Ispas S., Dina C., Bulbuc I., Iliescu D.M. and Bordei P.
Our study was performed on 21 cases, of which 12 were plastic casts and 9 were CT reconstruction. We found that, most frequently (68.75% of the cases), the pulmonary veins were formed by two roots, one superior and one inferior. In 28.13% of cases, the pulmonary veins were formed from three roots (superior, middle and inferior) and in only one case the superior right pulmonary vein had five roots. The venous roots confluence to form the corresponding trunk was at a distance of between 0.5-2 cm. The termination of the superior pulmonary veins was on the upper part of the anterior atrial wall, most commonly in its lateral side. The distance between the right pulmonary veins was between 0.4-3 cm. The inferior pulmonary veins ended on the infero-lateral part of the posterior atrial wall. The distance between the left pulmonary veins was 1.2-3.4 cm. Among the variation in number of the pulmonary veins we met: three cases with three right pulmonary veins and one case when the inferior right pulmonary vein joined terminally the inferior left pulmonary vein, forming a single venous trunk. Supplementary pulmonary veins were encountered only on the right; in one case there were two posterior right pulmonary veins (superior and inferior), in the second case were anterior right pulmonary veins (superior and inferior) and in a third case were three veins, superior, middle and inferior
Our results were obtained on 24 cases, 12 plastic molds and 12 dissections, examining the relations between the branches of origin of the pulmonary veins, and of their roots and trunks with the corresponding bronchuses and arteries.
We assessed the situation of the superior and inferior right pulmonary veins, of the superior, middle and inferior lobes pedicles, together with the general assessment of the right pulmonary pedicles. Same is on the left. We cannot speak of a general sample that applies to the broncho-pulmonary vascular pedicles or to the relations between the pulmonary veins and their branches with broncho-arterial elements, as they are quite varied; they are characteristic of each lung lobe and even segment, being unable to assess standard relations only in the hilum. When variation in number occurs, even into the hilum we may have altered relations. Also is quite common that vascular branches may pass from one lobe to another, as long as the pulmonary fissures are rarely complete.
Cr.P Dimitriu, C. Ionescu, P. Bordei and I. Bulbuc
Background and purpose:limited data exist to guide proper patient selection for preventive treatment of unruptured cerebral aneurysms. Cerebral aneurysms have been associated with anomalies of arterial segments that are forming the brain arterial circle of Willis but whether this association is also related to aneurysm rupture is not known. The occurrence of cerebral aneurysm rupture when a circle of Willis anomaly was present or absent was compared.
Material and methods: we have performed this study on a number of 312 cases, of which 87 were dissections, 22 dissection followed by plastic injection, 135 magnetic resonance angiography (MRA), 75 computer tomography angiography (CTA), 40 digital subtraction angiographies (DSA), 30 in vivo (intraoperatory) observation. Brain vascular imaging was reviewed for aneurysm size, morphology and presence of anterior cerebral artery anomalies.
Results: we divided the study group in 2 cohorts, one control group of 272 cases, in which we have study the anatomical variants occurrence and aneurysm occurrence in general population and another included 45 patients admitted thru emergency room for subarachnoid hemorrhage, of those 38 were ruptured aneurysm of anterior communicating artery (ACoA). Mean aneurysm size was 8.9 mm. An anterior cerebral artery anomaly was identified in 31 cases (81.5%). Multivariate analysis revealed a higher risk of aneurysm rupture when an anterior cerebral artery was present.
Conclusions: this study shows that anterior cerebral artery anomalies are more commonly found in ruptured as opposed to unruptured ACoA aneurysms. The presence of an ACA anomaly may be an important characteristic for selecting patients for preventive aneurysm treatment.
Cr.P. Dimitriu, D.M. Iliescu, P. Bordei and I. Bulbuc
Recurrent artery of Heubner (RAH) is the largest and most constant perforating branch of anterior cerebral artery. It supplies blood to the medial portion of the orbitofrontal cortex, the anterior portion of the caudate nucleus, the anterior third of the putamen, the external segment of the globus pallidus, and the anterior crus of the internal capsule The anatomical variation of RAH is related to its traject, number, presence, or absence, and the diverse origin from ACA is of considerable clinical impact mainly from the point of view of the surgical procedures involving the anterior portion of the circle of Willis or the topographically related structures. The present study aimed to demonstrate vascular anatomy of this RAH and its variation. The study included 60 human cadaveric brains fixed in the formalin and examined under operating microscope. 22 freshly harvested human cadaveric brains, injected with a polymer (Technovit 7143), a partial coroded and also we have consulted 30 digital subtraction angiograms. We have evaluated the origin, traject and caliber of recurrent artery of Heubner, our results were compared with other anatomical studies published. The most obvious finding was the great variability of its origin but in 91% of the cases it was in the range of 2mm around anterior communicating artery, that could be harmed during aneurismal clipping. The RAH is commonly arising from ACA-ACoA junction. This portion of the circle of Willis is the place of many anatomical variations and malformations. The vessel can be absent, single, or multiple, and its diameter is highly variable. The awareness of these distinct anatomical and morphometric variations of the RAH is essential in planning the neurosurgical procedures in the anterior part of the circle of Willis to avoid the unexpected neurological complications.