Ljiljana Vasović

Trigeminal artery: a review of normal and pathological features

ObjectsCarotid–vertebrobasilar anastomoses—the trigeminal, otic, hypoglossal, and proatlantal intersegmental arteries—serve as transitory channels between primitive internal carotid arteries and bilateral longitudinal neural arterial plexus, which is the precursor of future basilar artery, when the human embryo reaches about 4-mm length.Material and methodsNormal and/or abnormal morphofunctional aspects of the prenatal and postnatal forms of the trigeminal artery are described according to personal and literature data. Many arteries of similar origin and course are also noted in the differential diagnosis of the trigeminal artery.ConclusionsThe persistent primitive trigeminal artery, as the most commonly carotid–vertebrobasilar anastomosis, has a reported incidence of 0.03–2.2% in the literature. There is female sex predilection, and it may be discovered in patients of any age, on either side, and in association with many vascular variants. Although the significance of persistent primitive trigeminal artery regarding the development of an aneurysm or association with another pathological condition may not be clear, its (ab)normal morphology is the inspiration for anatomists, especially for neurosurgeons, before planning diagnostic and therapeutic procedures.

Peculiarities of the sural nerve complex morphologic types in human fetuses

The sural nerve is the most frequently used sensory nerve in nerve transplantation. It can be transplanted alone or together with the other elements of the neurovascular stalk within the superficial sural flap. The aim of this study was to define the morphologic types of the sural nerve complex, as well as to describe their specific characteristics. Microdissection was performed on 100 human fetuses (200 calves) after 10% formalin fixation. Five morphologic types of sural nerve complex with different incidence were defined. Two morphologic types dominated: type I (58.5%) in which the sural nerve was formed by merging of a fibular communicating branch and the medial sural cutaneous nerve, and type III (26%) in which the medial sural cutaneous nerve took over the function of the sural nerve. Other morphologic variations were less common.

Reevaluation of the morphological parameters according to 11 different duplications of the fetal vertebral artery at prevertebral (V1) and intracranial (V4) parts.

It is noted that the vertebral artery lies buried in a sea of generalities, prejudices, fear, and ignorance in the clinical literature. This fact is the reason why this observation is based on 11 cases, selected from 206 fetal cases, of various duplications of the vertebral artery. Aberrant or anastomotic vessels are illustrated and their definition is largely modified according to the recent anatomic terminology. Duplications of the vertebral artery indicate the ‘segmental duplication’ as a first form, and the presence of an abnormal ‘fenestra’ in the vessel’s trunk as a second form of duplication. There are 9 (5 at prevertebral and 4 at intracranial parts) or 4.36% cases of ‘segmental duplication’ of the vertebral artery and 2 or 0.98% ‘arteria vertebralis unifenestrata’ at the intracranial part of all 206 cases. Successive morphological parameters of aberrant or anastomotic vessels are described and discussed according to personal cases and cases in the literature.

The tenth vascular component in a rare form of the cerebral arterial circle of fetuses.

The ancient knowledge of the cerebral arterial circle (CAC) angioarchitecture could be supplemented by either a new or a forgotten old fact about it. Therefore, 7 cases of a rare form of the CAC of fetuses were described, where the so-called intermediate communicating artery, as an excess vessel into the posterior part, represented either its new vascular component or the developmental segment of this part. The paper aims at revealing the fetal history and morphological features of this ‘underdeveloped’ posterior part of the CAC during the 2nd and 3rd gestational trimesters, which could be of anatomical and clinical meaning in similar prenatal and/or postnatal cases.

Age-Related Changes of the Human Fetal Kidney Size

Early prenatal diagnostics and the importance of genetic counseling are of great interest for echosonographic evaluation of normal fetus anatomy. Development of the human fetal kidney runs through a series of continual and mutually dependent changes during which the kidney obtains its morphological and functional maturity. This study was created to estimate the changes in kidney size during gestation in fetuses from the 4th to the 10th lunar month, to evaluate the dynamics of their growth, as well as to establish the validity of the volume calculated from these dimensions. Serial measurements of kidney dimensions (length, width, thickness) were performed in 110 fetuses. Photomicrographs of kidneys from the 4th, 6th, 8th and 10th lunar months are also presented. On the basis of the results obtained by our examination, we concluded that the period from the 14th to 16th week of intrauterine life is the fastest period of kidney growth during fetal development. Using the ellipsoid formula for calculating the fetal renal volume offers an underestimation of about 32–33% on average. The importance of this study lies in determining the average fetal kidney dimensions, which could be used as standard values in obstetrics.

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.

