Microvascular anatomy of the medial temporal region

View More View Less
  • 1 Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China;
  • | 2 Department of Neurosurgery, Stanford Hospital, Stanford, California;
  • | 3 Department of Neurosurgery, Hospital El Cruce, Buenos Aires, Argentina;
  • | 4 Department of Neurological Surgery, Indiana University, Indianapolis, Indiana; and
  • | 5 The Neurosurgical Atlas, Carmel, Indiana
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $45.00
USD  $515.00
USD  $612.00
Print or Print + Online Sign in

OBJECTIVE

The authors investigated the microvascular anatomy of the hippocampus and its implications for medial temporal tumor surgery. They aimed to reveal the anatomical variability of the arterial supply and venous drainage of the hippocampus, emphasizing its clinical implications for the removal of associated tumors.

METHODS

Forty-seven silicon-injected cerebral hemispheres were examined using microscopy. The origin, course, irrigation territory, spatial relationships, and anastomosis of the hippocampal arteries and veins were investigated. Illustrative cases of hippocampectomy for medial temporal tumor surgery are also provided.

RESULTS

The hippocampal arteries can be divided into 3 segments, the anterior (AHA), middle (MHA), and posterior (PHA) hippocampal artery complexes, which correspond to irrigation of the hippocampal head, body, and tail, respectively. The uncal hippocampal and anterior hippocampal-parahippocampal arteries contribute to the AHA complex, the posterior hippocampal-parahippocampal arteries serve as the MHA complex, and the PHA and splenial artery compose the PHA complex. Rich anastomoses between hippocampal arteries were observed, and in 11 (23%) hemispheres, anastomoses between each segment formed a complete vascular arcade at the hippocampal sulcus. Three veins were involved in hippocampal drainage—the anterior hippocampal, anterior longitudinal hippocampal, and posterior longitudinal hippocampal veins—which drain the hippocampal head, body, and tail, respectively, into the basal and internal cerebral veins.

CONCLUSIONS

An understanding of the vascular variability and network of the hippocampus is essential for medial temporal tumor surgery via anterior temporal lobectomy with amygdalohippocampectomy and transsylvian selective amygdalohippocampectomy. Stereotactic procedures in this region should also consider the anatomy of the vascular arcade at the hippocampal sulcus.

ABBREVIATIONS

AChA = anterior choroidal artery; AHA = anterior hippocampal artery; AHPA = anterior hippocampal-parahippocampal artery; AHV = anterior hippocampal vein; AITA = anterior inferior temporal artery; ALHV = anterior longitudinal hippocampal vein; AVM = arteriovenous malformation; ITA = inferior temporal artery; LPChA = lateral posterior choroidal artery; MHA = middle hippocampal artery; MITA = middle inferior temporal artery; MTLE = mesial temporal lobe epilepsy; MTR = medial temporal region; PCA = posterior cerebral artery; PHA = posterior hippocampal artery; PHPA = posterior hippocampal-parahippocampal artery; PITA = posterior inferior temporal artery; PLHV = posterior longitudinal hippocampal vein; PLU = posterior limit of the uncus; SA = splenial artery; SAH = selective amygdalohippocampectomy; UHA = uncohippocampal artery.

Supplementary Materials

    • Tables S1-S4 and Figs. S1-S6 (PDF 11,187 KB)

Schematics of transseptal interforniceal resection of a superiorly recessed colloid cyst. ©Mark Souweidane, published with permission. See the article by Tosi et al. (pp 813–819).

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $515.00
USD  $612.00
  • 1

    Marinković S, Milisavljević M, Puškaš L. Microvascular anatomy of the hippocampal formation. Surg Neurol. 1992;37(5):339349.

  • 2

    Erdem A, Yaşargil G, Roth P. Microsurgical anatomy of the hippocampal arteries. J Neurosurg. 1993;79(2):256265.

  • 3

    Duvernoy HM, Cattin F, Risold PY. The Human Hippocampus. Functional Anatomy, Vascularization and Serial Sections with MRI. 4th ed. Springer;2013.

    • Search Google Scholar
    • Export Citation
  • 4

    Fernández-Miranda JC, de Oliveira E, Rubino PA, Wen HT, Rhoton AL Jr. Microvascular anatomy of the medial temporal region: part 1: its application to arteriovenous malformation surgery. Neurosurgery. 2010;67(3 Suppl Operative):ons237ons276.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Destrieux C, Bourry D, Velut S. Surgical anatomy of the hippocampus. Neurochirurgie. 2013;59(4-5):149158.

  • 6

    Rubio RR, Shehata J, Kournoutas I, Chae R, Vigo V, Wang M, et al. Construction of neuroanatomical volumetric models using 3-dimensional scanning techniques: technical note and applications. World Neurosurg. 2019;126:359368.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7

    Uchimura J. Uber die Gefässversorgung des ammon-shornes. Z Gesamte Neurol Psychiatr. 1928;112:119.

  • 8

    Scharrer E. Vascularization and vulnerability of the cornu ammonis in the opossum. Arch Neurol Psychiatry. 1940;44(3):483506.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    Muller J, Shaw L. Arterial vascularization of the human hippocampus, l. Extracerebral relationships. Arch Neurol. 1965;13:4547.

  • 10

    Hamoir XL, Grandin CB, Peeters A, Robert A, Cosnard G, Duprez T. MRI of hyperacute stroke in the AChA territory. Eur Radiol. 2004;14(3):417424.

  • 11

    Xu Y, Mohyeldin A, Doniz-Gonzalez A, Vigo V, Pastor-Escartin F, Meng L, et al. Microsurgical anatomy of the lateral posterior choroidal artery: implications for intraventricular surgery involving the choroid plexus. J Neurosurg. Published online April 9, 2021.doi: 10.3171/2020.8.JNS202230

    • Search Google Scholar
    • Export Citation
  • 12

    Kasow DL, Destian S, Braun C, Quintas JC, Kagetsu NJ, Johnson CE. Corpus callosum infarcts with atypical clinical and radiologic presentations. AJNR Am J Neuroradiol. 2000;21(10):18761880.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Kovanda TJ, Tubbs RS, Cohen-Gadol AA. Transsylvian selective amygdalohippocampectomy for treatment of medial temporal lobe epilepsy: Surgical technique and operative nuances to avoid complications. Surg Neurol Int. 2014;5:133.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Yaşargil MG, Krayenbühl N, Roth P, Hsu SP, Yaşargil DC. The selective amygdalohippocampectomy for intractable temporal limbic seizures. J Neurosurg. 2010;112(1):168185.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 3465 3465 349
Full Text Views 664 664 199
PDF Downloads 1024 1024 321
EPUB Downloads 0 0 0