Variations of the cerebral arterial circle: morphological and clinical analysis / Variaciones del círculo arterial cerebral: análisis morfológico y clínico

SUMMARY: The variations knowledge of the cerebral arterial circle (CAC) is relevant due to its influence on the development of ischemic encephalic disorders. Among these variations, when the external diameter of the posterior communicating artery exceeds the posterior cerebral artery caliber, we have a fetal conformation of this circle. The aim of this study was to describe the variations of the CAC in Chilean individuals and to know the type of arterial conformation. Thirty adult brains were used to measure lengths and caliber of the pre-communicating segments of the anterior (A1) and posterior (P1) cerebral arteries, and the anterior (ACoA) and posterior (PCoA) communicating arteries. The arterial conformation type was established, and the length and caliber of these vessels were compared according to the right or left side. It was observed that 76.6 % of the CACs presented aplasia and / or hypoplasia. Of its components, PCoA was hypoplasic in 53.3 %, appearing bilaterally in 40 % of the subjects. The comparison according to the side, indicated that the mean length of A1 and PCoA on the right side was slightly higher. In the case of caliber, the mean of A1, P1 and PCoA was higher on the left side. Regarding P1 and PcoA caliber, 33 % of the CACs presented unilateral fetal conformation. Regardless of the variability presented by the CAC, there is consensus that PCoA exhibits the greatest variability. The understanding of this variability requires an analysis of the embryonic aspects that can explain the fetal conformation of the CAC in the adult.

RESUMEN: El conocimiento de las variaciones del círculo arterial cerebral (CAC) resultan relevantes por su influencia en el desarrollo de trastornos isquémicos encefálicos. De estas variaciones, los cambios del calibre de la arteria comunicante posterior (ACoP) determinan una conformación fetal de este círculo. El objetivo de este estudio fue describir las variaciones del CAC en individuos chilenos y conocer el tipo de conformación arterial. Se utilizaron 30 encéfalos adultos a los que se midieron las longitudes y calibres de los segmentos precomunicante de las arterias cerebrales anteriores (A1) y posteriores (P1), y de las arterias comunicante anterior (ACoA) y ACoP. Se estableció el tipo de conformación arterial y se comparó la longitud y calibre de estos vasos según lateralidad. Se observó que el 76,6 % de los CAC presentaron agenesias y/o hipoplasias. De sus componentes, la ACoP fue hipoplásica en el 53,3 %, presentándose bilateral en el 40 %. La comparación según lateralidad indicó que la longitud media de A1 y ACoP del lado derecho fueron levemente superiores. En el caso de los calibres, la media de A1, P1 y ACoP fue superior en el lado izquierdo. Respecto de los calibres de P1 y ACoP, el 33 % de los CAC presentaron conformación fetal unilateral. Independientemente de la variabilidad que presenta el CAC, existe consenso de que la ACoP exhibe la mayor variabilidad. La comprensión de esta variabilidad requiere un análisis de los aspectos embrionarios que pueden explicar la conformación fetal de esté círculo arterial en el adulto.

Arterial abnormalities and associated variations of the vertebrobasilar system on the brain base: apropos of a rare case / Anomalías arteriales y variaciones asociadas del sistema vertebrobasilar en la base del cerebro: un caso raro

SUMMARY: The presented case characterizes an association of primitive and definitive arteries with variations on the cadaveric brain base of a very old man. This case is found by the retrospective review of the data archive obtained during many years of cooperation of the author and co-authors. Fenestration of the (ectatic) basilar artery, partial and total duplication of some cerebellar arteries was associated with other variations of the vertebrobasilar and carotid systems. Although this is a case autopsied because of the myocardial infarction, the peculiarity of the case lies in the absence of the aneurysm based on the fenestration or dissection of one of the cerebral arteries.

RESUMEN: El caso presentado caracteriza una asociación de arterias primitivas y definitivas con variaciones sobre la base cerebral cadavérica de un anciano. Este caso se encuentra mediante la revisión retrospectiva de datos obtenidos durante muchos años de un trabajo de cooperación del autor y coautores. La fenestración de la arteria basilar (ectásica), la duplicación parcial y total de algunas arterias cerebelosas se asoció con otras variaciones de los sistemas vertebrobasilar y carotídeo. Si bien se trata de un caso de autopsia a causa de un infarto del miocardio, la peculiaridad del caso radica en la ausencia del aneurisma en base a la fenestración o disección de una de las arterias cerebrales.

Anatomical description and variations of the anterior arterial brain circulation in Colombian cadaveric specimens / Descripción anatómica y variaciones de la circulación cerebral arterial anterior en especímenes cadavéricos colombianos

SUMMARY: Understanding microsurgical neuroanatomy is a fundamental part of the training of neurosurgeons. Notwithstanding the fact that throughout history the study in cadavers has been a fundamental part of training, the publication of these studies has never marked a trend, and in our country the available studies are limited. A descriptive anatomical study was carried out on 22 specimens regarding the anatomical arrangement of the anterior circulation arteries of the brain and the most frequent anatomical variants in the sample used. To this end, bilateral pterional and bifrontal approaches were performed, obtaining a total of 132 arteries, including supraclinoid internal carotid arteries (ICA), anterior cerebral arteries in their A1 segment (ACA), and middle cerebral arteries in their M1 segment (MCA). measurements in each of these segments were made and anatomical variants were documented. Out of 22 cadaveric specimens, 17 (77 %) were male. the mean age was 59 years (range 36-81 years). Internal carotid artery mean length was 12.73 and 12.86 in the right and left side respectively. Anatomical variants identified were hypoplasia of segment A1 in 1 (4.5 %) specimen, duplication in 1 (4.5 %) and trifurcation of segment M1 in 3 (13.6 %) specimens. A similarity was found between our data and data reported by literature, with some differences, especially in the anterior communicating artery.