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

BackgroundIn 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.MethodThe 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).ResultsThere 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.ConclusionResults 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.

Psammoma bodies - friends or foes of the aging choroid plexus.

Psammoma bodies are structures classified in the group of dystrophic calcifications, which occur in some kind of tumors and in choroid plexus during the aging process. Despite early discovery of their presence in choroid plexus stroma, mechanisms responsible for their formation remained unclear. Their presence in some kind of tumors was even more extensively studied, but significant breakthrough in the field of their etiology was not attained, too. However, till today correlation between their presence in tumors and aging is not established. Also, there are not any data about structural differences between ones found in tumors and ones found in choroid plexus. This might points to the assumption that besides the aging, some other causes might be involved in their formation in choroid plexus. Furthermore, it is contradictory that forms, like psammoma bodies, present in such malignant formations as tumors, represent quite benign phenomenon in choroid plexus. Literature data and the results of our previous researches revealed that there might be connections between, these, on the first sight quite different processes. Firstly, psammoma bodies are present in stroma of tumors with predominantly papillomatous morphology, which is present in choroid plexus, too. Initial forms of psammoma bodies might be formed in fibrovascular core of choroid plexus villi, similarly like in tumors papillae of papillary thyroid cancer. Their further growth leads to the progressive destruction of both tumors papillae and choroidal villi. Choroid plexus stroma is characterized by the fenestrated blood vessels presence, which are similar to newly formed vessels in tumors. This makes it vulnerable to the noxious agents from circulation. It can contain lymphocytes, macrophages, dendritic cells and myofibroblasts in cases with psammoma bodies, similarly to tumors stroma which is in activated, proinflammatory state. So, all these facts can suggest that similar processes can lead to psammoma bodies formation in both tumors and choroid plexus and, that they might have harmful effect on choroid plexus structure and function during the aging process. Significantly higher degree of choroidal epithelial cells atrophy, in cases with present psammoma bodies proves that partially. Further researches should be focused on detection of osteopontin and nanobacteria, already detected in tumors psammoma bodies, in choroid plexus ones. Discovery of choroidal psammoma bodies mechanisms formation can be important for elucidation of some aspects in pathogenesis of some tumors, too. Application of choroid plexus epithelial cells functional markers in cases with psammoma bodies should show their functional status.

Morphometric Analysis of Nonsclerosed Glomeruli Size and Connective Tissue Content during the Aging Process

Number of sclerotic glomeruli increases during the aging process. Consequently, majority of remained nonsclerosed glomeruli become hypertrophic and some of them sclerotic, too. The aim of this study was to quantify the size and connective tissue content of nonsclerosed glomeruli and to evaluate the percentage of hypertrophic ones in examined human cases during the aging. Material was right kidneys tissue of 30 cadavers obtained during routine autopsies. Cadavers were without previously diagnosed kidney disease, diabetes, hypertension, or any other systemic disease. Tissue specimens were routinely prepared for histological and morphometric analysis. Images of the histological slices were analyzed and captured under 400x magnification with digital camera. Further they were morphometrically and statistically analyzed with ImageJ and NCSS-PASS software. Multiple and linear regression of obtained morphometric parameters showed significant increase of glomerular connective tissue area and percentage. Cluster analysis showed the presence of two types of glomeruli. Second type was characterized with significantly larger size, connective tissue content, and significantly lower cellularity, in relation to the first type. Such glomeruli might be considered as hypertrophic. First type of glomeruli was predominant in younger cases, while second type of glomeruli was predominant in cases older than 55 years.

Extraneural Arterial Blood Vessels of Human Fetal Sciatic Nerve

Nerves get segmental blood supply either from the neighboring muscular and cutaneous branches or from the regional main arterial trunks. The aim of our research was to detect, in the gluteal and posterior femoral region, the blood vessels which are involved in the blood supply of the human fetal sciatic nerve, as well as to establish their origin. Micro-dissection was performed on 48 fetal lower extremities which were previously fixed in 10% formalin. Micropaque solution (barium sulfate) was injected into their blood vessels. The fetal gestational age was established by measuring the crump-crown length and it ranged from the third to the ninth lunar month. The observed nutritional arteries of the human sciatic nerve originated from the inferior gluteal artery, medial circumflex femoral artery, perforating branches, and popliteal artery. The anastomotic arterial chain of the human sciatic nerve was observed in all cases. In 75% of the cases it was composed of the branches of the inferior gluteal artery, the medial circumflex femoral artery and the first two perforating arteries. The nutrient branch of the third perforating branch was less frequently (in 14.5% of the cases) part of this anastomotic arterial chain.