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Biomedical subjects

F Umansky

Publications and source records attributed to F Umansky.

At least 55 records · Page 3Linked to original sources
PubMed1988

Microsurgical removal of arteriovenous malformations of the basal ganglia.

Arteriovenous malformations in the basal ganglia region have been a problem in neurosurgical practice. We report six cases of deep-seated malformations fed mainly by the perforating branches of the middle cerebral artery. There were no deaths in the series. Four patients returned to their previous activities, and the other two patients had persistent hemiparesis and dysphasia, present preoperatively, with worsening in one case. Both of these patients improved and are independent. We show the feasibility of satisfactory microsurgical treatment of these lesions based on the knowledge of microanatomical studies.

Basal Ganglia↗
PubMed1987

Microanatomy of the premamillary artery.

The premamillary artery was studied in 50 unfixed human brain hemispheres (51 vessels were found) which were injected with polyester resin and dissected under the operating microscope. In one hemisphere there was duplication of the premamillary artery. There were premamillary arteries arising from the posterior communicating artery (PCoA) in 49 cases and from the posterior cerebral artery in the remaining two. The arteries originated from the superior and lateral surfaces of the PCoA and coursed superiorly, laterally, and posteriorly to enter a triangular perforated space limited by the mamillary body and tuber cinereum medially, the optic tract anterolaterally, and the cerebral peduncle posterolaterally. This space is called the paramedian perforated substance. The premamillary artery had an outer diameter of 0.6 +/- 0.2 mm on the right side and 0.6 +/- 0.1 mm on the left. The length of the premamillary artery was 12.0 +/- 2.0 mm on the right side and 12.7 +/- 1.9 mm on the left. Sixty-three percent of the premamillary arteries gave off branches that supplied the cerebral peduncles, optic tract, and paramedian perforated space. The clinical importance of these anatomical data in the symptomatology and management of vascular and neoplastic diseases in and around the posterior circle of Willis is discussed.

Cerebral Arteries↗
PubMed1987

Microanatomy of the posterior communicating artery.

Fifty unfixed cerebral hemispheres were injected with polyester resin and dissected under the operating microscope to show the anatomy of the posterior communicating artery (PCoA). There was a single PCoA in every hemisphere. Eleven (22%) were of fetal origin, and 17 (34%) were hypoplastic. Infundibular dilatations were found in 5 (10%) of the arteries. The outer diameter (OD) of the PCoA at its origin was 1.5 +/- 0.8 mm on the right and 1.6 +/- 0.6 mm on the left. At the junction of the PCoA with the P1 segment of the posterior cerebral artery, the PCoA had an OD of 1.4 +/- 0.7 mm on the right side and 1.6 +/- 0.6 mm on the left. The total length of the PCoA was 12.7 +/- 3.2 mm on the right and 12.5 +/- 1.7 mm on the left side. PCoA branches originated from the superior (36%) or lateral (64%) surface of the PCoA and coursed superiorly, posteriorly, or laterally. These vessels supplied the paramedian perforated substance (21%), the tuber cinereum (16.8%), the sulcus between the optic tract and the tuber cinereum (14.4%), the circuminfundibular anastomosis (11.5%), the mamillary bodies (8.4%), the sulcus between the optic tract and the cerebral peduncles (7.6%), and the cerebral peduncles (5.7%). The largest and most constant branch of the PCoA was the premamillary artery. The number and size of the branches from the PCoA were independent of the size of the parent artery.

Adult↗
PubMed1986

Microanatomy of the anterior cerebral artery.

The microanatomic features of the anterior cerebral artery were studied in 30 unfixed human brains which were injected with tinted polyester resin via cannulation of the internal carotid arteries under microscopic dissection. The outer diameter, length, and number of perforating branches were measured for each of the following vessels: anterior cerebral artery (proximal A1 segment, distal A2 segment), anterior communicating artery, and recurrent artery of Heubner. The perforating branches of the proximal segment of the anterior cerebral artery penetrated the brain at the anterior perforated substance, lateral chiasm, and optic tracts. The perforating branches of the anterior communicating artery penetrated the brain at the lamina terminalis, anterior perforated substance, and medial chiasm. The first 5 mm of the distal anterior cerebral artery (A2) had perforating branches penetrating the brain at the gyrus rectus and olfactory sulcus. The recurrent artery of Heubner originated from the A2 segment of the anterior cerebral artery in 57% of the cases, from the anterior cerebral artery-anterior communicating artery junction in 35%, and from the A1 segment in 8%. The depth of the interhemispheric fissure at the genu was 36.0 +/- 0.5 mm and at the midbody of the corpus callosum, 35.0 +/- 0.5 mm. Extension of the dissection to approach the anterior communicating artery from the genu of the corpus callosum using the anterior interhemispheric route was an additional 31.7 +/- 0.7 mm. The callosal arterial supply from the anterior cerebral artery showed short callosal branches in all brain specimens and long callosal vessels in 10% of the specimens.