RESUMEN: Entender la neuroanatomía microquirúrgica es una parte fundamental de la formación de los neurocirujanos. A pesar de que, durante la historia, el estudio en cadáveres ha sido parte fundamental del entrenamiento, no ha sido tendencia la publicación de estos estudios, y en nuestro país son limitados los que se encuentran. Se realizó un estudio descriptivo anatómico en 22 especímenes acerca de la disposición anatómica de las arterias de la circulación cerebral anterior y las variantes anatómicas más frecuentes en población colombiana. Para dicho objetivo se realizaron abordajes bilaterales pterionales, y bifrontales obteniendo un total de 132 arterias incluyendo las arterias carotídeas internas supraclinoideas (ACI), arterias cerebrales anteriores en su segmento A1 (ACA) y las arterias cerebrales medias en su segmento M1 (ACM), se realizaron mediciones en cada uno de estos segmentos y se documentaron las variantes anatómicas. De los 22 especímenes cadavéricos, 17 (77 %) eran masculinos, la edad media fue de 59 años (rango 36-81 años). La longitud media de la arteria carótida interna fue de 12,73 mm en el lado derecho y de 12,86 mm en el lado izquierdo. Las variantes anatómicas identificadas fueron hipoplasia del segmento A1 en 1 (4,5 %), duplicación de A1 en 1 (4,5 %) y trifurcación del segmento M1 en 3 (13,6 %) muestras. Se encontró una similitud entre nuestros datos y los reportados por la literatura, con algunas diferencias, especialmente en el segmento de la arteria comunicante anterior.

Evaluación morfológica y variaciones del circulo arterial cerebral: un estudio con material cadavérico en una muestra de población colombianas / Morphological evaluation and variations of the cerebral arterial circle: a study with cadaveric material in a Colombian population sample

RESUMEN: El círculo arterial cerebral (CAC) mencionado también como polígono de Willis es una red de anastomosis vascular situado en la base del cerebro, constituido por ramas de la arteria carótida interna (ACI) y del sistema vertebro-basilar. Este estudio evaluó la morfología de las arterias que conforman el CAC en una muestra de individuos colombianos. Previa canalización de la ACI y de la arteria vertebral (AV), se perfundió con resina poliéster (palatal 85 % y estireno 15 %) los lechos vasculares del CAC de 70 encéfalos extraídos de cadáveres a quienes se les practicó necropsia en el Instituto de Medicina Legal de Bucaramanga, Colombia. La arteria comunicante anterior (ACoA) se observó en 68 encéfalos (97,1 %), con ausencia en 2 de las muestras (2,9 %); en promedio su diámetro fue de 1,91?1,04 mm y su longitud 2,21?0,97 mm respectivamente. Asimismo, se encontró hipoplasia en 6 muestras (8,4 %). La arteria comunicante posterior (ACoP) estuvo ausente en 2 de las muestras (5,7 %); su longitud fue 11,63?2,12 mm, mientras que su calibre fue de 1,21?0,58 mm, siendo ligeramente mayor en el lado derecho, sin diferencias estadísticamente significativas con relación al lado de presentación (p= 0,763). Se encontró hipoplasia de la ACoP en forma bilateral en 19 de las muestras (27,1 %) y unilateral en 15 muestras (21,4 %). En 8 muestras (20 %) de 35 CAC evaluados se observó configuración fetal. La incidencia de hipoplasia de la ACoP y de configuración fetal encontrados en el presente estudio, se ubican en el segmento superior de lo reportado en la literatura. Estas expresiones morfológicas han sido consideradas como coadyuvantes en el desarrollo de accidentes cerebro-vasculares (ACV).

SUMMARY: The cerebral arterial circle (CAC), also referred to as the polygon of Willis is a network of vascular anastomoses located at the base of the brain, consisting of branches of the internal carotid artery (ICA) and the vertebrobasilar system (VBS). This study evaluated the morphology of the arteries forming the CAC in a sample of Colombian individuals. After cannulation of the ICA and the vertebral artery (VA), the vascular beds of the ACC of 70 brains extracted from cadavers at the Institute of Legal Medicine of Bucaramanga, Colombia, were perfused with polyester resin (85 % palatal and 15 % styrene). The anterior communicating artery (ACoA) was observed in 68 brains (97.1 %), with absence in 2 of the samples (2.9 %); on average its diameter was 1.91?1.04mm and its length 2.21?0.97mm respectively. Likewise, hypoplasia was found in 6 samples (8.4 %). The posterior communicating artery (ACoP) was absent in 2 of the samples (5,7 %); its length was 11.63?2.12mm, while its caliber was 1.21?0.58mm, being slightly larger on the right side, with no statistically significant differences in relation to the side of presentation (p= 0.763). Hypoplasia of the ACoP was found bilaterally in 19 of the samples (27.1 %) and unilaterally in 15 samples (21.4 %). Fetal configuration was observed in 8 samples (20 %) of 35 CACs evaluated. The incidence of ACoP hypoplasia and fetal configuration found in the present study are in the upper segment of those reported in the literature. These morphological expressions have been considered as coadjuvants in the development of cerebrovascular accidents (CVA).

