ORIGIN OF THE LEFT VERTEBRAL ARTERY FROM IPSILATERAL COMMON CAROTID ARTERY IN A HUMAN FETUS: CASE REPORT AND BRIEF REVIEW OF THE LITERATURE

Although the vertebral artery (VA) is a type of artery with a lot of variations, its origin from the common carotid artery (CCA) is one of the rarities that deserves to be presented.Microdissection of injected arteries in the thorax and neck of human fetuses under the operating microscope was used and documented in the workbook and photos. The origin of the left VA from ipsilateral CCA, and its entry into the transverse foramen of the fourth cervical vertebra (C IV), associated with the normal vascular arrangement of branches of the aortic arch were the main features of this case. Simultaneously, the right VA of normal (subclavian) origin entered the C V transverse foramen. A present case of the left VA−CCA variant is the only one discovered in human fetuses, respectively, in total it is the tenth human case in the literature. However, the future findings could show whether the right aortic arch and the carotid stenosis discovered in half of known adult cases can be possible causal and/or consequent abnormalities of the left VA−CCA variant

APROPOS OF THE SIMULTANEOUS ABSENCE OF SOME EMBRYOLOGICAL VASCULAR FORERUNNERS AND PERSISTENCE OF OTHER ONES ON THE BRAIN BASE IN LATE ADULTHOOD

Associated arterial abnormalities and variations on the brain base were discovered in a cadaveric specimen of the male gender of older life age. This case was found by a retrospective analysis of 388 forensic cases in a common data archive of the authors of this report. Arterial abnormalities were related to the aplasia of (intracranial part) of the right vertebral artery and (large) fenestration of the pre-communicating part of the right posterior cerebral artery. Arterial variations included different morphological statuses such as a special origin, double vessels, and small or oversized caliber. The brain angioarchitecture in the present case was not the base for the aneurysm's development, probably because of the lesser influence of hemodynamic factors on the walls of persistent primitive and definitive arteries, as well as due to good collateral circulation till to the end of the sixth decade of life.

UNUSUAL ARTERIAL ANASTOMOSES ON THE ANTERIOR SIDE OF THE MEDULLA OBLONGATA: A CASE REPORT

The cerebral arterial circle is a constant carotid-basilar anastomosis on the brain base. However, some transitory primitive intercarotid or carotid-vertebral or carotid-basilar or lateral basilo-vertebral anastomoses can persist and change the common angioarchitecture of the brain. One of these transitory persistent anastomoses was found in a 72-year-old male, autopsied at the Institute for Forensic Medicine of Niš, after  a fatal cranial fracture.  We discovered persistent lateral basilovertebral anastomosis that originated from the right side of the basilar artery, immediately below the beginning of the right anterior inferior cerebellar artery, which was connected with the left anterior spinal artery (ASA). In addition, there were two transversal anastomoses between both vertebral arteries. Although the discovered arterial anastomoses on the ventral side of the medulla oblongata persisted in the human adult, pathologic changes of this artery and other cerebral arteries were not found.  The rarity of these vascular variants in the vertebrobasilar system deserves a description in this article and future scientific attention.Key words: Human brain, lateral basilo-vertebral anastomosis, anterior spinal artery, intervertebral anastomose

MOYAMOYA PHENOMENON IN SERBIAN POPULATION

Letter to Edito

VARIABLE LEFT AND/OR RIGHT VERTEBRAL ARTERY IN PREVERTEBRAL PART: A REVIEW OF FEATURES IN THE POSTNATAL PERIOD

The vertebral artery (VA), as the first upstream branch of the subclavian artery on both sides courses having four topographical parts ― prevertebral, cervical, atlantic and intracranial to the interlocking connection into basilar artery. However, its amenability to the variations can be at the origin, and/or course and/or termination. The review of postnatal features of variable VA origin and its prevertebral part was performed according to the 171 literature case reports. Among them, 94 cases of variable left VA, 30 cases of variable left and right VAs and 47 cases of variable right VA have been analyzed. The left and/or right VAs were showed as simple or common vessels or segmentally duplicated at their origin from the aorta and/or subclavian or common carotid or external carotid artery or unusual arterial stems. Different patterns of single VA origin and/or arrangement associated with main supra-aortic arteries variants were presented as 30 primary (basic) and 32 complementary models. Nine different vascular and/or visceral pathological processes were common independently of unilateral or bilateral variability of the VA; however, there were only eight patients with pathological changes in variable VA.Key words: Human vertebral artery, morphologic variants, postnatal status, associated disorder