Cerebral Arteries↗
PubMed1986

Microvascular anatomy of the interpeduncular fossa.

An understanding of the microvascular anatomy of the midbrain and posterior diencephalon is essential in the surgical management of lesions in that region. A description of the arterial pattern of blood supply to these areas is the purpose of this study. Perforating branches originating from the last 5 mm of the basilar artery, from the initial 7 mm of both superior cerebellar arteries (SCA's), and from the initial segment (P1 segment) of the posterior cerebral artery were studied in 56 unfixed human cadaver brain hemispheres. The brains were injected with polyester resin. The perforating branches penetrated through a small space in the upper part of the interpeduncular fossa. The anterior two-thirds of this space was occupied by the posterior perforated substance (PPS), and the posterior one-third was the site of penetration of the branches that supply the inferior mesencephalon. The PPS was divided into anterior and posterior halves. The anterior half was perforated by the paramedian thalamic arteries (diameter 0.57 +/- 0.11 mm) while the superior paramedian mesencephalic arteries (diameter 0.20 +/- 0.06 mm) perforated the posterior half. The perforating arteries originated from a trunk exclusive to the anterior half in 30%, from a trunk supplying both halves in 57%, and from a trunk exclusive to the posterior half in 13% of specimens. There were 26 naturally occurring anastomoses between the perforating branches. The paramedian inferior mesencephalic arteries penetrating the posterior one-third of the upper part of the interpeduncular fossa arose from the P1 segment in 32% of the brains studied, from the proximal 7 mm of the SCA in 45%, and from the last 5 mm of the basilar artery in 23%.

Basilar Artery↗
PubMed1985

Hyperostotic meningioma presenting as an asymptomatic forehead bulge in a 7-year-old girl.

The case of an asymptomatic 7-year-old girl with a hard bulge in the left forehead is presented. The radiological evaluation disclosed a hyperostotic mass with a large intracranial extension. A surgical specimen revealed a meningioma. The presence of a localized cranial bulge as the only sign of an intracranial tumor and the diagnostic value of computerized tomography (CT) are discussed.

Child↗
PubMed1985

Middle cerebral artery reconstruction.

The authors have conducted an experimental study of the microanatomic features of the middle cerebral artery in unfixed human brains to assess the feasibility of reconstructive procedures within the Sylvian fissure. It was found that reconstructive procedures within the Sylvian fissure such as end-to-end, end-to-side, side-to-side, and grafting procedures were possible according to the anatomic data provided by our study. Possible surgical solutions to theoretical pathologic situations involving the middle cerebral artery vascular tree are highlighted and their feasibility is discussed.

Cerebral Arteries↗
PubMed1985

The perforating branches of the middle cerebral artery. A microanatomical study.

The perforating branches (PFB's) of the middle cerebral artery (MCA) were studied in 34 unfixed brain hemispheres which were injected with a polyester resin and dissected under the operating microscope. Five hundred and eight vessels were identified and their site of origin, branching pattern, outer diameter (OD), and length recorded. Four hundred and two PFB's (79%) originated from the main trunk of the MCA before its division; the remaining 106 vessels (21%) had their origin from branches of the MCA as follows: superior trunk, 43 vessels (8.5%); inferior trunk, 30 vessels (6%); middle trunk, four vessels (0.8%); early temporal branch, 27 vessels (5.3%); and early frontal branch, two vessels (0.4%). The number of PFB's in each hemisphere varied from five to 29 (mean 14.9 +/- 0.7 vessels). The great majority of PFB's (96%) originated along the proximal 17 mm of the MCA. The PFB's arising in the first 10 mm had a mean OD of 0.35 +/- 0.01 mm and a mean length of 9.25 +/- 0.19 mm, and those arising from the second 10 mm had a mean OD of 0.47 +/- 0.02 mm and a mean length of 16.67 +/- 1.4 mm. A clear distinction between a medial and lateral group of PFB's was present in only 14 hemispheres (41%). In nine hemispheres (26%), perforating vessels from the anterior cerebral artery (A1 segment) and from the recurrent artery of Heubner replaced the medial group of PFB's of the MCA. In one case this group originated in an accessory MCA. In three hemispheres (9%) a small anastomosis (OD 0.2 mm) was seen between a PFB of the recurrent artery of Heubner and one of the MCA. From a total of 508 PFB's, 255 vessels (50%) originated as single vessels, while 253 vessels (50%) originated as branches of common stems. The OD of the single vessels ranged from 0.1 mm to 1.1 mm (mean 0.39 +/- 0.02 mm), and the length from 3 to 20 mm (mean 10.8 +/- 0.2 mm). The common stems ranged in OD from 0.6 to 1.8 mm (mean 0.87 +/- 0.04 mm), and in length from 1 to 15 mm (mean 4.1 +/- 0.4 mm). The clinical application of these anatomical data to the management of aneurysms and arteriovenous malformations of the MCA, and in the field of interventional neuroradiology is described. The most frequent pathological entities involving the perforating vessels are also discussed.

