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[The circle of Willis in children and the factors shaping it]
Insights
The study of the circulus arteriosus cerebri in children reveals that asymmetry is common, influenced by brain conditions and embryological factors, impacting adult anatomy.
Area of Science:
- Neuroanatomy
- Vascular Biology
- Developmental Biology
Context:
- The circulus arteriosus cerebri (Circle of Willis) is a critical arterial circle at the base of the brain.
- Its development and variations can influence cerebral blood flow and neurological health.
- Understanding its pediatric morphology is essential for diagnosing and managing cerebrovascular conditions.
Purpose:
- To investigate the anatomical variations and symmetry of the circulus arteriosus cerebri in children.
- To identify factors contributing to asymmetry in this vascular structure.
- To propose a grading system for these variations based on anatomical criteria.
Summary:
- This study analyzed the circulus arteriosus cerebri in 41 pediatric brains (birth to 14 years), measuring arterial segments.
- Asymmetry was observed in the majority of cases (24/41), linked to cerebral conditions and embryological factors.
- A three-grade system (foetal, compensatory, and failure of adaptation) was proposed based on symmetry of the circle and its cortical efferent branches.
Impact:
- The proposed grading system provides a framework for classifying circulus arteriosus cerebri development.
- Pediatric asymmetry in the circulus arteriosus cerebri may have long-term consequences on adult cerebrovascular anatomy and function.
- This research highlights the importance of early-life vascular development in determining adult health outcomes.
Abstract:
The pattern of the circulus arteriosus cerebri was studied on the sagittal plane in 41 brains taking off on children from birth to 14 years. Internal diameters were measured on the segments of the circulus, on the cortical efferent vessels and on the internal carotid afferent arteries. In only 17/41 cases, a symetry of the segment of the cortical efferent branches and of the carotid arteries. We found different factors associated with the assymetry of the circulus arteriosus, namely cerebral conditions as demonstrated in our pathological cases and embryological dispositions. Three grades are proposed according anatomic criteria. They are related to a greater complexity and interaction of the conditions mentionned above:-grade 1 "foetal" : symetry is complete;-grade 2 : there is a symetry of the cortical branches, but an assymetry of the circulus arteriosus, which is obtained by compensatory modelling of the circulus arteriosus, working to equalize the cerebral flow; -grade 3 : there is an assymetry of the circulus and of the cortical efferent branches suggesting a failure of adaptation. It is assumed that this modelling of the circulus has consequences on adult anatomic and functional conditions. Indeed, the other modelating factors which affect the adult circulus refer mainly to the grade obtained in childhood.