Arterial supply and morphological characteristics of sympathetic neurons in the human superior cervical ganglion.

The aim of this study was the micromorphological analysis of the distribution of microvessels, mast cells and ganglionic neurons in two parts, proximal and distal of the human superior cervical sympathetic ganglions (SCSGs). Statistical analyses were applied to detect the possible metric regional differences in their densities. Five injected human SCSGs with colored India ink and gelatin were microdissected and examined. Second group of five human SCSGs was prepared and serially sliced for CD34 and mast cell tryptase immunostaining. The microscopic fields of two parts of the SCSGs were analyzed for the following quantifications: microvessel density (MVD), mast cell density (MCD), and ganglionic cell count and measurements. The mean number of CD34-positive microvessels in microscopic fields, the MVD, had a value of 83 for the upper parts, and 82.7 for the lower parts of SCSGs. The mean number of tryptase-positive mast cells in microscopic fields, the MCD, was 4.5 in the proximal parts, and 4.7 in the distal parts of SCSGs. The mean number of ganglionic neurons in microscopic fields was 19.5 in the proximal parts, and 19.8 in the distal parts of SCSGs. The density of CD34-positive microvessels, the density of tryptase-positive mast cells, and the density, mean diameters and mean areas of ganglionic neurons were not significantly different in two observed parts, upper and lower of the SCSGs. In conclusion, the distributions of microvessels, mast cells, and neurons in two parts of the SCSGs were uniform with no specific micromorphological variations, there is a homogenous vascular and cellular pattern within the SCSGs.

Persistent median artery and communicating branch related to the superficial palmar arch.

Microvascular surgery, plastic and reconstructive hand surgery, and coronary artery bypass surgery call for a microanatomical study of the branching pattern of the superficial palmar arch (SPA). For the anatomical analysis, we used a group of 20 dissected human hands injected with 4% formaldehyde solution and a 10% mixture of melted gelatin and India ink. The morphometric study was performed on 40 human hands of adult persons injected with methyl-methacrylate fluid into the ulnar and radial arteries simultaneously and afterwards corroded in 40% KOH solution for the preparation of corrosion cast specimens. The mean diameter of the SPA, between the second and third common palmar digital arteries, was 1.86 ± 0.08 mm. We identified the persistent median artery (PMA) in 5% of hands. We distinguished the three main groups of the SPAs according to variations in morphology and branching of the arch: Type 1, the long SPA; Type 2, the middle length SPA; and Type 3, the short SPA found in 27.5% of specimens. The communicating branch (CB), a vessel interconnecting the SPA to the closest branch of the radial artery, is classified into two different morphological groups. The third type of incomplete short arterial arch is the most important of the three groups of SPAs. That short SPA is potentially inadequate for restoring circulation after occlusion or radial artery harvesting for coronary artery bypass.

Anatomy of septocutaneous blood vessels of the anterior forearm.

Aim To measure a calibre of radial and ulnar septocutaneous perforators at the anterior forearm, and to count its number in proximal, middle and distal thirds. Methods The study was conducted on 50 fresh amputated forearms (trauma, tumours) in the period between January 2012 and December 2021. Forearms were collected from several hospitals in Belgrade, and analysed at the Institute of Anatomy, Medical School, University of Belgrade, Serbia. Injection of ink-gelatin and fine dissection of autopsy material was performed on 30 forearms, and corrosion method with injecting methyl methacrylate for 3D analysis on the other 20 forearms. Results A mean calibre of septocutaneous perforators on the radial artery was 0.53±0.46 mm (0.2-0.85). Averagely, there were 8.1 radial artery septocutaneous perforators - two perforators on the proximal third, 3.7 on the middle third, and 2.7 on the distal third. The mean calibre of ulnar artery perforators was 0.65±0.35 mm (0.18-1.8). The average number of septocutaneous perforators of the ulnar artery was 5.6; 1.2 on the proximal third, two on the middle third, and 2.2 on distal third. Conclusion Determination of the origin, calibre and spreading directions of the arterial septocutaneous perforators on the anterior forearm provide quantification of data about arborisation of radial and ulnar septocutaneous perforators at the anterior forearm. Clinical relevance of those anatomical data is in defining of safe locations and dimensions of forearm fasciocutaneous flaps in plastic surgery.

