Milena Trandafilović

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.

Types and Subtypes of the Posterior Part of the Cerebral arterial Circle in Human Adult Cadavers

The main cerebral distribution center of 15-20% blood flow from the cardiac output is the cerebral arterial circle or circle of Willis, a nonagon of collateral vessels on the human brain base. At about 4 mm stage of the embryo, the primitive internal carotid arteries, which develop as cranial extensions of the paired dorsal aorta, are formed. Paired longitudinal neural arteries appear along the hindbrain and coalesce to form the basilar trunk at the 7to 12-mm stage. The caudal division of the primitive internal carotid artery anastomoses with ipsilateral neural artery and becomes the posterior communicating artery. At the 40-mm stage the posterior cerebral arteries are as extensions of the posterior communicating arteries. The vertebrobasilar system develops and thus participates in the supply of the posterior cerebral artery through the segment between the basilar artery and the post-communicating part of the posterior cerebral artery. In that phase, the component vessels of the circle of Willis all have the same caliber (Silver & Wilkins, 1991). The posterior cerebral artery originates from the basilar bifurcation within the interpeduncular cistern. From its origin the artery curves superior to the corresponding oculomotor nerve in relation to the antero-medial portion of the cerebral peduncle and joins ipsilateral posterior communicating artery (Yasargil, 1984). The posterior communicating artery takes origin from the infero-lateral wall of the cerebral part of the internal carotid artery. It is encased in a sleeve of arachnoid along the course from the carotid cistern to the piercing of the interpeduncular cistern and junction with posterior cerebral artery (Yasargil, 1984). Topographically, the circle of Willis is divided on anterior and posterior parts. The anterior part composes five vascular components – bilateral cerebral parts of internal carotid arteries (communicating and choroid subparts) and the pre-communicating part of anterior cerebral arteries interconnected by the anterior communicating artery; the posterior part composes

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

BackgroundAs 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 presentationExamination 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.ConclusionsBased 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.

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.

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.

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.

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 in a 77-years-old cadaver autopsied due to the myocardial infarction was discovered. Many vascular variants and abnormalities such as an aplasia of the right vertebral artery (VA), a 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 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.

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.

Erratum to “Unilateral Aplasia versus Bilateral Aplasia of the Vertebral Artery: A Review of Associated Abnormalities”

[This corrects the article DOI: 10.1155/2017/7238672.].