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Microvascular anatomy of foramen caecum medullae oblongatae
A Mahmood1, M Dujovny, M Torche
1Department of Neurological Surgery, Henry Ford Neurosurgical Institute, Henry Ford Hospital Division, Detroit, Michigan.
Abstract:
The foramen caecum (FC) is a triangular-shaped fossa situated in the midline on the base of the brain stem, at the pontomedullary junction. Although this area is known to have a very high concentration of brainstem perforating vessels, its microvascular anatomy has not been studied in detail. The purpose of this study was to detail the microvasculature of this territory. Twenty unfixed brains were injected with silicone rubber solution and dissected under a microscope equipped with a camera. The origin, course, outer diameter, and branching pattern of the perforators were examined. The total number of perforators found in the 20 brains was 287, with an average (+/- standard deviation) of 14.35 +/- 1.24 perforators per brain (range seven to 28). Their origin was as follows: right vertebral artery in 52 perforators (18.11%); left vertebral artery in 35 (12.19%); basilar artery below the anterior inferior cerebellar artery (AICA) in 139 (48.43%); basilar artery above the AICA in 46 (16.02%); AICA in 10 (3.48%); and anterior spinal artery in five (1.74%). Most of the perforators arose as sub-branches of larger trunks; their average outer diameter was 0.16 +/- 0.006 mm while that of trunks was 0.35 +/- 0.02 mm. These anatomical data are important for those wishing 1) to study the pathophysiology of vascular insults to this area caused by atheromas, thrombi, and emboli; 2) to plan vertebrobasilar aneurysm surgery; 3) to plan surgery for vertebrobasilar insufficiency; and 4) to study foramen magnum neoplasms.
Insights
This study details the microvascular anatomy of the foramen caecum (FC), revealing an average of 14.35 perforating vessels per brain. These findings are crucial for understanding vascular insults and planning neurosurgery in the brainstem region.
Area of Science:
- Neuroanatomy
- Vascular Anatomy
- Microsurgery
Background:
- The foramen caecum (FC) is a critical brainstem region at the pontomedullary junction.
- This area is known for a high density of perforating vessels, yet its microvascular anatomy lacks detailed study.
Purpose of the Study:
- To meticulously describe the microvasculature of the foramen caecum.
- To provide anatomical data for clinical applications in neurovascular and oncological surgery.
Main Methods:
- Silicone rubber injection into 20 unfixed human brains.
- Microscopic dissection and detailed examination of perforating vessels' origin, course, diameter, and branching patterns.
Main Results:
- A total of 287 perforators were identified, averaging 14.35 per brain (range: 7-28).
- Major origins included the basilar artery (48.43% below AICA), vertebral arteries (18.11% right, 12.19% left), and basilar artery above AICA (16.02%).
- Average outer diameter of perforators was 0.16 mm, and of supplying trunks was 0.35 mm.
Conclusions:
- This detailed microvascular map of the foramen caecum is essential for understanding vascular pathologies.
- The data aids in surgical planning for vertebrobasilar aneurysms, insufficiency, and foramen magnum tumors.