In vivo toxicity evaluation of two polyoxotungstates with potential antidiabetic activity using Wistar rats as a model system.

In this study, the in vivo hypoglycemic effect of a donut-shaped polyanion salt (NH4)14[Na@P5W30O110]·31H2O {NaP5W30} and its Ag-containing derivative K14[Ag@P5W30O110]·22H2O·6KCl {AgP5W30}, as well as their hepatotoxicity and nephrotoxicity, was evaluated. In the screening hypoglycemic study, Wistar albino rats with streptozotocin induced diabetes were treated intraperitoneally with three single doses (5, 10, and 20 mg per kg per b.w.) of both investigated polyoxotungstates. The blood glucose levels, measured before and after 2, 4 and 6 h polyoxotungstate application, showed that both studied compounds induced the most pronounced and time dependent glucose lowering effects at the doses of 20 mg kg-1. Thus, daily doses of 20 mg kg-1 were administered to Wistar albino rats orally for 14 days in further toxicity examinations. The serum glucose concentration and biochemical parameters of kidney and liver function, as well as a histopathological analysis of kidney and liver tissues were evaluated 14 days after the polyoxotungstate administration. Both investigated compounds did not induce statistically significant alterations of the serum glucose and uric acid concentrations, as well as some of the liver function markers (serum alanine and aspartate aminotransferases, and alkaline phosphatase activities). However, the significant decrease in serum total protein and albumin concentrations and the increase in biochemical parameters of renal function - serum urea (up to 63.1%) and creatinine concentrations (up to 23.3%) were observed for both polyoxotungstates. In addition, the detected biochemical changes were in accordance with kidney and liver histhopathological analysis. Accordingly, the hepatotoxic and nephrotoxic effects of these potential antidiabetic polyoxotungstates could be considered as mild.

Silver Nanomaterials in Contemporary Molecular Physiology Research.

Silver nanoparticles have numerous potential applications in engineering, industry, biology and medicine. Because of their unique chemical properties, they have become the focus of many research teams all over the world. Silver nanoparticles may exhibit significant antimicrobial and anticancer effects, and they may be a valuable part of various bioassays and biosensors. However, the research on biological and medical uses of AgNPs is related with numerous potential problems and challenges that need to be overcome in the years ahead. Possible toxic effects of silver nanoparticles on living organisms represent a great concern, both in clinical medicine and public health. Nevertheless, in the future, it may be expected that all metallic nanomaterials, including the ones made from silver will greatly benefit almost all natural scientific fields. In this short review, we focus on the recent research on silver nanoparticles in experimental physiology, as well as other areas of fundamental and clinical medicine.

Microsurgical anatomy of the extra-articular segment of middle genicular artery.

PURPOSE: Knowledge of the incompletely studied microsurgical anatomy of the extracapsular part of the middle genicular artery (MGA) could imply an educational value and clinical significance because of the possible risk of injury during knee surgery. METHODS: Thirty formol-fixed cadaveric lower limbs in full extension were dissected and used for the measurements of MGA parameters. A second group of measurements was performed on distal ends of 30 adult femurs. Two fresh injected cadaveric lower limbs were explored by means of multidetector computed tomographic angiography (MDCTA). RESULTS: The MGA originated from the popliteal artery (PA), facing the lateral half of the intercondylar fossa in 16 (53.4 %) specimens, together with the superior lateral genicular artery (SLGA) in ten (33.3 %) cases, or from the same point of origin with SLGA and superior medial genicular artery (SMGA) in 4 (13.3 %) cases. The MGA averaged 15.6 mm in length and 1.8 mm in the outer diameter. After its curved direction the MGA entered the posterior capsule. The average distances of the point of MGA entrance into the joint capsule were as follows: to the lateral femoral epicondyle it was 34.88 mm, to the medial femoral epicondyle 46.38 mm, 5.74 mm lateral to the posterior midline, with an average vertical distance to the femoral subcondylar plane of 28.73 mm. CONCLUSION: This detailed anatomical examination with measurements of the extracapsular part of a MGA could be of clinical importance and useful in knee surgery for the prevention of vascular injury of MGA and PA, as well as in radiological examination of the knee region.

