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Medullary branches of the vertebral artery: microsurgical anatomy and clinical significance

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Abstract

Background

Since the medullary arteries are of a great neurologic and neurosurgical significance, the aim was to perform a detailed microanatomic study of these vessels, as well as of the medullary infarctions in a group of patients.

Methods

The arteries of 26 halves of the brain stem were injected with India ink and gelatin, microdissected and measured with an ocular micrometer. Neurologic and magnetic resonance imaging (MRI) examinations were performed in 11 patients.

Results

The perforating medullary arteries, averaging 6.7 in number and 0.26 mm in diameter, most often originated from the anterior spinal artery (ASA), and rarely from the vertebral (VA) (38.5%) and the basilar artery (BA) (11.6%). They supplied the medial medullary region. The anterolateral arteries, 4.8 in number and 0.2 mm in size, most often arose from the ASA and PerfAs, and nourished the anterolateral region. The lateral arteries, 2.2 in number and 0.31 mm in diameter, usually originated from the VA and the posterior inferior cerebellar artery (PICA). They supplied the lateral medullary region. The dorsal arteries, which mainly arose from the PICA and the posterior spinal artery (PSA), nourished the dorsal region, including the roof of the 4th ventricle. The anastomotic channels, averaging 0.3 mm in size, were noted in 42.3%. Among the medullary infarctions, the lateral ones were most frequently present (72.8%).

Conclusion

The obtained anatomic data, which can explain the medullary infarctions symptomatology, are also important in order to avoid damage to the medullary arteries during neurosurgical and neuroradiologic interventions.

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Authors and Affiliations

  1. Department of Neuroscience, Institute of Medical Research, University of Belgrade, Belgrade, Serbia

    Bojana Djukić

  2. Seat in Mitrovica, Faculty of Medicine, University of Prishtina, Mitrovica, Serbia

    Nataša Djukić-Macut

  3. Faculty of Medicine, Institute of Anatomy, University of Belgrade, Dr. Subotić, 4/2, 11000, Belgrade, Serbia

    Vuk Djulejić, Jelena Boljanović & Slobodan Marinković

  4. Faculty of Medicine, Clinic of Neurosurgery, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia

    Ivan Milić

  5. Faculty of Veterinary Medicine, Institute of Anatomy, University of Belgrade, Belgrade, Serbia

    Miloš Blagojević

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  1. Bojana Djukić
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  2. Nataša Djukić-Macut
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Correspondence to Slobodan Marinković.

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All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Comments

This is a very interesting study that showed clinical and imagenological correlation of anatomical findings in the compromise of the medulla oblongata arterial irrigation. The authors used specimen injection to show the different and more frequent patterns of the irrigation of this portion of the brainstem. Moreover, they correlate the MRI findings in a small clinical series of patients with medullary infarctions with the anatomical data obtained in the study. This data and the very clear figures of the paper are very useful in order to understand the more frequent ischemic findings in the medulla oblongata imaging in the specific occlusion of the vessels in this vital region.

Jorge Mura

Providencia RM

Chile

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Djukić, B., Djukić-Macut, N., Djulejić, V. et al. Medullary branches of the vertebral artery: microsurgical anatomy and clinical significance. Acta Neurochir 165, 1807–1819 (2023). https://doi.org/10.1007/s00701-023-05613-7

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