Anatomic study of the arterial vascularization of the brain base of paca (Cuniculus paca) / Estudo anatômico da vascularização arterial da base do encéfalo da paca (Cuniculus paca)

Paca (Cuniculus paca Linnaeus, 1766), rodent belong to the Cuniculidae family, has encouraged numerous scientific researches and for this reason could be an experimental model in both human and veterinary areas. And recently, the economic exploitation of the meat cuts, has being direct implication in its zootechnical importance. However, no anatomical descriptions regarding the vascularization of the base of the brain in this rodent has being found. Thus, the aim of the present study was to describe the arteries and the pattern of the vasculature and to compare it with the other species already established in the literature. For this, five pacas, donated by the Unesp Jaboticabal Wildlife Sector, were euthanized followed by the vascular arterial system was injected with red-stained-centrifuged latex by the common carotid artery. After craniectomy, the brains were removed and the arteries were identified and, in addition, compared with those described in other animal species. The presence of the right and left vertebral arteries, close to the medulla oblongata, was detected, originating the basilar artery, which divided into the terminal branches of the right and left basilar artery. Ventral to the optic tract there was the right internal carotid artery and the left, dividing the middle cerebral artery and left rostral and right; dorsal to the optic chiasm, the medial branch of the rostral cerebral arteries was identified. Based on the results, it is concluded that the vascularization of the paca brain base is supplied by the carotid and vertebrobasilar system.(AU)

A paca (Cuniculus paca Linnaeus 1766), roedor da família Cuniculidae, tem encorajado inúmeras pesquisas científicas, tornando-a modelo experimental tanto na área humana quanto na veterinária, além da recente exploração econômica de seus cortes cárneos, que favoreceu diretamente sua importância zootécnica. No entanto, não há até o momento, descrições anatômicas referentes à padronização da vascularização da base do encéfalo neste roedor. Assim, o objetivo do presente trabalho foi realizar tal delineamento arterial nessa região do sistema nervoso central e compará-lo com as demais espécies já estabelecidas na literatura. Para isso, foram eutanasiadas cinco pacas doadas pelo setor de Animais Silvestres da Unesp Jaboticabal, as quais foram submetidas posteriormente à injeção de látex centrifugado e corante líquido xadrez vermelho, pela artéria carótida comum. Após craniectomia e segregação do encéfalo de todos os cadáveres, realizou-se a identificação das artérias presentes na base deste órgão e, ademais, comparação destas com as descritas cientificamente em outras espécies animais. Detectou-se a presença das artérias vertebral direita e esquerda, próximas à medula oblonga, originando a artéria basilar, que se dividiu nos ramos terminais da artéria basilar direito e esquerdo. Ventral ao trato óptico verificou-se a artéria carótida interna direita e esquerda dividindo-se na artéria cerebral média e rostral direita e esquerda; ainda, dorsal ao quiasma óptico, identificou-se o ramo medial das artérias cerebrais rostrais. Com base nos resultados obtidos, conclui-se que a vascularização da base do encéfalo da paca é suprida pelo sistema carotídeo e vertebro-basilar.(AU)

Morphological evaluation of the distal medial striate artery. A study with cadaveric material / Evaluación morfológica de la arteria estriada medial distal. Un estudio con material cadavérico

Abstract Objective: To evaluate the morphology of the distal medial striated artery, taking into account biometric variables useful for clinical and surgical management. Methods: A descriptive transversal study was performed with a sample of brains, who underwent autopsy at the Institute of Legal Medicine and Forensic Sciences of Bucaramanga-Colombia, which were evaluated using the perfusion technique of vascular structures with polyester resin. Results: The distal medial striated artery was presented in 1.4% and 4.2% duplicated in the right and left hemispheres respectively. Agenesis was presented in 2.8% in the left hemisphere. Its origin was 44.6% of the anterior cerebral artery junction site with the anterior communicating artery and was observed in 6 cases (4.2%) presented with a common trunk with the orbitofrontal artery. The main qualitative finding was the sinuous trajectory that was observed in 57.7% on the right side and 45.1% in the left hemisphere. Also, an important alteration found at the biometric analysis was hypoplasia that could be related to the decreased blood supply to the basal nuclei. The diameter was 0.5 ± 0.2 mm and its total length was 20.3 ± 4.1 mm. Conclusions: The topographical knowledge of this structure determines the vulnerability of its morphology because it can complicate surgical procedures performed in the anterior segment of the arterial circle of the brain. Besides, the observed collateral circulation contributes to the blood supply and the perfect functionality of the subcortical nervous structures.

Resumen Objetivo: Evaluar la morfología de la arteria estriada medial distal, teniendo en cuenta variables biométricas útiles para el manejo clínico y quirúrgico. Métodos: Estudio descriptivo transversal con una muestra de cerebros que fueron sometidos a autopsia en el Instituto de Medicina Legal y Ciencias Forenses de Bucaramanga-Colombia, fueron evaluados mediante la técnica de perfusión de estructuras vasculares con resina de poliéster. Resultados: La arteria estriada medial distal se presentó en 1.4% y 4.2% duplicada en el hemisferio derecho e izquierdo respectivamente. Agenesia se presentó en 2.8% en el hemisferio izquierdo. Su origen fue 44.6% del sitio de unión de la arteria cerebral anterior con la arteria comunicante anterior y se observó en 6 casos (4.2%) que presentaban un tronco común con la arteria orbitofrontal. El hallazgo principal fue la trayectoria sinuosa que se observó en 57.7% en el lado derecho y 45.1% en el hemisferio izquierdo. También una alteración importante encontrada en el análisis biométrico fue la hipoplasia que podría estar relacionada con la disminución del suministro de sangre a los núcleos basales. El diámetro fue de 0.5 ±0.2 mm y su longitud total fue de 20.3 ±4.1 mm. Conclusiones: El conocimiento topográfico de esta estructura determina la vulnerabilidad de su morfología, porque puede complicar los procedimientos quirúrgicos realizados en el segmento anterior del círculo arterial del cerebro. Además, la circulación colateral observada contribuye al riego sanguíneo y al perfecto funcionamiento de las estructuras nerviosas subcorticales.