Semitendinosus tendon regeneration after anterior cruciate ligament reconstruction: can we use it twice?

PURPOSE: It has been demonstrated that the semitendinosus tendon can regenerate after being harvested in its whole length and thickness for anterior cruciate ligament (ACL) reconstruction. Ultrasound studies and guided biopsies of the regenerated tendon have shown compatibility and resembling features of the normal tendon. The question is if this neo-tendon is biologically and functionally adequate for re-use? METHODS: Two randomised groups of 150 volunteers were followed up for two years after harvesting the semitendinosus only (25) or the semitendinosus and gracilis tendons (25) in ACL reconstruction. The patients were followed up with clinical and ultrasound examinations, biopsies and histological tests. Surgical exploration was done in three patients for macroscopic verification. The injected arteries of four lower limbs were dissected and the tendon's arterial supplies were examined. RESULTS: Seventy-two percent of the cases showed regeneration of the semitendinosus tendons. The neotendons were inserted mostly below the knee joint (83.3%) where they had fused with the gracilis tendon, and above the joint (60%) when the gracilis was harvested as well. The isokinetic strength of the hamstrings and quadriceps was not significantly diminished on the operated side. A macroscopic and histological analysis of the regenerated tendons demonstrates close resemblance to normal anatomy, with focal areas of fibrosis. In one patient the regenerated tendon was used for medial patellofemoral ligament reconstruction. CONCLUSION: The semitendinosus muscle can recover and the tendon has great potential to regenerate after harvesting for ACL reconstruction. Our data suggest that the regenerated tendons could be used for iterative ligament reconstruction.

Surgical anatomy and histology of the levator palpebrae superioris muscle for blepharoptosis correction.

BACKGROUND/AIM: The detailed knowledge of the architecture of the upper eyelid is very important in numerous upper eyelid corrective surgeries. The article deals with the detailed anatomy of the major components of the upper lid, which are commonly seen in surgical practice. METHODS: This study was conducted on 19 human cadavers (12 adults and 7 infants) without pathologic changes in the orbital region and eyelids. Anatomic microdissection of the contents of the orbita was performed bilaterally on 12 orbits from 6 unfixed cadavers (3 male and 3 female). Micromorphologic investigations of the orbital tissue were performed on 8 en bloc excised and formalin-fixed orbits of infant cadavers. Specimens were fixed according to the Duvernoy method. An intra-arterial injection of 5% mixture of melt formalin and black ink was administered into the carotid arterial system. Using routine fixation, decalcination, dehydration, illumination, impregnation and molding procedures in paraplast, specimens were prepared for cross-sections. RESULTS: The measurement of the muscle length and diameter in situ in 6 nonfixed cadavers (12 orbits) showed an average length of the levator palpbrae superioris (LPS) muscle body of the 42.0 +/- 1.41 mm on the right, and 40.3 +/- 1.63 mm on the left side. In all the cases, the LPS had blood supply from 4 different arterial systems: the lacrimal, supratrochlear, and supraorbital artery and muscle branches of the ophthalmic artery. The LPS muscle in all the specimens was supplied by the superior medial branch of the oculomotor nerve. The connective tissue associated with the LPS muscle contains two transverse ligaments: the superior (Whitnall's) and intermuscular transverse ligaments (ITL). The orbital septum in all the specimens originated from the arcus marginalis of the frontal bone, and consisted of two layers--the superficial and the inner layer. In addition, a detailed histological analysis revealed that the upper eyelid's crease was formed by the conjoined fascia including the fascia of the orbicularis muscle, the superficial layer of the orbital septum, and the aponeurosis of the LPS muscle, as well as the pretarsal fascia. CONCLUSION: The conducted study provided a valuable morphological basis for biomechanical and clinical considerations regarding blepharoptosis surgery.

