Surgical Anatomy of Supratentorial Midline Lesions

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includes the parieto-occipital and calcarine arteries (13, 34). MATERIALS AND METHODS Twenty brains from human cadaver craniums were used for this microsurgical anatomic study. The internal carotid arteries and the vertebral arteries were dissected at the neck and then cannulated. Saline irrigation was used to wash out any residual luminal clots. After a satisfactory collateral flow across the circle of Willis was established, both the carotid and the vertebral arteries were perfused with red-colored latex. The calvarium and dura were opened to allow the cadaver craniums, as well as the brains, to be fixed in a 10% formal-dehyde solution to prepare them for microdissection. After a minimum of 1 month, the brains were removed from the craniums, with special care taken to cut the carotid and vertebral arteries proximally. The various anatomic features of the corpus callosum, as well as its vascularity, were studied using an operating microscope with ×6 to×40 magnification. Many details, including the origin, course, anastomoses, number, and caliber of the arterial branches involved in the blood supply of the corpus callosum, were carefully examined. The data were recorded and analyzed. RESULTS This study verified that the corpus callosum receives its blood supply from three main arterial systems: 1) the ACoA, 2) the pericallosal artery, and 3) the posterior pericallosal artery. The ACoA The ACoA, which connects both A1 segments of the ACA, was found to be located 1 to 9 mm (average, 4 mm) from the anterior aspect of the lamina terminalis. The ACoA gave rise to perforator branches in all of our specimens. Their number ranged between 1 and 6 (average, 2.5), and the diameters ranged from 0.15 to 2.1 mm (average, 0.37 mm). These branches were divided into three subgroups: 1) the hypothalamic artery (which did not supply the corpus callosum), 2) the subcallosal artery, and 3) the median callosal artery. In 80% of the specimens, either the subcallosal artery or the median callosal artery was present and contributed to the blood supply of the corpus callosum, especially to the anterior portion. These two arteries were never found to arise together from the ACoA. When either one was present, it occurred as a single artery, always as the dominant branch arising from the ACoA (Fig. 2, A-C).
FIGURE 2. Anatomic variations of the branches arising from the ACoA seen in sagittal ( A, C, E, G) and horizontal(B, D, F, H) planes. A andB, the hypothalamic artery ( open arrow) arises from the ACoA and supplies the anterior portion of the hypothalamus, the paraterminal gyrus, the subcallosal area, the column of the fornix, and the medial portion of the anterior commissure. In no instance did it supply the corpus callosum. In 20% of the specimens, the ACoA gave rise to only hypothalamic arteries. C andD, the subcallosal artery ( open arrow) supplies the same area as the hypothalamic artery and, in addition, the medial portions of the rostrum ( R) and genu (G) of the corpus callosum. It was present in 50% of the specimens and always as a single dominant artery. E through H, the median callosal artery follows the same course as
Page 1 and 2: To Print: Click your browser's PRIN
Page 3 and 4: After cutting through the medial po
Page 5 and 6: Figure 3. Case 1. A-C: Preoperative
Page 11 and 12: Figure 10. Case 8. A-C: Preoperativ
Page 13 and 14: Case 1 Figure 12. Case 10. A-C: Pre
Page 15 and 16: interhemispheric fissure or via a s
Page 17 and 18: Copyright © by the Congress of Neu
Page 19 and 20: We dissected 20 previously frozen,
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Page 25 and 26: Türe et al. present an anatomic re
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Page 29 and 30: temporo-occipital) gyrus (5, 13, 20
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Page 33 and 34: can also be identified. FIGURE 7. L
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Page 37 and 38: FIGURE 13. Illustration of the brai
Page 39 and 40: FIGURE 15. Drawing from one of Reil
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Page 45 and 46: adjacent territories. This occurs v
Page 47: atrial portion of the lateral ventr
Page 51 and 52: FIGURE 11. Arterial vascularization
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Page 55 and 56: from 0 to 7 (average, 1.1) per hemi
Page 57 and 58: DISCUSSION The fibers of the corpus
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Page 63 and 64: Arteries of the insula middle, and
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Page 67 and 68: Arteries of the insula Parasylvian
Page 69 and 70: Arteries of the insula The frontal
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Page 73: Arteries of the insula 17. Penfield

Surgical Anatomy of Supratentorial Midline Lesions

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