Adult↗
PubMed1985

Cerebral revascularization to a main limb of the middle cerebral artery in the Sylvian fissure. An alternative approach to conventional anastomosis.

Thirteen patients underwent an anastomosis of the superficial temporal artery (STA) or a saphenous vein graft to one of the secondary trunks of the middle cerebral artery (MCA). They included five patients with giant MCA trifurcation aneurysms, four patients in whom an earlier conventional STA-MCA anastomosis had become occluded, two patients who had stenosis of one of the secondary limbs of the MCA, and one patient who had a carotid-cavernous fistula. One patient had a saphenous vein graft from the common carotid artery to a secondary trunk of the MCA to bypass an occluded internal carotid artery and severely stenosed external carotid artery. The primary advantages of this procedure are that a large-caliber anastomosis to one of the secondary limbs of the MCA immediately restores flow into the MCA tree with a larger amount of vessel filling than with a standard cortical bypass, and large vessels can be used for the anastomosis. The disadvantages are that one of the secondary branches of the MCA must be occluded, the cerebral hemisphere around the Sylvian fissure must be retracted, a lumbar subarachnoid drain is needed, and the anastomosis must be performed deep within the Sylvian fissure. The procedure is a satisfactory alternative in cases in which a conventional STA-MCA anastomosis has either failed or would be less likely to succeed.

Adult↗
PubMed1984

Microsurgical anatomy of the recurrent artery of Heubner.

The recurrent arteries of Heubner were studied in 30 unfixed human brains (60 hemispheres) obtained from routine autopsies of individuals with a mean age of 34 years. The arteries were injected with tinted polyester resin via cannulation of the internal carotid arteries, and dissected under microscopic magnification. The recurrent artery of Heubner was absent in two hemispheres and double in seven hemispheres, either with a separate origin (in two) or from a common stem (in five). The artery of Heubner had a mean outer diameter of 0.8 +/- 0.04 mm (range 0.3 to 1.5 mm) and a mean length of 23.4 +/- 1.1 mm (range 12 to 38 mm). It originated from the A2 segment of the anterior cerebral artery (ACA) in 57% of the specimens, from the junction of the ACA and the anterior communicating artery in 35%, and from the A1 segment of the ACA in 8%. Three types of recurrent courses were observed. In the Type I or superior course, seen in 41 (63%) of the 65 arteries, the artery followed the superior wall of the A1 segment of the ACA. In the Type II or anterior course, the arteries found in 22 (34%) of specimens maintained a rostral position in relation to the A1 segment. In the Type III or posterior course, taken by two (3%) arteries, a posterior course of the vessel in the anterior perforated substance was found. The branching pattern was identified down to a range of 100 to 200 mu, and the average number of branches was 6.5 +/- 0.4 (range 3 to 12). Four groups of branches were observed. The olfactory group was represented in 91% by a single olfactory branch, with a mean outer diameter of 0.3 +/- 0.03 mm. On average, 1.9 +/- 0.27 frontal branches were found with a mean diameter of 0.13 +/- 0.01 mm. The branches penetrating the anterior perforated substance had a larger outer diameter (mean 0.4 +/- 0.03 mm) with an average number of 2.5 +/- 0.2 branches. The Sylvian fissure branches were more numerous (mean 3 +/- 0.3) with a mean outer diameter of 0.4 +/- 0.03 mm. The point of penetration of the main trunk was found to be constant at the level of the lateral perforated substance-medial Sylvian fissure in 85% of the cases. This report emphasizes the advantages of the intravascular casting resin injection technique in unfixed human brains over other conventional methods. It also describes the application of these anatomic data to the surgical strategy for the anterior circle of Willis, including the possible use of the recurrent artery of Heubner for microvascular reconstructive procedures.