Intramesencephalic course of the oculomotor nerve fibers: microanatomy and possible clinical significance.

Comprehension of the mesencephalic syndromes that affect oculomotor nerve fascicles requires a detailed knowledge of their relationship with the adjacent structures and the blood supply of the central midbrain region. This was the reasoning behind our study, which was performed in ten serially sectioned midbrains stained with cresyl violet and luxol fast blue, in three microdissected midbrains, and in two injected and cleared specimens. Three continuous groups of the intramesencephalic oculomotor nerve fascicles were distinguished: the caudal, intermediate and rostral. The caudal fascicles, which most likely innervate the superior rectus and the levator palpebrae superioris muscles, extend through the superior cerebellar peduncle just caudal to the red nucleus and close to the lateral lemniscus. The intermediate fascicles, devoted to the medial rectus and the inferior oblique muscles, always pass through the superior cerebellar peduncle, just medial to the caudal part of the red nucleus (60 %), and less frequently (40 %) through the nucleus itself. The rostral oculomotor fascicles, which terminate in the inferior rectus and sphincter pupillae muscles, course medial to the rostral part of the red nucleus. While the rostral and intermediate oculomotor fascicles are supplied only by the medial twigs of the paramedian mesencephalic perforating arteries, the caudal fascicles are also nourished by the lateral branches of the same perforating arteries. The data obtained form an important basis for the explanation of certain mesencephalic syndromes, and even anticipate some new syndromes not yet described in the literature.

Morphometric analysis, region of supply and microanatomy of the lenticulostriate arteries and their clinical significance.

The lenticulostriate arteries (LSA) and their microanatomy, region of supply and atherosclerosis were examined in 24 microdissected brains, arterial casts, and histological specimens. The LSA ranged from 2 to 12 in number and from 0.10 mm to 1.28 mm in diameter. They always arose from the initial segment of the middle cerebral artery (MCA), often from the MCA leptomeningeal branches (38.24%), and rarely from the insular segment (2.94%). They always originated as individual branches, often (61.76%) with their own common stems. In two hemispheres we found that the LSA supplied either a larger or a smaller portion of the basal ganglia and internal capsule than usual. The number of twigs to the innominate substance (substantia innominata) (3-11), and their diameters (0.07-0.30 mm), has been described for the first time, to our knowledge. Microatheromas were found in two LSA. Data about the LSA microanatomy and territory could form the basis of safer neurosurgery, more accurate neuroimaging evaluation, and precise neurological diagnosis in patients with focal ischemic lesions in the basal ganglia and internal capsule.

Occipital sulci of the human brain: variability and morphometry.

The external morphology of the occipital lobe was investigated in 15 human post-mortem brains (30 hemispheres) fixed in formalin. We identified, described and measured the lengths of nine major human occipital sulci and five variable ones, comparing both types between individuals and hemispheres. Morphological variability of human occipital sulci is related to interindividual and interhemispheric differences in their presence, origin, type, segmentation, intersection and length. The major occipital sulci, particularly the parieto-occipital, the calcarine, the inferior lateral occipital and the anterior occipital sulci, as well as two points of their intersections (cuneal point and intersection of the transverse occipital and superior occipital sulcus) may be used as reliable anatomical landmarks for the location of architectonically and functionally defined human visual areas (V1, V2, V3, V3A, V5/MT+, LO1 and LO2) and during less invasive neurosurgical procedures in the cases of focal lesions within the occipital lobe. Two lateral occipital sulci (inferior and superior) were defined on the lateral surface of the occipital lobe. The variable lunate sulcus was studied and combining our results with those from histological and functional imaging studies, we suggest that the lunate sulci of human and nonhuman primates are not homologous.

Skin vascularisation field by the ascending branch of the peroneal artery ramus perforans.