Vascularization of the Alouatta belzebul brain base / Vascularização da base do encéfalo de Alouatta belzebul

We studied the arterial circle in the brain of five specimens of the Alouatta belzebul primate. The material had the arterial system perfused (water at 40°C), injected with stained latex (Neoprene 650), fixed in aqueous formaldehyde solution (10%) and dissected for vessel verification. The arterial circle of this primate is composed of two vascular systems: the vertebra-basilar and the carotid ones, which anastomose to close the arterial circuit. In the caudal portion of the arterial circle, there are the vertebral arteries and their branches: the rostral spinal artery and the caudal inferior cerebellar artery. The anastomosis of the vertebral arteries gives rise to the basilar artery. It presented an anatomical variation at the beginning of its path, forming a double basilar artery, called arterial island. In its course, it emitted branches giving rise to the rostral inferior cerebellar artery, the pontine arteries, the rostral cerebellar arteries, the satellite rostral cerebellar arteries and its terminal branch, the caudal cerebral artery, which presented itself in two segments: the pre-communicating one and post-communicating, joining the internal carotid artery and originating the caudal communicating artery. This group of arteries and anastomoses enclose the caudal portion of the arterial circle. From the right and left internal carotid arteries begins the rostral portion of the arterial circle, which consists of the right and left rostral cerebral arteries and the right and left middle cerebral arteries. The rostral cerebral arteries anastomose into a single trunk, giving rise to the interhemispheric artery, and in A. belzebul and Sapajus libidinosus, the rostral communicating artery is absent. The interhemispheric artery goes to the midbrain region and the corpus callosum knee divides into pericalous artery and callosarginal artery, which will supply the pre and post-central regions of the cerebral hemispheres of this species, as well as other non-human and human primates. It is noted that in the first part of the left rostral cerebral artery, there is a direct inosculation between the recurrent branch of the rostral cerebral artery and left middle cerebral artery to supply the entorhinal region. This fact also occurs in Pongo spp. The middle cerebral artery travels along the lateral sulcus where it emits several superficial branches to irrigate the superior and inferior lateral cortical regions of the frontal, parietal and temporal lobes. It is not part of the arterial circle but is the terminal branch of the internal carotid artery. A. belzebul can be considered to depend on two sources of supply to the brain: the vertebra-basilar and carotid systems, contributing to the intervention of veterinarians during clinical and surgical procedures in other primates, as well as the preservation of wild animals.(AU)

Estudamos o círculo arterial no encéfalo de cinco espécimes do primata Alouatta belzebul. O material teve o sistema arterial perfundido (água a 40°C), injetado com látex corado (Neoprene 650), fixado em solução aquosa de formaldeído (10%) e dissecado para verificação dos vasos. O círculo arterial deste primata é composto por dois sistemas vasculares: vértebro-basilar e o sistema carotídeo, que se anastomosam para fechar o circuito arterial. Na porção caudal do círculo arterial encontra-se as artérias vertebrais e seus ramos: artéria espinal rostral e a cerebelar inferior caudal. A anastomose das artérias vertebrais dá origem a artéria basilar. Esta apresentou uma variação anatômica no início do seu trajeto, formando uma dupla artéria basilar, denominada ilha arterial. Em seu trajeto emitiu ramos dando origem a artéria cerebelar inferior rostral, as artérias pontinas, as artérias cerebelares rostrais, as artérias cerebelares rostrais satélites e o seu ramo terminal, a artéria cerebral caudal, que apresentou-se em dois segmentos: o pré-comunicante e pós-comunicante, unindo-se a artéria carótida interna e originando a artéria comunicante caudal. Este grupo de artérias e anastomoses encerram a porção caudal do círculo arterial. Das artérias carótidas internas direita e esquerda, inicia-se a porção rostral do círculo arterial, ao qual é constituído pelas artérias cerebrais rostrais direita e esquerda e as artérias cerebrais médias direita e esquerda. As artérias cerebrais rostrais se anastomosam em um tronco único dando origem a artéria inter-hemisférica e em A. belzebul e Sapajus libidinosus, a artéria comunicante rostral se encontra ausente. A artéria inter-hemisférica segue para região média do encéfalo e no joelho do corpo caloso se divide em artéria pericalosa e artéria calosomarginal, que vão suprir as regiões pré e pós-central dos hemisférios cerebrais desta espécie, assim como outros primatas não humanos e humano. Nota-se que na primeira parte da artéria cerebral rostral esquerda, ocorre uma inosculação direta entre o ramo recorrente da artéria cerebral rostral e artéria cerebral média esquerda para suprir a região entorrinal, esse fato também ocorre em Pongo spp. A artéria cerebral média segue seu trajeto pelo sulco lateral onde emite vários ramos superficiais para irrigar as regiões corticais supero e ínfero lateral do lobo frontal, parietal e temporal, esta não faz parte do círculo arterial mas é o ramo terminal da artéria carótida interna. Pode-se considerar que A. belzebul depende de duas fontes de suprimento para o encéfalo: os sistemas vértebro-basilar e carotídeo, contribuindo na intervenção de médicos veterinários durante os procedimentos clínicos e cirúrgicos em outros primatas, assim como na preservação de animais silvestres.(AU)

Repercusión neurológica por cambios en el flujo sanguíneo cerebral en neonatos sometidos a cirugía cardiovascular / Neurological repercussions of changes in cerebral blood flow in neonates undergoing cardiovascular surgery

