adult pancreas and established the exact location of adult stem- or progenitor-like cells that give rise to beta cells. PDECs were cultured in direct contact with or without MSCs in serum-containing culture media. The cytomorphology of the cells in co-cultures was determined and the immunocytochemical study of the cells was carried out using anti-Ngn3, anti-insulin and anti-cytokeratin-7 (CK7) antibodies. Both the PDEC/MSC- and PDEC/MSC+ cultures showed out- pocketing from duct epithelium by the end of the second week, which are distinct as cell clusters only in PDEC/MSC+ cells later in week four, exhibiting numerous branching ducts. Co-expression of Ngn3 with insulin was observed in both cultures from the second week. However, characterizations of these Ngn3+ cells in the PDEC/MSC+ culture revealed that these cells also co-expressed a CK7 biomarker. This study provides new evidence of the ductal epithelial nature of beta cells in injured adult pancreata; and that the mesenchymal stromal cells are required to sustain Ngn3 expression for beta cell maturation and function.

Anatomy of the Middle Cerebral Artery: Cortical Branches, Branching Pattern and Anomalies.

The middle cerebral artery (MCA) covers a large part of the cerebral hemispheres and is therefore exposed during surgical intervention in this area. Aspects of cerebral branches tend to vary, different branching patterns can be described, and several anomalies can be observed. Knowledge of these variations and anomalies is important and can be helpful to neurosurgeons and clinicians. The aim of this manuscript was to review the available literature on the cortical branches, branching pattern and anomalies of the MCA, to identify the gaps in the literature, and to fill these gaps by including the results of a pilot study. Twenty hemispheres were perfused with colored silicone and the MCA was dissected. For the cortical branches, the diameter, length, presence, duplication and origins were noted. Most commonly duplicated was the anterior parietal artery in 30.0%, and most commonly absent was the common temporal artery in 65.0%. A detailed description on the origins is given. Criteria were described for the bifurcation subtypes and medial bifurcation (50.0%) was most commonly observed. No anomalies were observed. Aspects previously neglected of the MCA cortical branches were reported in the pilot study. The branching subtypes were identified and criteria are given. Illustrations of the different branching subtypes and anomalies are provided. Certain aspects of the MCA anatomy have been neglected, and future studies should give adequate descriptions of the MCA cortical branches, MCA branching pattern, and any anomalies observed.

Review of the Anatomy of the Distal Anterior Cerebral Artery and Its Anomalies.

The anterior cerebral artery (ACA) varies considerably and this complicates the description of the normal anatomy. The segmentation of the ACA is mostly agreed on by different authors, although the relationship of the pericallosal and callosomarginal arteries (CmA) is not agreed upon. The two basic configurations of the ACA are determined by the presence or absence of the CmA. The diameter, length and origin of the cortical branches have been measured and described by various authors and display great variability. Common anomalies of the ACA include the azygos, bihemispheric, and median anterior cerebral arteries. A pilot study was done on 19 hemispheres to assess the variation of the branches of the ACA. The most common variations included absence and duplication. The inferior internal parietal artery and the CmA were most commonly absent and the paracentral lobule artery was the most frequently duplicated (36.8%). The inferior internal parietal artery originated from the posterior cerebral artery in 40.0% and this was the most unusual origin observed. It is important to be aware of the possibility of variations since these variations can have serious clinical implications. The knowledge of these variations can be helpful to clinicians and neurosurgeons. The aim of this article is to review the anatomy and variations of the anterior cerebral artery, as described in the literature. This was also compared to the results from a pilot study.