BACKGROUND/AIM: Soft tissue defects in the distal third of the lower leg are persistent and constitute a major problem in the reconstructive surgery. This study presents an analysis of the anatomical vascularization filed of ascending branch of the peroneal artery ramus perforans (PARS). The aim of this study was to assess reliability of the distal flap on the antero-lateral aspect of a lower leg distal third. METHODS: Direct gentiana violet injection into the interosseal perforator of ten fresh cadaveric lower legs with subsequent corrosion acrylic preparation was performed to reveal vascularization filed of the ascending branch of the PARP. Height, length, diameter and communication of perforating branch and its subsequent smaller ascending and descending branches were determined. The CAMIA software was used. RESULTS: Our results show that the PARP is always present. Its origin from the peroneal artery is at the medial height of 66 mm when measured from the inferior border of the lateral malleolus. Medium length of ramus perforans is 51.7mm. After transition through the interosseous membrane, ramus perforans divides into ascending and descending branches. The diameter proximal to the level of bifurcation is 1.37 mm (variation 1.0-1.8 mm), and the diameter of the ascending branch distal to the level of bifurcation is 1 mm. Using CAMIA software, the medium length, width and area of the vascularization filed labeled with gentian violet were calculated to be 164 mm (variation 125-210 mm), 66 mm (57-77 mm), and 10,305 mm2 (6,385 mm2-14,341 mm2), respectively. CONCLUSION: Our results support the use of fasciocutaneous distal flap, vascularized by the ascending branch of the PARP for reconstruction of soft tissue defects in the distal third of the lower limb, malleolar regions and dorsum.

Vasculature and neurovascular relationships of the trigeminal nerve root.

BACKGROUND: Specific microanatomical characteristics of the trigeminal nerve root (TNR) blood supply and close neurovascular relationships with surrounding vessels as well as their possible clinical significance were the main reasons for this study. METHOD: The vasculature of 25 adult and four fetal TNRs were microdissected and examined under the stereoscopic microscope, after injecting their arteries with India ink. RESULTS: The trigeminal vessels, which varied between two and five in number, arose from two or three of the following arteries: the superolateral pontine (92%), anterior inferior cerebellar (AICA) (88%), inferolateral pontine (72%), and superior cerebellar (SCA) (12%). The trigeminal vascular twigs had a mean diameter of 0.215 mm. A single vessel may supply either the motor portion of the nerve root or the sensory portion or both. The trigeminal vasculature formed the proximal and distal rings. The proximal ring was located at the trigeminal root entry zone. Its central branches extended along the TNR to the principal sensory and motor trigeminal nuclei while its peripheral longitudinal twigs followed the TNR fascicles. The incomplete distal arterial ring embraced the middle portion of the TNR before the level of its entrance into the arachnoid sleeve. The most frequent contact of the TNR was noticed with the SCA (20%), the petrosal or Dandy's vein (24%), and the AICA (12%). CONCLUSIONS: The observed characteristics of the TNR vasculature could be the anatomical basis for decompressive neurovascular surgery.

Immunohistochemistry of displaced sensory neurons in the trigeminal nerve root.

The aim of this study was to examine the morphology and the immunohistochemical features of displaced ganglion cells in the trigeminal nerve root (TNR). Forty human TNRs of 20 persons, obtained during routine autopsy in accordance with the Declaration of Helsinki, were examined following Klüver-Barrera and azan trichrome histological staining, and immunohistochemical reactions against certain neuronal markers, neuropeptides and neurotransmitters. A total number of 61 displaced neurons were investigated, which were present in 80% of individuals studied. Displaced neurons were found in 55.0% of the TNRs, either in the sensory portion (22.5%), motor portion (22.5%) or both (10.0%). Neuronal diameter varied from 12.5 x 25.0 to 45.0 x 63.7 (mean 27.6 x 41.6) microm, and in area between 245 and 2,065 (mean 927) microm(2). Each neuron was surrounded by 2-17 elongated satellite cells per slice. The immune reaction was positive in all the neurons studied for neuron-specific enolase, protein gene product 9.5, neurofilament protein and synaptophysin, and in some neurons for calcitonin gene-related peptide (CGRP; 24.4%), cholecystokinin (CCK; 13.3%), somatostatin (SST; 17.8%), substance P (SP; 15.6%), vasoactive intestinal polypeptide (4.4%), neuropeptide Y (8.9%), and serotonin (11.1%). The immune reactions were most frequent against the CGRP, SP, CCK and SST. We concluded that displaced neurons in the TNR morphologically and immunohistochemically resembled the sensory neurons in the trigeminal ganglion.