Resumen Introducción: La cirugía de cardiopatías congénitas puede generar alteraciones perfusorias cerebrales con repercusión neurológica. Objetivo: Analizar la relación del índice de resistencia (IR) vascular cerebral periquirúrgico con funciones neurológicas mediatas posteriores a cirugía de cardiopatía congénita. Método: Estudio de cohorte prospectivo de 34 neonatos en quienes se determinó IR de la arteria basilar, niveles séricos de oxígeno, dióxido de carbono y lactato, antes y después de procedimientos paliativos o correctivos. Relacionamos el IR prequirúrgico con la capacidad posquirúrgica para iniciar la vía enteral o restablecer la respiración espontánea no asistida. Resultados: Se integraron tres grupos: 17 neonatos con IR alto > 0.73, cinco con IR normal de 0.63 a 0.73 y seis con IR bajo < 0.63. En los primeros persistió IR alto en el posquirúrgico, con hiperlactatemia e hipoxia persistentes; en 86 % no se logró iniciar la vía enteral ni retirar la ventilación asistida. En los segundos, el IR se mantuvo en valores normales. En los terceros, si bien el IR, el lactato sérico y la presión arterial de oxígeno tendieron a normalizarse, 71 % presentó daño neurológico grave. Conclusiones: Los cambios en el IR fueron frecuentes, aunque el daño neurológico parece presentarse más cuando el IR se mantiene alto, posiblemente asociado a flujos cerebrales bajos.

Abstract Introduction: Surgery for congenital heart disease can generate cerebral perfusion-associated alterations with neurological repercussions. Objective: To analyze the relationship of peri-surgical cerebrovascular resistance index (RI) with mediate neurological functions after congenital heart disease surgery. Method: Prospective cohort study of 34 neonates in whom basilar artery RI, serum oxygen, carbon dioxide and lactate levels were determined before and after palliative or corrective procedures. We related pre-surgical RI with post-surgical ability to initiate the enteral route or to restore unassisted spontaneous breathing. Results: Three groups were formed: 17 neonates with high RI (> 0.73), five with normal RI (0.63-0.73) and six with low RI (< 0.63). In the former group, high RI persisted in the postoperative period, with persistent hyperlactatemia and hypoxia; in 86%, the enteral route could not be initiated, and neither could assisted ventilation be withdrawn. In the second group, IR remained within normal values. In the third group, although RI, serum lactate and arterial oxygen pressure tended to normalize, 71% had severe neurological damage. Conclusions: RI changes were common, although neurological damage appears to occur more commonly when RI remains high, possibly associated with low cerebral blood flow.

Prevalencia de la arteria estriada medial distal en una muestra de poblaciones Colombiana y Peruana / Prevalence of distal medial striatal artery in a sample of Colombian and Peruvian populations

La arteria estriada medial distal hace parte de la circulación encefálica, nace de la arteria cerebral anterior generalmente a nivel de la arteria comunicante anterior, aunque según distintos estudios su origen varía, siendo así difícil de determinar con exactitud. Su importancia clínica radica en la prevalencia de aneurismas encontrados en esta arteria, que posteriormente podrían causar complicaciones debido a la región que irrigan, siendo estas las secuelas somático-vitales y neuropsicológicas, además de su inadecuado abordaje quirúrgico sin prever las alteraciones que puedan ser ocasionados; a causa de lo anterior es de vital importancia que los profesionales de la salud tengan previo conocimiento de la anatomía y la prevalencia de esta arteria en la población. Se realizó un estudio observacional de tipo descriptivo en donde se analizó la arteria estriada medial distal en 70 encéfalos, piezas de los anfiteatros de Medicina de la Universidad de Ciencias Aplicadas y Ambientales U.D.C.A. (Bogotá), la Universidad Científica del Sur UCSUR (Lima); fijados en formol al 10 %, se realizaron mediciones morfométricas mediante calibrador digital y se tomó el registro fotográfico con una cámara Canon. Posteriormente se ejecutó el análisis estadístico mediante el programa IBM SPSS Stadistics 24. Se encontró una prevalencia del 88,6 % de al menos una arteria estriada medial distal en población colombiana y un 97,1 % de la población peruana. Se identificó un diámetro externo promedio de 0,64 mm en población colombiana y de 0,68 mm en población peruana. Se observó una longitud promedio de 2,5 cm en ambas poblaciones. Se evidenció el mayor lugar de origen en la porción A2 de la ACA con un 37,1 % de población colombiana y un 51,4 % de población peruana. Se debe conocer adecuadamente la anatomía y las correspondientes variaciones anatómicas de esta arteria para así poder realizar un adecuado abordaje neurológico y neuroquirúrgico.

The distal medial striate artery is part of the brain circulation, born from the anterior cerebral artery generally at the level of the anterior communicating artery, although according to different studies its origin varies, being thus difficult to determine with accuracy. Its clinical importance lies in the prevalence of aneurysms found in this artery, which could later cause complications due to the region they irrigate, these being the somatic-vital and neuropsychological sequelae, in addition to its inadequate surgical approach without foreseeing the alterations that may be caused; Because of the above it is of vital importance that health professionals have prior knowledge of the anatomy and prevalence of this artery in the population. An observational descriptive study was carried out in which the distal medial striated artery in 70 brain cells, pieces from the Medicine amphitheatres of the Universidad de Ciencias Aplicadas y Ambientales U.D.C.A. (Bogotá), the Universidad Científica del Sur UCSUR (Lima); fixed in 10 % formalin, morphometric measurements were made by automatic calibrator and the photographic record was taken with a Canon camera. Subsequently, the statistical analysis was executed through the IBM SPSS Statistics program 24. A prevalence of 88.6 % of at least one distal medial striate artery was found in the Colombian population and 97.1 % of the Peruvian population. An average external diameter of 0.64 mm was identified in the Colombian population and 0.68 mm in the Peruvian population. An average length of 2.5 cm was observed in both populations. The largest place of origin was evidenced in the A2 portion of the ACA with 37.1 % of the Colombian population and 51.4 % of the Peruvian population. The anatomy and the corresponding anatomical variations of this artery must be adequately known to be able to perform an adequate neurological and neurosurgical approach.

