Hu Rong, Feng Hua
Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University, 30 Gaotanyan Street, Chongqing 400038, China.
Curr Pharm Des. 2017;23(15):2206-2211. doi: 10.2174/1381612823666170220163750.
Spontaneous intracerebral hemorrhage (ICH) is the poorest prognosis of all stroke subtypes with a high mortality and morbidity. Although considerable progress has been made, no intervention is currently available to alter the outcome of patients with ICH, suggesting a new concept directing ICH study is urgently needed.
Most ICH occurs in the deep area of the brain, the basal ganglion, whose blood supply is mainly from lenticulostriate arteries (LSAs). Thus, we focus on ICH occurring in this deep brain area. We summarize the structural and functional features of LSAs and the deep brain, and their interactions, which is essential for the pathogenesis, pathophysiology and management of ICH.
Here, we review the microanatomy, histological characters, hemodynamics and hypertensive pathology of LSAs. Especially, we look into the interactions between LSAs and their surrounding nerve tissues. The unique microanatomic, histological and hemodynamic features of LSAs underpin its high risk of rupture. The interactions between LSAs and the deep brain determine the pathophysiological process of ICH.
LSAs and the circumferential deep brain are an interactive and mutually affected entity. We propose a new concept called lenticulostriate-artery neural complex (LNC) to integrate the structural, functional and pathological characteristics of this area, which would be a pragmatic paradigm in directing the future basic and clinical studies on ICH.
自发性脑出血(ICH)是所有卒中亚型中预后最差的,具有高死亡率和高发病率。尽管已取得了相当大的进展,但目前尚无干预措施可改变ICH患者的预后,这表明迫切需要一个指导ICH研究的新概念。
大多数ICH发生在脑深部区域,即基底神经节,其血液供应主要来自豆纹动脉(LSAs)。因此,我们关注发生在这个脑深部区域的ICH。我们总结了LSAs和深部脑区的结构和功能特征及其相互作用,这对ICH的发病机制、病理生理学和治疗至关重要。
在此,我们回顾了LSAs的微观解剖学、组织学特征、血流动力学和高血压病理。特别是,我们研究了LSAs与其周围神经组织之间的相互作用。LSAs独特的微观解剖学、组织学和血流动力学特征是其高破裂风险的基础。LSAs与深部脑区之间的相互作用决定了ICH的病理生理过程。
LSAs和周围深部脑区是一个相互作用、相互影响的实体。我们提出了一个名为豆纹动脉神经复合体(LNC)的新概念,以整合该区域的结构、功能和病理特征,这将是指导未来ICH基础和临床研究的一个实用范式。