Adult↗
PubMed1984

Microsurgical anatomy of the proximal segments of the middle cerebral artery.

The microvascular anatomy of the proximal segments (M1 and M2) of the middle cerebral artery (MCA) was studied in 70 unfixed brain hemispheres from 35 cadavers. The arteries were injected with a tinted polyester resin and dissected under magnification by microsurgical techniques. The authors studied the outer diameter (OD), length, site of origin, and pattern of branching of the main trunk, secondary trunks, and the initial insular portion of the cortical branches of the MCA. The degree of mobilization of the arteries lying over the insular cortex was also assessed. The main trunk of the MCA, which had an OD of 3 +/- 0.1 mm bilaterally and a length of 15 +/- 1.1 mm in the right hemisphere and 15.7 +/- 1.3 mm in the left hemisphere, could be divided into four groups: Group I: absence of a main division (that is, a single-trunk type of MCA) (in 6% of cases); Group II: bifurcation (64%); Group III: trifurcation (29%); and Group IV: quadrifurcation (1%). The secondary trunks resulting from the division of the main trunk of the MCA had a mean OD ranging from 1.4 to 2.3 mm and a mean length that varied from 12.1 to 14.9 mm. The mean OD of the cortical branches measured near their origin in the main and secondary trunks indicated that the angular artery was the largest vessel, with a mean OD of 1.5 mm on both sides of the brain. The temporopolar artery was the smallest, with a mean OD of 0.8 mm in the right hemisphere and 0.9 mm in the left hemisphere. The authors also describe the patterns of origin of the cortical vessels from the main trunk (early branches) and from the secondary trunks, as well as their branching pattern at the site of origin (single vessels and common stems). These anatomical data indicate that it is possible to perform microvascular reconstructive procedures, such as anastomosis, grafting, and reimplantation of branches in the insular area. The advantages of using unfixed specimens, intravascular injections, and magnification to reproduce in vivo conditions as closely as possible are also discussed.

Cerebral Arteries↗
PubMed1983

Successful removal of an acute brain stem hematoma in a young child.

Several days after receiving a blow to the occipital region, a 5-year-old boy presented with acute symptoms and signs of a space-occupying-lesion in the posterior fossa. A CAT scan revealed a mass with increased density in the region of the fourth ventricle. A suboccipital craniectomy disclosed a subependymal hematoma bulging into the fourth ventricle. The hematoma was evacuated, and the child subsequently made a complete recovery. It is stressed that surgical intervention should be considered in all such cases and particularly in young patients who show progressive neurological deficits.

Brain Stem↗
PubMed1983

Regional cerebral blood flow in the acute stage of experimentally induced subarachnoid hemorrhage.

Subarachnoid hemorrhage (SAH) was induced in 13 adult mongrel cats by a slow injection of fresh autogenous blood into the cisterna magna. Serial determinations of regional cerebral blood flow (rCBF) in the cortex and deep-seated areas (internal capsule, thalamus, and caudate nucleus) were made during the following 2 hours, while intracranial pressure (ICP) was maintained at normal values. A decrease in rCBF was observed in all the areas examined. This reduction followed a characteristic triphasic pattern with an initial steep decline immediately after the SAH. The clinical implications of these findings are discussed.

Animals↗
PubMed1982

The lateral wall of the cavernous sinus. With special reference to the nerves related to it.

In a study of the cavernous sinus in 70 specimens, the lateral wall of the sinus was found to be formed by two layers: a superficial, dural layer and a deep layer. The latter was formed by the sheaths of nerves III, IV, and V 1,2 plus a reticular membrane extending between the sheaths. This membrane was often incomplete, particularly between the sheaths of nerves III and IV above, and V1 below. These findings do not conform with the descriptions of a single dural layer of the lateral wall, with nerves III, IV, and V 1,2 embedded in it, nor to other descriptions showing the cavity of the sinus divided into two compartments by a septum close to the lateral wall, with nerves III, IV, and V1 located within the septum. In the present study, the superficial and the deep layers of the lateral wall were found to be loosely attached to each other and easy to separate. In no case was a superficial compartment of the sinus found to be present between the two layers, and the nerves were never found to be running embedded in the superficial layer.

Adult↗