Morphological configuration and topography of the brain arterial supply of the one-humped camel ( Camelus dromedarius, Linnaeus 1758) / Configuración morfológica y topografía del suministro arterial del encéfalo del camello de una joroba ( Camelus dromedarius, Linnaeus 1758)

This study investigated the anatomy of the arteries of the brain, including the arterial circle of the brain, its branches and junctions, in five camel (Camelus dromedarius, Linnaeus 1758) following intravascular injection of colored latex via common carotid artery. The course and distribution of the arterial supply to the brain was described and morphological analysis was made. The basilar artery contributed to the blood supply of the brain in the camel in contrast to the situation in other Artiodactyla order.

En presente estudio se analizó la anatomía de las arterias del encéfalo en cinco camellos (Camelus dromedarius, Linnaeus 1758). Después de administrar una inyección intravascular de látex coloreado en la arteria carótida común se estudiaron las arterias incluyendo al círculo arterial del cerebro, sus ramas y uniones. Fueron descritos en detalle el curso y la distribución del suministro arterial al encéfalo y se realizó un análisis morfológico. La arteria basilar contribuyó al suministro de sangre del encéfalo del camello, diferenciando este aspecto en otras especies de Artiodactyla.

Predictors of outcomes after correction of acute type a aortic dissection under moderate hypothermic circulatory arrest and antegrade cerebral perfusion

Abstract Introduction: Hypothermic circulatory arrest is widely used for correction of acute type A aortic dissection pathology. We present our experience of 45 consecutive patients operated in our unit with bilateral antegrade cerebral perfusion and moderate hypothermic circulatory arrest. Methods: Between January 2011 and April 2015, 45 consecutive patients were admitted for acute type A aortic dissection and operated emergently under moderate hypothermic circulatory arrest and bilateral antegrade cerebral perfusion. Results: Mean age was 58±11.4 years old. Median circulatory arrest time was 41.5 (30-54) minutes while the 30-day mortality and postoperative permanent neurological deficits rates were 6.7% and 13.3%, respectively. Unadjusted analysis revealed that the factors associated with 30-day mortality were: preoperative hemodynamic instability (OR: 14.8, 95% CI: 2.41, 90.6, P=0.004); and postoperative requirement for open sternum management (OR: 5.0, 95% CI: 1.041, 24.02, P=0.044) while preoperative hemodynamic instability (OR: 8.8, 95% CI: 1.41, 54.9, P=0.02) and postoperative sepsis or multiple organ dysfunction (OR: 13.6, 95% CI: 2.1, 89.9, P=0.007) were correlated with neurological dysfunction. By multivariable logistic regression analysis, postoperative sepsis and multiple organ dysfunction independently predicted (OR: 15.9, 95% CI: 1.05, 96.4, P=0.045) the incidence of severe postoperative neurological complication. During median follow-up of 6 (2-12) months, the survival rate was 86.7%. Conclusion: Bilateral antegrade cerebral perfusion and direct carotid perfusion for cardiopulmonary bypass, in the surgical treatment for correction of acute aortic dissection type A, is a valuable technique with low 30-day mortality rate. However, postoperative severe neurological dysfunctions remain an issue that warrants further research.

Cerebral blood flow and vasoreactivity in aging: an arterial spin labeling study

Regional cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) in young and elderly participants were assessed using pulsed arterial spin labeling (ASL) and blood oxygenation level-dependent (BOLD) magnetic resonance imaging (MRI) techniques in combination with inhalation of CO2. Pulsed ASL and BOLD-MRI were acquired in seventeen asymptomatic volunteers (10 young adults, age: 30±7 years; 7 elderly adults, age: 64±8 years) with no history of diabetes, hypertension, and neurological diseases. Data from one elderly participant was excluded due to the incorrigible head motion. Average baseline CBF in gray matter was significantly reduced in elderly (46±9 mL·100 g-1·min-1) compared to young adults (57±8 mL·100 g-1·min-1; P=0.02). Decreased pulsed ASL-CVR and BOLD-CVR in gray matter were also observed in elderly (2.12±1.30 and 0.13±0.06 %/mmHg, respectively) compared to young adults (3.28±1.43 and 0.28±0.11 %/mmHg, respectively; P<0.05), suggesting some degree of vascular impairment with aging. Moreover, age-related decrease in baseline CBF was observed in different brain regions (inferior, middle and superior frontal gyri; precentral and postcentral gyri; superior temporal gyrus; cingulate gyri; insula, putamen, caudate, and supramarginal gyrus). In conclusion, CBF and CVR were successfully investigated using a protocol that causes minimal or no discomfort for the participants. Age-related decreases in baseline CBF and CVR were observed in the cerebral cortex, which may be related to the vulnerability for neurological disorders in aging.

Morphometric study of the rostral epidural rete mirabile in the dromedary (Camelus dromedarius, Linnaeus 1758) / Estudio morfométrico de la rete mirabile epidural rostral en el dromedario (Camelus dromedarius, Linnaeus 1758)

In camels, the rostral epidural rete mirabile had a spongy appearance, and consisted of a dense network of anastomosing arteries occupying the entire cavity of the cavernous sinus. In this study, we measured the length of each rostral epidural rete mirabile lobe, taken between the rostral and the caudal roots dissected in situ before spreading and after reconstitution, and the total length of the rostral epidural rete mirabile after linear reconstitution. The length of the left lobe of the rete was 6.0±0.4 mm and the length of the right lobe was 5.8 ± 0.5 mm. The combined length of the RERM after separation of the arteries was 305.2±9.7 cm. To conclude, we added information to literature in relation to morphometry of the camel RERM and showed this interesting structure with photographic documentation of dissections with latex injection in arterial and venous vessels.