Ultrastructure and immunohistochemistry of the trigeminal peripheral myelinated axons in patients with neuralgia.

OBJECTIVE: Detailed ultrastructural and immunohistochemical examination of the trigeminal axons surrounded by the peripheral type of the myelin could add new information about the extent of the trigeminal nerve lesion in neuralgia. PATIENTS, MATERIALS AND METHODS: The examination comprised, firstly, the 10 trigeminal nerve roots (TNRs) in which the neurovascular contact was found in 20% of the cases, and the 2 additional control TNRs. Secondly, the biopsy specimens were taken from 6 patients with trigeminal neuralgia and 2 patients with trigeminal neuropathy following a partial TNR rhizotomy. The specimens were examined under the electron microscope (EM) and/or using the immunohistochemical (IHC) methods. RESULTS: In addition to the central zone of demyelination, the EM examination of the TNR also revealed alterations of the peripheral myelin, i.e. deformation, thickening, demyelination and remyelination, as well as changes of the peripheral axons, that is, atrophy or hypertrophy, neurofilaments increase, loss of the myelin and sprouting occasionally. Some Schwann cells were also damaged. The IHC examination usually showed a moderate immune reaction against neuron-specific enolase (NSE) and protein gene product 9.5 (PGP9.5), but sporadically weaker reaction against the S-100 protein, synaptophysin (SY), neurofilament protein (NFP) and glial fibrillary acidic protein (GFAP). The substance P (SP) and calcitonin gene-related peptide (CGRP) immunoreactivity was weak at some sites, but strong at some other places. CONCLUSIONS: The pathological changes affect not only the central nerve fibers of the TNR, but also some of the peripheral axons, their myelin sheath and Schwann cells. These are signs of the retrograde ultrastructural and biochemical alterations, which could participate in the pathophysiological mechanism underlying the trigeminal neuralgia.

Omental Morgagni-Larrey hernia: an anatomical pictorial essay.

This paper reports on a case of an omental diaphragmatic hernia revealed during routine anatomical dissection of an obese 85-year-old male with plethoric appearance of the upper body. The hernial mass, with a size of 12 cm x 9 cm, was detected in the anterior mediastinum. It had a long peduncle originating from the transverse colon and passing through the right sternocostal diaphragmatic opening of Morgagni-Larrey. The whole greater omentum was tightly packed and tumid within the serous hernial sac, but without signs of torquation. To our knowledge, this is the first systematic analysis of the omental hernial anatomy by a step-by-step iconography.

[Angiosome of the fibular artery as anatomic basis for free composite fibular flap].

