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BIBTEX RIS

Microvascular Anatomy of the Medial Temporal Region

2010; Lippincott Williams & Wilkins; Volume: 67; Issue: 3 Linguagem: Inglês

10.1227/01.neu.0000381003.74951.35

2332-4260

Juan Fernandez‐Miranda, Evandro de Oliveira, Pablo Rubino, Hung Tzu Wen, Albert L. Rhoton,

Cerebral Venous Sinus Thrombosis

BACKGROUND The medial temporal region (also called the temporomesial or mediobasal temporal region) is the site of the most complex cortical anatomy. OBJECTIVE To investigate the anatomic variability of the arterial supply and venous drainage of each segment of the medial temporal region (MTR), and to discuss and illustrate the implications of the findings for surgery of arteriovenous malformations (AVM) of the MTR. METHODS Forty-seven cerebral hemispheres and 10 silicon-injected cadaveric heads were examined using ×3 to ×40 magnification. Illustrative surgical cases of MTR AVMs were selected. RESULTS The anterior choroidal artery (AChA) gave rise to an anterior uncal artery in 83% of hemispheres and a posterior uncal or unco-hippocampal artery in 98%. The plexal segment of the AChA gave off neural branches in 38%. The MCA was the site of origin of anterior uncal, unco-parahippocampal, or anterior parahippocampal arteries in 94% of hemispheres. An anterior uncal artery arose from the internal carotid artery (ICA) in 45% of hemispheres. The posterior cerebral artery (PCA) irrigated the entorhinal area through its anterior parahippocampal or hippocampo-parahippocampal branches in every case. A PCA bifurcation was identified in 89% of hemispheres, typically at the middle segment of the MTR. The most common pattern of bifurcation was by division into posteroinferior temporal and parieto-occipital arterial trunks. The anterior segment of the basal vein had a predominant anterior drainage in 35% of hemispheres, and the middle segment had a predominant inferior drainage in 16%. CONCLUSION An understanding of the vascular variability of the MTR is essential for accurate microsurgical resection of MTR AVMs.