En los camellos, la rete mirabile epidural rostral (RMER) tenía una apariencia esponjosa y consistía en una densa red de arterias anastomosadas que ocupaban toda la cavidad del seno cavernoso. En este estudio se midió la longitud de cada lóbulo epitelial rostral de la rete mirabile, tomado entre las raíces rostral y caudal, disecadas in situ, antes de su propagación y después de la reconstitución, como así también la longitud total de la rete mirabile epidural rostral tras la reconstitución lineal. La longitud del lóbulo izquierdo de la rete mirabile fue de 6,0±0,4 mm y la longitud del lóbulo derecho fue de 5,8±0,5 mm. La longitud combinada del RMER después de la separación de las arterias fue de 305,2±9,7 cm. Para concluir, se agregó información de la literatura en relación con la morfometría del RMER de camellos y se mostró esta interesante estructura con documentación fotográfica de disecciones con inyección de látex en vasos arteriales y venosos.

Endovascular thrombectomy for the treatment of acute ischemic stroke / Tratamento endovascular do acidente vascular isquêmico agudo

ABSTRACT Few patients benefit from the current standard treatment for acute ischemic stroke (AIS), encouraging the development of new treatments. Objective To systematically review the literature on the efficacy and/or safety of endovascular thrombectomy in AIS compared to standard treatment and to identify ongoing randomized controlled trials (RCTs). Method Searches for RCTs were performed in Medline/Embase, and for ongoing trials: International Clinical Trial Registry Platform, Clinicaltrials.gov and ISRCTN registry (to June 15th, 2015). Results From the eight published RCTs, five showed the superiority of treatment that includes thrombectomy compared to standard care alone. From the 13 ongoing RCTs, 3 have been halted, one has not started, one has unknown status and eight will end between 2016 - 2020. Conclusion Evidence favours a combination of the standard therapy with endovascular thrombectomy. The selection criteria however limit the number of people who can benefit. Further studies are needed to prove its cost-effectiveness.

RESUMO Poucos pacientes se beneficiam do atual tratamento para o acidente vascular cerebral isquêmico agudo (AVCIA), incentivando o desenvolvimento de novos tratamentos. Objetivo Revisão sistemática da literatura sobre a eficácia e/ou segurança da trombectomia endovascular (TE) em AVCIA comparado com tratamento padrão (TP) e identificar ensaios clínicos randomizados controlados (ECR) atualmente em andamento. Método Buscas por ECRs foram conduzidas no Medline,Embase, International Clinical Trial Registry Platform, Clinicaltrials.gov e no ISRCTN registry (to June 15th, 2015). Resultados Oito ECRs publicados foram identificados, dos quais cinco mostraram superioridade do tratamento com trombectomia comparado ao TP. Dos 13 ERCs registrados, 3 foram suspensos, um não iniciou, um temstatus desconhecido e oito encerrarão recrutamento entre 2016 e 2020. Conclusão A evidência favorece a combinação do TP com a TE em relação ao TP somente. Os critérios de inclusão limitam o número daqueles que poderiam se beneficiar. Mais estudos são necessários para demonstrar o custo-efetividade desta intervenção.

Brain caspase-3 and intestinal FABP responses in preterm and term rats submitted to birth asphyxia

Neonatal asphyxia can cause irreversible injury of multiple organs resulting in hypoxic-ischemic encephalopathy and necrotizing enterocolitis (NEC). This injury is dependent on time, severity, and gestational age, once the preterm babies need ventilator support. Our aim was to assess the different brain and intestinal effects of ischemia and reperfusion in neonate rats after birth anoxia and mechanical ventilation. Preterm and term neonates were divided into 8 subgroups (n=12/group): 1) preterm control (PTC), 2) preterm ventilated (PTV), 3) preterm asphyxiated (PTA), 4) preterm asphyxiated and ventilated (PTAV), 5) term control (TC), 6) term ventilated (TV), 7) term asphyxiated (TA), and 8) term asphyxiated and ventilated (TAV). We measured body, brain, and intestine weights and respective ratios [(BW), (BrW), (IW), (BrW/BW) and (IW/BW)]. Histology analysis and damage grading were performed in the brain (cortex/hippocampus) and intestine (jejunum/ileum) tissues, as well as immunohistochemistry analysis for caspase-3 and intestinal fatty acid-binding protein (I-FABP). IW was lower in the TA than in the other terms (P<0.05), and the IW/BW ratio was lower in the TA than in the TAV (P<0.005). PTA, PTAV and TA presented high levels of brain damage. In histological intestinal analysis, PTAV and TAV had higher scores than the other groups. Caspase-3 was higher in PTAV (cortex) and TA (cortex/hippocampus) (P<0.005). I-FABP was higher in PTAV (P<0.005) and TA (ileum) (P<0.05). I-FABP expression was increased in PTAV subgroup (P<0.0001). Brain and intestinal responses in neonatal rats caused by neonatal asphyxia, with or without mechanical ventilation, varied with gestational age, with increased expression of caspase-3 and I-FABP biomarkers.

Comparison of cerebral artery angle in adults and fetuses / Comparación del ángulo de arteria cerebral en adultos y fetos

In this study we generated casting specimens of human cerebral blood vessels for twenty-five fetuses and thirty-six adults. The degrees of the angles were measured and comprised for those blood vessels frequently involved in the interventional catheterization.

En este estudio generamos muestras de los vasos sanguíneos cerebrales humanos en veinticinco fetos y treinta y seis adultos. Fueron medidos y comprendidos los ángulos de aquellos vasos sanguíneos implicados frecuentemente en intervenciones de cateterismo.

