Cerebral Angiography: Normal Anatomy and Vascular Pathology

379 Pages·2014·56.87 MB·English

by  Gianni Boris Bradac (auth.)

Gianni Boris Bradac
Cerebral
Angiography
Normal Anatomy and
Vascular Pathology
Second Edition
123
Cerebral Angiography

Gianni Boris Bradac
Cerebral Angiography
Normal Anatomy and Vascular
Pathology
Second Edition
Gianni Boris Bradac, MD
Past director of Neuroradiology
Professor Emeritus of Neuroradiology
Department of Neuroscience
University of Turin
Ospedale Molinette
Turin
Italy
With the collaboration of
Edoardo Boccardi MD
Director of Neuroradiology
Ospedale Niguarda “Ca Granda”
Milan
Italy

ISBN 978-3-642-54403-3 ISBN 978-3-642-54404-0 (eBook)
DOI 10.1007/978-3-642-54404-0
Springer Heidelberg New York Dordrecht London
Library of Congress Control Number: 2014937448
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Prefa ce
This is a revised and enlarged edition of Cerebral Angiography published in
2011. The fi rst part of the book describes the normal anatomy of the cerebral
arteries, with attention given to their embryological development, and its pos-
sible anomalies, their morphological aspect, their function, and their vascular
territories. The intraorbital and extracranial vascularization is also consid-
ered. One chapter is dedicated to the embryological development and to the
normal anatomy of the intra- and extracranial veins. This fi rst part of the book
will serve as a basis for the correct interpretation of pathological processes
and their clinical relevance, which will be covered in the second part of the
book. Among the pathologies considered are vascular abnormalities, includ-
ing aneurysms; the different types of angiomas and fi stulas; atherosclerotic
and non-atherosclerotic stenosis and occlusion of the cerebral vessels; venous
thrombosis and other correlated venous pathologies; and intraorbital and
extracranial vascular malformations. The pathogenesis of the pathological
processes and their different morphological and dynamic aspects, infl uencing
the clinical aspects and the therapy, are described. While the emphasis
throughout is on the diagnostic value of cerebral angiography, many exam-
ples of endovascular treatment in different pathological situations are also
presented, with discussion about indications, risks, and results.
W e hope that this edition, also, will be of practical use for all the physi-
cians involved in the study of the cerebral vessels and treatment of vascular
pathology.
Historical Aspects
In July 1927, Prof. Egas Moniz, director of the neurological clinic in Lisboa,
presented at the congress of the Neurological French Society in Paris his fi rst
experiences with a method to study the cerebral vessels that he called
“L’encephalographie arterielle.” The interest for this new method called later
“cerebral angiography” was great. Among the several neurological authori-
ties present in the congress, we report the comment of Prof. Babinski:
Le radiographies qui vient de presenter E. Moniz sont remarquables. Si les observa-
tions ulterieures établissent défi nitivement que les injections auxquelles il a recours
sont inoffensives, tous les neurologistes seront reconnaissants a notre éminent col-
légue de leur avoir procuré un nouveau moyen pouvant permettre de localiser des
tumeurs intracraniennes dont le siège est souvent si diffi cile a déterminer.
v
vi Preface
S ince then, great progresses have been made, starting with the introduc-
tion of the catheter technique (Seldinger 1953), the subtraction (Ziedses des
Plantes 1963) followed by the introduction of more and more suitable cathe-
ters, guide wires, and less toxic contrast media. All these aspects along with
the improved technological equipment have characterized the evolution of
the cerebral angiography which has become a very important neuroradiologi-
cal diagnostic method. Certainly, the evolution of new methods such as
angio-CT, angio-MR, and ultrasounds allows to replace today in many cases
cerebral angiography. However, every time the diagnosis is not suffi ciently
clear or fi ner details are required to understand the clinical symptoms or to
plan the therapy, especially when an endovascular approach is considered,
angiography remains today the method of choice.
References
Babinski J (1927) Revue Neurologique 34:72
Moniz E (1927) Revue Neurologique 34:72
Seldinger SI (1953) Acta Radiol (Stock) 39:368
Ziedses des Plantes BG (1963) Acta Radiol Diagn 1:961
Turin, Italy G. B. Bradac
Acknowledgements
This book refl ects the work done and the experience gained in the
Neuroradiological Units at the Molinette Hospital of Turin University, at
Niguarda Hospital in Milan, and Santa Croce Hospital in Cuneo. It would not
have been possible without the involvement of the members (doctors, tech-
nologists, nurses, etc.) working in different times in these units as well as
the members of the anesthesiological, neurosurgical, maxillary surgery,
otolaryngology and stroke units.
To all these persons we would like to express our sincere thanks.
We are especially grateful to M. Coriasco, B.Sc. (clinical technologists)
for his help with the technical aspects concerning the manuscript and for the
image processing to improve the quality of the fi gures, Mr. G. Hippmann for
his effort to correctly represent the schematic drawings and Mr. P. Prejith for
his work in the preparation of this 2nd edition.
Finally we would like to express our gratefulness to all members of
Springer-Verlag, especially C.D. Bachem, Mr. G. Karthikeyan, Dr. U. Heilmann
and Dr. Freyberg.
G.B. Bradac
E. Boccardi
vii

Contents
1 Aortic Arch and Origin of the Cranial Cerebral Arteries. . . . 1
2 Carotid Artery (CA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2.1 Cervical Segment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2.2 Petrous Segment of ICA . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
2.3 Cavernous Segment of ICA . . . . . . . . . . . . . . . . . . . . . . . . . 10
2.4 Supraclinoid Segment of ICA . . . . . . . . . . . . . . . . . . . . . . . 12
2.4.1 In the Ophthalmic Segment Arise the Ophthalmic
Artery and Superior Hypophyseal Arteries . . . . . . . 12
2.4.2 In the Communicating Segment Arises the PcomA . . 18
2.4.3 In the Choroidal Segment Arise the Anterior
Choroidal Artery and Often Perforators
Directly from the ICA . . . . . . . . . . . . . . . . . . . . . . . 19
2.5 Congenital Anomalies of the ICA . . . . . . . . . . . . . . . . . . . . 21
3 External Carotid Artery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
3.1 Superior Thyroid Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
3.2 Lingual Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
3.3 Facial Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
3.4 Ascending Pharyngeal Artery . . . . . . . . . . . . . . . . . . . . . . . 29
3.5 Occipital Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
3.6 Posterior Auricular Artery . . . . . . . . . . . . . . . . . . . . . . . . . . 32
3.7 Internal Maxillary Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
3.7.1 Proximal Branches . . . . . . . . . . . . . . . . . . . . . . . . . 34
3.7.2 Masticator Space . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
3.7.3 Distal IMA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
3.7.4 The Terminal Branch . . . . . . . . . . . . . . . . . . . . . . . . 37
3.8 Superfi cial Temporal Artery . . . . . . . . . . . . . . . . . . . . . . . . 38
3.9 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
3.9.1 Vascular Malformations . . . . . . . . . . . . . . . . . . . . . 38
3.9.2 Hemangiomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
3.9.3 Juvenile Angiofi bromas . . . . . . . . . . . . . . . . . . . . . . 43
3.9.4 Paragangliomas (Chemodectomas) . . . . . . . . . . . . . 43
3.9.5 Meningiomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
3.9.6 General Considerations in Endovascular
Treatment in the ECA Area . . . . . . . . . . . . . . . . . . . . 47
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