Microsurgical anatomy of the lateral posterior choroidal artery: implications for intraventricular surgery involving the choroid plexus

View More View Less
  • 1 Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China;
  • | 2 Department of Neurosurgery, Stanford Hospital, Stanford, California;
  • | 3 The Neurosurgical Atlas, Carmel, Indiana; and
  • | 4 Indiana University Department of Neurological Surgery, Indianapolis, Indiana
Restricted access

Purchase Now

USD  $45.00

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

USD  $505.00

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

USD  $600.00
Print or Print + Online

OBJECTIVE

The lateral posterior choroidal artery (LPChA) should be a major surgical consideration in the microsurgical management of lateral ventricular tumors. Here the authors aim to delineate the microsurgical anatomy of the LPChA by using anatomical microdissections. They describe the trajectory, segments, and variations of the LPChA and discuss the surgical implications when approaching the choroid plexus using different routes.

METHODS

Twelve colored silicone–injected, lightly fixed, postmortem human head specimens were prepared for dissection. The origin, diameter, trunk, course, segment, length, spatial relationships, and anastomosis of the LPChA were investigated. The surgical landmarks of 4 different approaches to the LPChA were also examined thoroughly.

RESULTS

The LPChA was present in 23 hemispheres (96%), and in 14 (61%) it originated from the posterior segment of the P2 (i.e., P2P); most commonly (61%) the LPChA had 2 trunks, and in 17 hemispheres (74%) it had a C-shaped trajectory. According to its course, the authors divided the LPChA into 3 segments: 1) cisternal, from PCA to choroidal fissure (length 10.6 ± 2.5 mm); 2) forniceal, starting at the choroidal fissure, 8.2 ± 5.7 mm posterior to the inferior choroidal point, and terminating at the posterior level of the choroidal fissure (length 28.7 ± 6.8 mm); and 3) pulvinar, starting at the posterior choroidal fissure and terminating in the pulvinar (length 5.9 ± 2.2 mm). The LPChA was divided into 3 patterns according to its entrance into the choroidal fissure: A (anterior) 78%; B (posterior) 13%; and C (mixed) 9%. The transsylvian trans–limen insulae approach provided the best exposure for cisternal and proximal forniceal segments; the lateral transtemporal approach facilitated a more direct approach to the forniceal segment, including cases with posterior entrance; the transparietal transcortical and contralateral posterior interhemispheric transfalcine transprecuneus approaches provided direct access to the pulvinar segment of the LPChA and to the posterior forniceal segment, including cases with posterior choroidal entrance.

CONCLUSIONS

The LPChA typically runs in the medial border of the choroid plexus, which may facilitate its recognition during surgery. The distance between the AChA at the inferior choroidal point and the LPChA is a valuable reference during surgery, but there are cases of posterior choroidal entrance. Most frequently, there are 2 or more LPChA trunks, which makes possible the sacrifice of one trunk feeding the tumor while preserving the other that provides supply to relevant structures. The intraventricular approaches can be selected based on the tumor location and the LPChA anatomy.

ABBREVIATIONS

AChA = anterior choroidal artery; ICA = internal carotid artery; LGB = lateral geniculate body; LPChA = lateral posterior choroidal artery; MPChA = medial posterior choroidal artery; PCA = posterior cerebral artery; P2A = anterior segment of the P2; P2P = posterior segment of the P2.

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

USD  $505.00

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

USD  $600.00

Contributor Notes

Correspondence Juan C. Fernandez-Miranda: Stanford Hospital, Stanford, CA. drjfm@stanford.edu.

INCLUDE WHEN CITING Published online April 9, 2021; DOI: 10.3171/2020.8.JNS202230.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Beevor CE. On the distribution of the different arteries supplying the human brain. Proc R Soc Lond B Biol Sci. 1909;200:155.

  • 2

    Millen JW, Woollam DH. Vascular patterns in the choroid plexus. J Anat. 1953;87(2):114123.

  • 3

    Hudson AJ. The development of the vascular pattern of the choroid plexus of the lateral ventricles. J Comp Neurol. 1960;115:171186.

  • 4

    Galloway JR, Greitz T. The medial and lateral choroid arteries. An anatomic and roentgenographic study. Acta Radiol. 1960;53:353366.

  • 5

    Fujii K, Lenkey C, Rhoton AL Jr. Microsurgical anatomy of the choroidal arteries: lateral and third ventricles. J Neurosurg. 1980;52(2):165188.

    • Search Google Scholar
    • Export Citation
  • 6

    Marinković S, Gibo H, Milisavljević M, et al. . Microanatomy of the intrachoroidal vasculature of the lateral ventricle. Neurosurgery. 2005;57(1)(suppl):2236.

    • Search Google Scholar
    • Export Citation
  • 7

    Nagata S, Rhoton AL Jr, Barry M. Microsurgical anatomy of the choroidal fissure. Surg Neurol. 1988;30(1):359.

  • 8

    Vinas FC, Lopez F, Dujovny M. Microsurgical anatomy of the posterior choroidal arteries. Neurol Res. 1995;17(5):334344.

  • 9

    Wolfram-Gabel R, Maillot C, Koritké JG, Laude M. The vascularization of the human tela choroidea of the lateral ventricle. Article in French. Acta Anat (Basel). 1987;128(4):301321.

    • Search Google Scholar
    • Export Citation
  • 10

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

    • Search Google Scholar
    • Export Citation
  • 11

    Wheatley BM. Selective amygdalohippocampectomy: the trans-middle temporal gyrus approach. Neurosurg Focus. 2008;25(3):E4.

  • 12

    Cikla U, Swanson KI, Tumturk A, et al. . Microsurgical resection of tumors of the lateral and third ventricles: operative corridors for difficult-to-reach lesions. J Neurooncol. 2016;130(2):331340.

    • Search Google Scholar
    • Export Citation
  • 13

    Bohnstedt BN, Kulwin CG, Shah MV, Cohen-Gadol AA. Posterior interhemispheric transfalcine transprecuneus approach for microsurgical resection of periatrial lesions: indications, technique, and outcomes. J Neurosurg. 2015;123(4):10451054.

    • Search Google Scholar
    • Export Citation
  • 14

    Zeal AA, Rhoton AL Jr. Microsurgical anatomy of the posterior cerebral artery. J Neurosurg. 1978;48(4):534559.

  • 15

    Saito R, Kumabe T, Sonoda Y, et al. . Infarction of the lateral posterior choroidal artery territory after manipulation of the choroid plexus at the atrium: causal association with subependymal artery injury. J Neurosurg. 2013;119(1):158163.

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 1551 1551 236
Full Text Views 163 163 34
PDF Downloads 173 173 45
EPUB Downloads 0 0 0