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Cerebral Angiography: Normal Anatomy and Vascular Pathology PDF

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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 © Springer-Verlag Berlin Heidelberg 2014 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifi cally for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher's location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) 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 ix

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This revised and enlarged edition of Cerebral Angiography, which includes new angiographic studies and illustrative drawings, offers detailed guidance on diagnostic use of the procedure. The first part of the book describes the normal anatomy of the cerebral arteries and veins, with attention to mor
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