Tadashi Hamasaki1, Hiroki Uchikawa2, Yuki Ohmori2, Yasuyuki Kaku2, Tomonori Ono3, Shuichi Tochihara4, Toshinori Hirai5, Tatsuya Kawano2, Akitake Mukasa2. 1. Department of Neurosurgery, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan. thamasaki-nsu@umin.ac.jp. 2. Department of Neurosurgery, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan. 3. Department of Neurosurgery, Epilepsy Center, National Hospital Organization Nagasaki Medical Center, 2-1001-1, Kuhara, Omura, Nagasaki, 856-8562, Japan. 4. Department of Central Radiology, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan. 5. Department of Diagnostic Radiology, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
Abstract
BACKGROUND: The preservation of the anterior choroidal artery (AChA) is essential for avoiding neurological sequelae after mesial temporal lobe epilepsy (mTLE) surgery. The purpose of this study is to reveal the anatomical variation in which the perforating branches arise from the plexal segment of the AChA by using a modern neuroimaging modality. METHODS: This study analyzed 3D rotational angiography (3DRA) images from 56 subjects. The AChA and perforating branches were visualized using slab MIP. We analyzed branching patterns, courses of the perforating arteries arising from the plexal segment of the AChA, and the anastomosis of the AChA with other cerebral arteries. RESULTS: The slab MIP applied to 3DRA visualized one or more perforating branches from the AChA in 92.9% of cases. The presence of perforating branches arising from the AChA plexal segment was 17.3%. Most of the branching points of plexal perforators were likely located in the operative field during hippocampal resection. The course of the AChA plexal perforators included the posterior limb of the internal capsule. Anastomosis with other cerebral arteries was visualized in 25% of the AChA with plexal perforators. CONCLUSIONS: 3DRA slab MIP was useful for visualizing the perforating branches of the AChA. Our results showed the possibility that surgical manipulation of the choroid plexus may cause infarction in the AChA territory. We suggest that the existence of the AChA plexal perforators should be recognized to further enhance the safety of hippocampal resection for mTLE.
BACKGROUND: The preservation of the anterior choroidal artery (AChA) is essential for avoiding neurological sequelae after mesial temporal lobe epilepsy (mTLE) surgery. The purpose of this study is to reveal the anatomical variation in which the perforating branches arise from the plexal segment of the AChA by using a modern neuroimaging modality. METHODS: This study analyzed 3D rotational angiography (3DRA) images from 56 subjects. The AChA and perforating branches were visualized using slab MIP. We analyzed branching patterns, courses of the perforating arteries arising from the plexal segment of the AChA, and the anastomosis of the AChA with other cerebral arteries. RESULTS: The slab MIP applied to 3DRA visualized one or more perforating branches from the AChA in 92.9% of cases. The presence of perforating branches arising from the AChA plexal segment was 17.3%. Most of the branching points of plexal perforators were likely located in the operative field during hippocampal resection. The course of the AChA plexal perforators included the posterior limb of the internal capsule. Anastomosis with other cerebral arteries was visualized in 25% of the AChA with plexal perforators. CONCLUSIONS: 3DRA slab MIP was useful for visualizing the perforating branches of the AChA. Our results showed the possibility that surgical manipulation of the choroid plexus may cause infarction in the AChA territory. We suggest that the existence of the AChA plexal perforators should be recognized to further enhance the safety of hippocampal resection for mTLE.
Authors: Inuka K Gooneratne; Shahidul Mannan; Jane de Tisi; Juan C Gonzalez; Andrew W McEvoy; Anna Miserocchi; Beate Diehl; Tim Wehner; Gail S Bell; Josemir W Sander; John S Duncan Journal: Epilepsy Res Date: 2017-03-01 Impact factor: 3.045
Authors: M Hiramatsu; K Sugiu; T Hishikawa; J Haruma; Y Takahashi; S Murai; K Nishi; Y Yamaoka; Y Shimazu; K Fujii; M Kameda; K Kurozumi; I Date Journal: AJNR Am J Neuroradiol Date: 2020-10-01 Impact factor: 3.825
Authors: Mandy M A Conijn; Jeroen Hendrikse; Jaco J M Zwanenburg; Taro Takahara; Mirjam I Geerlings; Willem P Th M Mali; Peter R Luijten Journal: Eur Radiol Date: 2009-12 Impact factor: 5.315