Memory deficit associated with increased brain proinflammatory cytokine levels and neurodegeneration in acute ischemic stroke / Déficit de memória associado ao aumento dos níveis cerebrais de citocinas pró-inflamatórias e neurodegeneração na isquemia cerebral aguda

The present study aimed to investigate behavioral changes and neuroinflammatory process following left unilateral common carotid artery occlusion (UCCAO), a model of cerebral ischemia. Post-ischemic behavioral changes following 15 min UCCAO were recorded 24 hours after reperfusion. The novel object recognition task was used to assess learning and memory. After behavioral test, brains from sham and ischemic mice were removed and processed to evaluate central nervous system pathology by TTC and H&E techniques as well as inflammatory mediators by ELISA. UCCAO promoted long-term memory impairment after reperfusion. Infarct areas were observed in the cerebrum by TTC stain. Moreover, the histopathological analysis revealed cerebral necrotic cavities surrounded by ischemic neurons and hippocampal neurodegeneration. In parallel with memory dysfunction, brain levels of TNF-a, IL-1b and CXCL1 were increased post ischemia compared with sham-operated group. These findings suggest an involvement of central nervous system inflammatory mediators and brain damage in cognitive impairment following unilateral acute ischemia.

O presente estudo teve como objetivo investigar alterações comportamentais e processos inflamatórios na isquemia cerebral induzida pela oclusão unilateral da carótida comum esquerda (UCCAO) em camundongos. As alterações comportamentais foram avaliadas após 15 minutos de isquemia e 24 horas de reperfusão. O teste de reconhecimento de objetos foi utilizado para avaliação da memória e do aprendizado. Em seguida, os animais foram mortos e os encéfalos foram coletados e processados para avaliação das alterações patológicas pelas técnicas de TTC e H&E, assim como da dosagem de mediadores inflamatórios por ELISA. A UCCAO promoveu alterações de memória após a reperfusão. Foram visualizadas áreas de infarto cerebral pela coloração de TTC e cavidades necróticas circundadas por neurônios isquêmicos no cérebro e neurodegeneração hipocampal. A UCCAO causou aumento dos níveis encefálicos de TNF-a, IL-1b e CXCL1. Estes achados demonstraram o envolvimento dos mediadores inflamatórios no sistema nervoso central e da neurodegeneração no déficit cognitivo após isquemia cerebral aguda.

Quality of life of people living with HIV/AIDS treated by the specialized service in Vitória-ES, Brazil / Qualidade de vida de pessoas que vivem com HIV/AIDS assistidas no serviço especializado em Vitória (ES), Brasil

The aim of this study is to establish the factors that influence the quality of life of people living with HIV/AIDS being treated at a specialized public service. The participants answered the questionnaire on sociodemographic conditions, issues related to HIV and daily habits. The quality of life was analyzed using the HIV/AIDS-targeted quality of life (HAT-QoL) instrument with 42 items divided into 9 fields: General Activity, Sexual Activity, Confidentiality Concerns, Health Concerns, Financial Concerns, HIV Awareness, Satisfaction with Life, Issues related to Medication and Trust in the Physician. Bivariate and multiple linear regressions were performed. Of the participants, 53.1% were women and had a mean age of 42 years. In analyzing the quality of life, the HAT-QoL domain with the lowest average was Financial Concerns (39.4), followed by Confidentiality Concerns (43.2), Sexual Activity (55.2) and Health Concerns (62. 88). There was an association between the variables: not being gainfully employed (p < 0.001), being mulatto or black (p = 0.045) and alcohol consumption (p = 0.041) with the worst quality of life scores. Inadequate socioeconomic and health conditions had a negative impact on the quality of life of people with HIV/AIDS.

O objetivo do presente estudo é verificar os fatores que influenciam na qualidade de vida das pessoas que vivem com HIV/AIDS assistidas no serviço especializado. Os entrevistados responderam os questionários sobre condições sociodemográficas, aspectos relacionados ao HIV e hábitos. A qualidade de vida foi analisada por meio do instrumento HAT-QoL, com 42 itens divididos em nove domínios: Atividade Geral, Atividade Sexual, Preocupações com Sigilo, Preocupação com a Saúde, Preocupação Financeira, Conscientização sobre o HIV, Satisfação com a Vida, Questões relativas à medicação e Confiança no médico. Análises bivariadas e regressão linear múltipla foram realizadas. Dos entrevistados, 53,1% eram mulheres e tinham média de idade de 42 anos. Na análise da qualidade de vida, o domínio do HAT-QoL com menor média foi Preocupação financeira (39,4), seguido de Preocupação com sigilo (43,2), Atividades sexuais (55,2) e Preocupação com a saúde (62,88). Houve associação entre as variáveis não ter vínculo trabalhista (p < 0,001), ser pardo ou negro (p = 0,045) e consumir bebida alcoólica (p = 0,041), com piores escores da qualidade de vida. Condições socioeconômicas e de saúde inadequadas apresentaram impacto negativo na qualidade de vida das pessoas com HIV/AIDS.

Interrelationship between implant and orthognathic surgery for the rehabilitation of edentulous cleft palate patients: a case report

A 43-year-old woman with a unilateral cleft lip and palate, presenting a totally edentulous maxilla and mandible with marked maxillomandibular discrepancy, attended the Prosthodontics section of the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo for treatment. She could not close her mouth and was dissatisfied with her complete dentures. Treatment planning comprised placement of six implants in the maxilla, four in the mandible followed by prostheses installation and orthognathic surgery. The mandibular full arch prosthesis guided the occlusion for orthognathic positioning of the maxilla. The maxillary complete prosthesis was designed to assist the orthognathic surgery with a provisional prosthesis (no metal framework), allowing reverse treatment planning. Maxillary and mandibular realignment was performed. Three months later, a relapse in the position of the maxilla was observed, which was offset with a new maxillary prosthesis. This isa complex interdisciplinary treatment and two-year follow-up is presented and discussed. It should be considered that this type of treatment could also be applied in non-cleft patients.