INTRODUCTION: The free osteoseptocutaneus fibular flap is, anatomically, an angiosome of the fibular artery. Knowledge of detailed topography anatomy of the fibular artery and its branches is necessary for successful creation and elevation of the flap. OBJECTIVE: The aim of the study was to determine topography of the tissue of the leg supplied only by the fibular artery, to describe topography relations of the branches of the fibular artery, their number, anastomoses, vascular plexus and the way of vascularization of the skin, muscle and bone tissue. METHOD: The popliteal artery was cannulated in 15 cadaveric legs, flushed with ink and then with 10% ink-gelatin. Fixation of tissue was performed with formalin and then micropreparation of the side branches of the fibular artery was performed. Also, two corrosive models were made. Localization of foramen nutrition was determined by measuring 50 fibulas. RESULTS: The skin supplied by the fibular artery forms distal two thirds of the lateral-posterior aspect of the leg. Vascularization of the skin arises from the side branches of the fibular artery forming a rich fascia plexus at the deep fascia level. From 3 up to 7 side branches of the fibular artery are incorporated in the fascia arterial plexus and can be separated as septocutaneus and myocutaneus, according to topography relations. The nutritive artery enters the fibula cortex at a spot that, measured from the top of the fibula, lies in the area between 32% and 65% of the whole length of the fibula. Periosteal circulation of the fibula originates from the short side branches of the fibular artery that anastomoses at the periosteum level. CONCLUSION: The axial line of flap has to be marked 2 cm posterior to the line from caput fibulae to malleolus lateralis. Numerous anastomoses between the side branches of the fibular artery in the fascia plexus enable good circulation of the skin even when some of the branches are not included in the flap. The middle third of fibula has to be used as bone graft because of localization of the foramen nutrition.

Microanatomy of the intrachoroidal vasculature of the lateral ventricle.

OBJECTIVE: Intraventricular surgery requires a detailed knowledge of the microanatomy of the choroid plexus vasculature. METHODS: Twenty choroid plexuses were microdissected, and two additional plexuses were prepared for microscopic examination. RESULTS: The choroid plexus was perfused primarily by the anterior choroidal artery (AChA) and the lateral posterior choroidal artery (LPChA). The AChA, which averaged 650 microm in diameter, most often (in 75% of cases) divided into the medial and lateral trunks, which averaged 450 microm in diameter. The medial trunk gave off the bush-like intrachoroidal branches, whereas the lateral trunk divided into the parallel arteries. The inferior LPChA was present in 50% of the hemispheres, both the inferior and superior LPChAs in 40%, and their common trunk in 10%. In 40%, the LPChA, which averaged 670 microm in diameter, divided into the terminal trunks, with a mean diameter of 490 microm. The anastomoses involving the trunks of the LPChA and other choroidal arteries averaged 310 microm in diameter. All primary intrachoroidal branches of the AChA and LPChA were divided into three groups. The parallel branches, which averaged from 220 to 230 microm in diameter, coursed along the lateral part of the choroid plexus. The tortuous glomus vessels, which averaged 310 microm in size, originated from the AChA (45%), the LPChA (15%), or both (40%). The bush-like vessels, with a mean diameter between 155 and 190 microm, ramified into smaller twigs, up to the intrachoroidal capillaries. CONCLUSION: The data obtained on the microanatomy of the intrachoroidal vasculature may have certain neurosurgical implications.

Microsurgical anatomy of the perforating branches of the vertebral artery.

BACKGROUND: There is limited data in the literature related to the microanatomic features of the perforating branches of the vertebral artery. METHODS: The 44 vertebral arteries and their branches were injected with india ink or a radiopaque substance and examined under the stereoscopic microscope. RESULTS: The perforating arteries were noted to range in number from 1 to 11 (mean, 6.5) and in diameter between 100 microm and 520 microm (average, 243 microm). They arose from the vertebral artery (VA) (54.54%), 8 from the right, the left or both VAs. The anterior spinal artery (ASA), which was singular (81.82%), duplicated (13.64%), or plexiform (4.55%), always gave rise to the perforators. The vascular roots of the ASA were the source of the perforators in 95.45% of the brains. The latter vessels arose from the anterolateral arteries in 50% of the cases. The anastomoses involving the perforators, which were present in 40.91% of the brains, varied in diameter between 100 microm and 350 microm (mean, 169 microm). The perforating vessels gave rise to the side branches in 95.45% of the brains that varied in diameter from 100 microm to 300 microm (average, 161 microm). The perforators usually entered the foramen cecum and the anterior median sulcus, and then continued close and parallel to the raphe of the medulla. The perforators can be compressed by a VA aneurysm, which was found in one among the 71 examined patients with cerebral aneurysms. CONCLUSIONS: The obtained data give additional information about the vascular anatomy of the pontomedullary region.