Perforating Arteries of the Lemniscal Trigone: A Microsurgical Neuroanatomic Description
Background: The perforating arteries in the dorsolateral zone of the midbrain play a crucial role in the functions of the brain stem. Their damage due to herniation, pathological lesions, or surgery, favored by the narrow tentorial incisura, can lead to hemorrhages or ischemia and subsequently to se...
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Frontiers Media S.A.
2021-08-01
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Series: | Frontiers in Neuroanatomy |
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Online Access: | https://www.frontiersin.org/articles/10.3389/fnana.2021.675313/full |
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Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Santino Ottavio Tomasi Santino Ottavio Tomasi Santino Ottavio Tomasi Giuseppe Emmanuele Umana Gianluca Scalia Roberto Luis Rubio-Rodriguez Roberto Luis Rubio-Rodriguez Roberto Luis Rubio-Rodriguez Giuseppe Raudino Julian Rechberger Philipp Geiger Bipin Chaurasia Kaan Yaǧmurlu Michael T. Lawton Peter A. Winkler Peter A. Winkler Peter A. Winkler |
spellingShingle |
Santino Ottavio Tomasi Santino Ottavio Tomasi Santino Ottavio Tomasi Giuseppe Emmanuele Umana Gianluca Scalia Roberto Luis Rubio-Rodriguez Roberto Luis Rubio-Rodriguez Roberto Luis Rubio-Rodriguez Giuseppe Raudino Julian Rechberger Philipp Geiger Bipin Chaurasia Kaan Yaǧmurlu Michael T. Lawton Peter A. Winkler Peter A. Winkler Peter A. Winkler Perforating Arteries of the Lemniscal Trigone: A Microsurgical Neuroanatomic Description Frontiers in Neuroanatomy lemniscal trigone dorsolateral midbrain perforating zone microsurgical anatomy arterial capillary network perforating arteries anatomical variability |
author_facet |
Santino Ottavio Tomasi Santino Ottavio Tomasi Santino Ottavio Tomasi Giuseppe Emmanuele Umana Gianluca Scalia Roberto Luis Rubio-Rodriguez Roberto Luis Rubio-Rodriguez Roberto Luis Rubio-Rodriguez Giuseppe Raudino Julian Rechberger Philipp Geiger Bipin Chaurasia Kaan Yaǧmurlu Michael T. Lawton Peter A. Winkler Peter A. Winkler Peter A. Winkler |
author_sort |
Santino Ottavio Tomasi |
title |
Perforating Arteries of the Lemniscal Trigone: A Microsurgical Neuroanatomic Description |
title_short |
Perforating Arteries of the Lemniscal Trigone: A Microsurgical Neuroanatomic Description |
title_full |
Perforating Arteries of the Lemniscal Trigone: A Microsurgical Neuroanatomic Description |
title_fullStr |
Perforating Arteries of the Lemniscal Trigone: A Microsurgical Neuroanatomic Description |
title_full_unstemmed |
Perforating Arteries of the Lemniscal Trigone: A Microsurgical Neuroanatomic Description |
title_sort |
perforating arteries of the lemniscal trigone: a microsurgical neuroanatomic description |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Neuroanatomy |
issn |
1662-5129 |
publishDate |
2021-08-01 |
description |
Background: The perforating arteries in the dorsolateral zone of the midbrain play a crucial role in the functions of the brain stem. Their damage due to herniation, pathological lesions, or surgery, favored by the narrow tentorial incisura, can lead to hemorrhages or ischemia and subsequently to severe consequences for the patient.Objective: In literature, not much attention has been directed to the perforating arteries in the lemniscus; in fact, no reports on the perforators of this anatomical region are available. The present study aims to a detailed analysis of the microanatomy and the clinical implications of these perforators, in relation to the parent vessels. We focused on the small vessels that penetrate the midbrain's dorsolateral surface, known as lemniscal trigone, to understand better their microanatomy and their functional importance in the clinical practice during the microsurgical approach to this area.Methods: Eighty-seven alcohol-fixed cadaveric hemispheres (44 brains) without any pathological lesions provided the material for studying the perforating vessels and their origin around the dorsolateral midbrain using an operating microscope (OPMI 1 FC, Zeiss). Measurements of the perforators' distances, in relation to the parent vessels, were taken using a digital caliper.Results: An origin from the SCA could be found in 70.11% (61) and from the PCA in 27.58% (24) of the hemispheres. In one hemisphere, an origin from the posterior choroidal artery was found (4.54%). No perforating branches were discovered in 8.04% of specimens (7).Conclusion: The perforating arteries of the lemniscal trigone stem not only from the superior cerebellar artery (SCA), as described in the few studies available in literature, but also from the posterior cerebral artery (PCA). Therefore, special attention should be paid during surgery to spare those vessels and associated perforators. A comprehensive understanding of the lemniscal trigone's perforating arteries is vital to avoid infarction of the brainstem when treating midbrain tumors or vascular malformations. |
