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Rete mirabile bei segmentaler Agenesie der A. carotis interna

Rete compensation in agenesis of the internal carotid artery

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Zusammenfassung

Der Begriff des „Wundernetzes“ oder Rete mirabile der A. carotis nimmt Bezug auf eine anatomische Struktur bei niederen Säugetieren (z. B. dem Schwein). Die Versorgung der intrakraniellen Gefäße wird von Ästen der A. carotis externa übernommen (z. B. der A. pharyngea ascendens oder der A. maxillaris interna). Die intrakranielle A. carotis interna entsteht aus einem dichten Netzwerk zahlreicher dicht beieinander verlaufender Gefäße mit jeweils geringem Durchmesser, die sich zu einem gemeinsamen arteriellen intrakraniellen Gefäß vereinen. Ein analoges Phänomen kann, wenngleich sehr selten, beim Menschen auftreten. Bei einer segmentalen Agenesie der A. carotis interna kann es zur Ausbildung eines sog. Rete mirabile der A. carotis kommen. Dabei finden sich sowohl im gedachten Verlauf der A. carotis interna als auch ausgehend von Ästen der A. carotis externa zahlreiche Gefäße, die meist einen Durchmesser von 1–2 mm aufweisen und geschlängelt verlaufen. Diese Gefäße konvergieren auf den intraduralen bzw. paraklinoidalen Verlaufsabschnitt der A. carotis interna, der seinerseits einen regelrechten Durchmesser aufweist. Diese seltene Form der Kollateralenbildung wird anhand von zwei Beispielen illustriert. Beide Patienten hatten eine aneurysmabedingte Subarachnoidalblutung erlitten. Bei einem Patienten wurde eine fibromuskuläre Dysplasie vom Media-Typ histologisch gesichert. Das Rete mirabile betraf jeweils nur eine A. carotis. Der knöcherne Karotiskanal beider Patienten war auf der betroffenen Seite hypoplastisch. Das Rete mirabile der A. carotis hat vermutlich keinen eigenen Krankheitswert, tritt aber gehäuft mit anderen intra- und extrakraniellen Gefäßerkrankungen auf.

Summary

The term carotid rete mirabile refers to an anatomic structure common in several lower mammals (e.g., swine). The blood supply for the intracranial arteries originates from branches of the external carotid artery, predominantly the ascending pharyngeal and internal maxillary arteries. In these animals the intracranial internal carotid artery forms from a dense network of numerous converging, small-caliber vessels. An analogous structure is rarely found in humans. Associated with segmental agenesis of the internal carotid artery, so-called carotid rete mirabile can be observed. In it numerous tortuous vessels with a diameter of 1–2 mm are found along the expected course of the internal carotid artery and coming from branches of the external carotid artery. These vessels converge to the intradural paraclinoid segment of the internal carotid artery, which shows a normal diameter. This rare pattern of collateral supply to the brain is illustrated here on the basis of two clinical case histories. Both patients presented with aneurysmal subarachnoid hemorrhage. In one, histological examination of a vessel biopsy revealed medial fibromuscular dysplasia. In both patients the rete mirabile was found in only one carotid system. The affected carotid canal in the skull base was hypoplastic. Human carotid rete mirabile probably has no inherent pathologic significance, but its frequent association with other intra- and extracranial vascular pathologies should be kept in mind.

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Authors and Affiliations

  1. Abteilung Radiologie und Neuroradiologie, Robert Janker Klinik, Bonn, Deutschland

    H. Henkes, J. Reinartz & E. Miloslavski

  2. Klinik für Radiologie und Neuroradiologie, Alfried Krupp Krankenhaus, Essen, Deutschland

    H. Henkes, S. Fischer, G. Albes & D. Kühne

  3. Klinik für Neuroradiologie, Klinikum Stuttgart - Katharinenhospital, Kriegsbergstraße 60, 70174, Stuttgart, Deutschland

    H. Henkes

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Henkes, H., Reinartz, J., Fischer, S. et al. Rete mirabile bei segmentaler Agenesie der A. carotis interna. Nervenarzt 78, 948–953 (2007). https://doi.org/10.1007/s00115-007-2260-x

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