Oklahoma State University Center for Health Sciences, Department of Anatomy and Cell Biology, 1111 W 17th Street, Tulsa, OK 74107, USA.
Ascension St. John Medical Center, Department of Neurology/Neurocritical Care, 2100 S Wheeling Ave, Tulsa, OK 74104, USA.
Neuroimage Clin. 2022;36:103272. doi: 10.1016/j.nicl.2022.103272. Epub 2022 Nov 18.
Ischemic strokes affecting the medial medulla are exceedingly rare. The anatomical basis for the relative infrequency of this stroke syndrome has been largely uninvestigated due to historically coarse MRI and CT scan resolution. We capture and digitally dissect the highest-ever-resolution diffusible iodine-based contrast-enhanced CT (diceCT) scanned images of a cadaveric brainstem to map arterial territories implicated in medial medullary infarctions. 3D reconstructions show that within the anterior spinal artery territory previously implicated in medial medullary syndrome (MMS), there are numerous, small sulcal artery branches perforating the medulla within the anterior median fissure. These branches proceed in parallel through the anteroposterior depth of the medulla as expected; however, we also identify a network of intraparenchymal, rostrocaudal anastomoses between these sulcal perforating branches. This network of intraparenchymal sulcal artery anastomoses has never been described and may provide a significant collateral supply of oxygenated blood flow throughout the medial medulla. By ramifying deeper tissues, these anastomoses can help explain the infrequency of MMS.
影响内侧髓质的缺血性中风极为罕见。由于历史上 MRI 和 CT 扫描分辨率较粗，这种中风综合征的相对罕见的解剖学基础在很大程度上尚未得到研究。我们捕获并对一具尸体脑干进行了迄今为止分辨率最高的弥散碘基对比增强 CT（diceCT）扫描图像进行数字化解剖，以绘制涉及内侧髓质梗死的动脉区域。3D 重建显示，在前脊髓动脉区域内，先前涉及内侧髓质综合征（MMS）的区域内有许多穿过前正中裂的小沟动脉分支。这些分支按预期在前后方向穿过髓质平行前进；然而，我们还在这些沟穿支之间发现了一个脑实质内的、前后向的吻合网络。这个脑实质内沟动脉吻合网络从未被描述过，它可能为整个内侧髓质提供了含氧血流的重要侧支供应。通过向更深的组织分支，这些吻合可以帮助解释 MMS 的罕见性。
