Ghazi-Birry H S, Brown W R, Moody D M, Challa V R, Block S M, Reboussin D M
Department of Radiology, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC, USA.
AJNR Am J Neuroradiol. 1997 Feb;18(2):219-29.
To examine the vascular supply and architecture of the germinal matrix in the preterm neonatal brain and to determine whether veins or arterioles are the source of germinal matrix hemorrhage.
Brains from eight preterm neonates (24 to 35 weeks' gestation) and two full-term infants were fixed in alcohol, embedded in celloidin, sectioned at 100- and 500-micron thicknesses, stained for alkaline phosphatase, and examined with light microscopy. High-resolution contact radiographs of 500-micron-thick sections were also mounted on glass slides for microscopic examination.
The upper and middle regions of the germinal matrix are supplied by branches of the lateral striate arteries, whereas the inferior part is supplied by branches of the recurrent artery of Heubner. In brain sections from four of the preterm infants, we found 15 circumscribed hemorrhagic foci within the germinal matrix. The largest was 5 mm in diameter; the smallest, 1 mm. All hemorrhages but one were closely associated with veins, with significant involvement of the perivenous space. The other hemorrhage appeared to be associated with an arteriole. In term and preterm infants, we found no arteriolar-to-arteriolar shunts, precapillary arteriolar-to-venules shunts, or vascular rete. At all gestational ages, the terminal vascular bed had only conventional branchings and connections.
In preterm neonates, staining for endogenous alkaline phosphatase allows visual differentiation between afferent and efferent vessels. Germinal matrix hemorrhage in preterm neonates is primarily venous in origin. A hemorrhage can tunnel along the venous perivascular space, collapsing the vein and rupturing the tethered connecting tributaries. Extravasation of blood from the arterial circulation appears to be much less common.
研究早产新生儿脑生发基质的血管供应和结构，并确定生发基质出血的来源是静脉还是小动脉。
将8例早产新生儿（孕龄24至35周）和2例足月儿的大脑用酒精固定，火棉胶包埋，切成100微米和500微米厚的切片，进行碱性磷酸酶染色，然后用光镜检查。500微米厚切片的高分辨率接触式X线照片也被安装在载玻片上用于显微镜检查。
生发基质的上部和中部由外侧纹状体动脉的分支供应，而下部由Heubner回返动脉的分支供应。在4例早产婴儿的脑切片中，我们在生发基质内发现了15个局限性出血灶。最大直径为5毫米；最小直径为1毫米。除1例出血外，所有出血均与静脉密切相关，静脉周围间隙有明显受累。另1例出血似乎与小动脉有关。在足月儿和早产儿中，我们未发现小动脉与小动脉之间的分流、毛细血管前小动脉与小静脉之间的分流或血管网。在所有孕周，终末血管床只有常规的分支和连接。
在早产新生儿中，内源性碱性磷酸酶染色可使传入和传出血管在视觉上得以区分。早产新生儿生发基质出血主要源于静脉。出血可沿静脉周围间隙蔓延，使静脉塌陷并使相连的分支破裂。动脉循环出血则明显少见得多。