AGE RELATED CHANGES IN THE WALLS OF ARCUATE ARTERIES OF KIDNEY: A LIGHT MICROSCOPIC STUDY

Although there are many published papers on macro- and microvascularization of the kidney, there has not been a single study that would describe the histological characteristics of the arcuate arteries in specific periods of life. Our motivation to do this study derived from the need to explain the genesis of the ischemic nephropathy and determine the morphological changes on the arcuate arteries. Tissue samples were taken from the kidneys of 50 different cadavers of both sexes. They were divided into five groups, according to their age. The kidneys were of average size and did not show any macroscopic pathological changes. After embedding in paraffin, 5 μm cross-sections through the arteries were prepared. The specimens were analyzed under standard light microscopy, after different staining. The first significant changes are characterized by the widening of the subendothelial layer and the progressive enlargement of the intima. Media gradually shows atrophy, increase of the volume of collagen fibers and reduction of cell numbers. Internal elastic lamina undergoes changes that in time make it wrinkled with denser waves to the point of multiplication. The arcuate arteries, of all the larger intrarenal arteries, undergo the biggest amount of changes. In the beginning, the arcuate arteries suffer a “JET phenomenon”, and that is why the age-related mechanical changes are more prominent in them. The dynamics of the change in their walls accelerates during aging. All described changes that start as a non-atherogenous fibromatosis of the tunica intima is a prerequisite for the development of an atheromatous plaque

ANTERIOR CEREBRAL–ANTERIOR COMMUNICATING COMPLEX IN THE POSTNATAL PERIOD: FROM A FENESTRATION TO THE MULTIPLICATION OF ARTERIES

The anterior cerebral artery is a medial terminal branch of the cerebral part of the internal carotid artery on both sides. These paired arteries are connected by the anterior communicating artery. Different abnormalities of the anterior communicating–anterior cerebral arteries can include an aplasia or hypoplasia, or variable origin and/or course and/or termination, or fenestration, or duplication or multiplication or persistence of primitive or additional vessels. The aim of this manuscript was to investigate the relationships of morphological abnormalities of an anterior communicating–anterior cerebral complex in human adults of Serbian population. Material represented 266 human cadavers autopsied at the Institute for Forensic Medicine in Niš. Cerebral arteries were investigated macroscopically, under the glass; outer vessel’s diameter was measured using ImageJ processing program. A total of 87 cases or 32.71% of different abnormalities of the anterior communicating–anterior cerebral complex were found and classified into six groups. The group of duplications of the anterior communicating artery with an incidence of 18.04% was the most frequent. The finding of only four aneurysms on the anterior communicating artery indicates that there was no significant difference in the rate of aneurysms in individuals of Serbian population with and without fenestrations or duplications or multiplications of the anterior cerebral–anterior communicating complex

RELATIONS OF THE INITIAL SEGMENT OF THE OCULOMOTOR NERVE AND ADJACENT ARTERIES IN FETAL AND ADULT PERIOD

The relationship between the initial part of the oculomotor nerve and the posterior cerebral and superior cerebellar arteries is well understood, but there is still insufficient data about details of these relationships. The aim of this work was to examine the relationships of the initial segment of the oculomotor nerve with adjacent arteries in fetal and adult period. The examination was performed on 259 human brains (191 adults and 68 fetuses). Arteries in fetal brain were perfused with Micropaque and examined by photo film. Adult cases were examined during the forensic autopsy and then basis of the brain was photographed. The close relationship of the initial segment of the oculomotor nerve with basilar artery in 8.3%, with superior cerebellar artery in 17.3%, with posterior cerebral artery in 68.6% of cases was noted. The root of the nerve appeared above postcommunicating part of the posterior cerebral artery in 1.3% of cases and under the level of superior cerebellar artery in 1.6% of cases. The oculomotor nerve with two roots was noted in 2.6% of cases. Neurovascular relationship between oculomotor nerve and adjacent arteries, as morphological characteristic on the ventral side of the brain trunk, has pathoanatomical meaning by the nerve disfunction caused by compressio

MORPHOMETRIC CHARACTERISTICS OF JUGULAR FORAMEN AND SIGMOID SINUS GROOVE: THEIR POSSIBLE CONNECTIONS WITH HIGH JUGULAR BULB PRESENCE

High jugular bulb represents very important variation in neurosurgery. The aim of our research was to measure certain characteristics of jugular foramen and surrounding bony structures in order to evaluate their possible significance in high jugular bulb detection. Thirty seven dried human skull sagittal sections were used as material. Sigmoid sinus groove width and depth, jugular fossa height and exocranial opening mean diameter were measured with vernier caliper. Internal auditory canal height and the distance between its inferior margin and superior margin of petrous bone, jugular foramen endocranial opening area and sino dural angle were measured with ImageJ. Cluster analysis with jugular fossa height as classification parameter was used for the classification of the analyzed skull sagittal sections. Classification analysis showed the presence of two groups: the first with predominantly low height of jugular fossa dome, the second with significantly higher values of jugular fossa dome, sino-dural angle and mean diameter of jugular fossa exocranial opening. This group predominantly included right skull sagittal sections. In addition, sigmoid sinus groove width and depth, jugular foramen endocranial opening area and jugular fossa exocranial opening mean diameter were significantly higher on the right in relation to the left side. So, it can be concluded that high jugular fossa dome is more frequently associated with sigmoid sinus groove anterior position, high values of mean diameter of jugular fossa exocranial opening and sigmoid sinus groove width and depth, especially on the right side