Article
Dorsal perforating arteries to the basal ganglia and the brainstem – the lemniscal trigone group of dorsal perforation zones and their implications for microsurgical and endovascular aneurysm treatment in a hybrid model – a microsurgical neuroanatomical study
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Authors
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Peter A. Winkler
- Research Laboratory for Microsurgical Neuroanatomy, Department of Neurosurgery, Christian Doppler Medical Center, Paracelsus Medical University Salzburg
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Cornelia Daller
- Research Laboratory for Microsurgical Neuroanatomy, Department of Neurosurgery, Christian Doppler Medical Center, Paracelsus Medical University Salzburg
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S. Ottavio Tomasi
- Research Laboratory for Microsurgical Neuroanatomy, Department of Neurosurgery, Christian Doppler Medical Center, Paracelsus Medical University Salzburg
| Published: | May 21, 2013 |
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Outline
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Objective: Nevertheless the basal surface of the brainstem is a considerable more area and opportunity for vascular perforation than does the dorsal surface the dorso-lateral midbrain perforation zone is crucial for the vascular supply of this high sensible area. The presented microsurgical neuroanatomical study was undertaken in order to elucidate the role of the lemniscal trigone group (LTG) of perforations and the source of the perforating arteries in this area. The knowledge of this vascular pattern is of great importance for endovascular and microsurgical treatment of P2 and P3 aneurysms, and for entering into the midbrain for removal of cavernous malformations in the brainstem.
Method: 50 cadaveric hemispheres were examined under operative microscope, and measurements were made with a digital caliper. We focused on the venous drainage, the diameters of the lemniscal trigone and on the small arteries passing through the perforations. Furthermore the origins of the perforating branches were identified.
Results: The lateral mesencephalic vein (LMV) was found in 100% with a mean diameter of 1.07. Four types of the lateral mesencephalic veins were identified on the basis of the veins course. Other smaller veins were also differentiated according to whether they drained mainly the cerebral peduncle, the lemniscal trigone, or the tectum. The perforating arterial branches entering the lemniscal trigone group (LTG) of the dorsal midbrain perforation zone are originating from the superior cerebellar artery (SCA) and the collicular and pericollicular arteries when present.
Conclusions: A thorough understanding of the microsurgical neuroanatomy of the mesencephalic veins and the perforating arteries in the area of the lemniscal trigone is crucial in aneurysm treatment and brainstem surgery in order to avoid brain damage due to venous infarction and occlusion of important perforators. Because knowledge of the course, variations, and inflow and outflow systems of this arteries and veins could improve surgical outcome, they warrant special attention during microsurgery and endovascular procedures.