topic |
lemniscal trigone dorsolateral midbrain perforating zone microsurgical anatomy arterial capillary network perforating arteries anatomical variability |
url |
https://www.frontiersin.org/articles/10.3389/fnana.2021.675313/full |
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doaj-ba3dcea71af240b983c01c22791193d42021-08-27T22:17:56ZengFrontiers Media S.A.Frontiers in Neuroanatomy1662-51292021-08-011510.3389/fnana.2021.675313675313Perforating Arteries of the Lemniscal Trigone: A Microsurgical Neuroanatomic DescriptionSantino Ottavio Tomasi0Santino Ottavio Tomasi1Santino Ottavio Tomasi2Giuseppe Emmanuele Umana3Gianluca Scalia4Roberto Luis Rubio-Rodriguez5Roberto Luis Rubio-Rodriguez6Roberto Luis Rubio-Rodriguez7Giuseppe Raudino8Julian Rechberger9Philipp Geiger10Bipin Chaurasia11Kaan Yaǧmurlu12Michael T. Lawton13Peter A. Winkler14Peter A. Winkler15Peter A. Winkler16Department of Neurological Surgery - Christian Doppler Klinik, Salzburg, AustriaDepartment of Neurosurgery, Paracelsus Medical University Salzburg, Salzburg, AustriaLaboratory for Microsurgical Neuroanatomy - Christian Doppler Klinik, Salzburg, AustriaDepartment of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, ItalyNeurosurgery Unit, Highly Specialized Hospital and of National Importance “Garibaldi”, Catania, ItalySkull Base and Cerebrovascular Laboratory, University of California, San Francisco, San Francisco, CA, United StatesDepartment of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United StatesDepartment of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, United StatesDepartment of Neurosurgery - Humanitas, Istituto Clinico Catanese, Catania, ItalyDepartment of Neurosurgery, Paracelsus Medical University Salzburg, Salzburg, AustriaDepartment of Neurosurgery, Paracelsus Medical University Salzburg, Salzburg, Austria0Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal1Department of Neurosurgery, University of Virginia, Charlottesville, VA, United States2Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United StatesDepartment of Neurological Surgery - Christian Doppler Klinik, Salzburg, AustriaDepartment of Neurosurgery, Paracelsus Medical University Salzburg, Salzburg, AustriaLaboratory for Microsurgical Neuroanatomy - Christian Doppler Klinik, Salzburg, AustriaBackground: The perforating arteries in the dorsolateral zone of the midbrain play a crucial role in the functions of the brain stem. Their damage due to herniation, pathological lesions, or surgery, favored by the narrow tentorial incisura, can lead to hemorrhages or ischemia and subsequently to severe consequences for the patient.Objective: In literature, not much attention has been directed to the perforating arteries in the lemniscus; in fact, no reports on the perforators of this anatomical region are available. The present study aims to a detailed analysis of the microanatomy and the clinical implications of these perforators, in relation to the parent vessels. We focused on the small vessels that penetrate the midbrain's dorsolateral surface, known as lemniscal trigone, to understand better their microanatomy and their functional importance in the clinical practice during the microsurgical approach to this area.Methods: Eighty-seven alcohol-fixed cadaveric hemispheres (44 brains) without any pathological lesions provided the material for studying the perforating vessels and their origin around the dorsolateral midbrain using an operating microscope (OPMI 1 FC, Zeiss). Measurements of the perforators' distances, in relation to the parent vessels, were taken using a digital caliper.Results: An origin from the SCA could be found in 70.11% (61) and from the PCA in 27.58% (24) of the hemispheres. In one hemisphere, an origin from the posterior choroidal artery was found (4.54%). No perforating branches were discovered in 8.04% of specimens (7).Conclusion: The perforating arteries of the lemniscal trigone stem not only from the superior cerebellar artery (SCA), as described in the few studies available in literature, but also from the posterior cerebral artery (PCA). Therefore, special attention should be paid during surgery to spare those vessels and associated perforators. A comprehensive understanding of the lemniscal trigone's perforating arteries is vital to avoid infarction of the brainstem when treating midbrain tumors or vascular malformations.https://www.frontiersin.org/articles/10.3389/fnana.2021.675313/fulllemniscal trigonedorsolateral midbrain perforating zonemicrosurgical anatomyarterial capillary networkperforating arteriesanatomical variability |