Bifurcation geometry and the presence of cerebral artery aneurysms.


OBJECT:The angles of arterial bifurcations are governed by principles of work minimization (optimality principle). This determines the relationship between the angle of a bifurcation and the radii of the vessels. Nevertheless, the model is predicated on an absence of significant communication between these branches. The circle of Willis changes this relationship because the vessels proximal to the ring of vessels have additional factors that determine work minimization compared with more distal branches. This must have an impact on understanding of the relationship between shear stress and aneurysm formation. The authors hypothesized that normal bifurcations of cerebral arteries beyond the circle of Willis would follow optimality principles of minimum work and that the presence of aneurysms would be associated with deviations from optimum bifurcation geometry. Nevertheless, the vessels participating in (or immediately proximal to) the circle of Willis may not follow the geometric model as it is generally applied and this must also be investigated. METHODS:One hundred seven bifurcations of the middle cerebral artery (MCA), distal internal carotid artery (ICA), and basilar artery (BA) were studied in 55 patients. The authors analyzed three-dimensional reconstructions of digital subtraction angiography images with respect to vessel radii and bifurcation angles. The junction exponent (that is, a calculated measure of the division of flow at the bifurcation) and the difference between the predicted optimal and observed branch angles were used as measures of deviation from the geometry thought best to minimize work. The mean junction exponent for MCA bifurcations was 2.9 +/- 1.2 (mean +/- standard deviation [SD]), which is close to the theoretical optimum of 3, but it was significantly smaller (p < 0.001; 1.7 +/- 0.8, mean +/- SD) for distal ICA bifurcations. In a multilevel multivariate logistic regression analysis, only the observed branch angles were significant independent predictors for the presence of an aneurysm. The odds ratio (OR) (95% confidence interval) for the presence of an aneurysm was 3.46 (1.02-11.74) between the lowest and highest tertile of the observed angle between the parent vessel and the largest branch. The corresponding OR for the smallest branch was 48.06 (9.7-238.2). CONCLUSIONS:The bifurcation beyond the circle of Willis (that is, the MCA) closely approximated optimality principles, whereas the bifurcations within the circle of Willis (that is, the distal ICA and BA) did not. This indicates that the confluence of hemodynamic forces plays an important role in the distribution of work at bifurcations within the circle of Willis. In addition, the observed branch angles were predictors for the presence of aneurysms.


J Neurosurg


Journal of neurosurgery


Ingebrigtsen T,Morgan MK,Faulder K,Ingebrigtsen L,Sparr T,Schirmer H




Has Abstract


2004-07-01 00:00:00












  • Distal posterior inferior cerebellar artery aneurysms: clinical features and management.

    abstract:OBJECT:Aneurysms located on the distal portion of the posterior inferior cerebellar artery (PICA) are uncommon, and their underlying pathology, natural history, and clinical management are poorly understood. To clarify these lesions more fully, the authors undertook a retrospective analysis of the clinical features and...

    journal_title:Journal of neurosurgery

    pub_type: 杂志文章


    authors: Lewis SB,Chang DJ,Peace DA,Lafrentz PJ,Day AL

    更新日期:2002-10-01 00:00:00

  • The prognosis in subarachnoid hemorrhage of unknown etiology.

    abstract::The mortality rate, risk of rebleeding, relevant subjective and objective symptoms, and daily functional capacity after a verified subarachnoid hemorrhage (SAH) of unknown etiology were evaluated in 44 patients treated during a 5-year period (1978 to 1983). A vascular basis for the SAH had been excluded by bilateral c...

    journal_title:Journal of neurosurgery

    pub_type: 杂志文章


    authors: Eskesen V,Sørensen EB,Rosenørn J,Schmidt K

    更新日期:1984-12-01 00:00:00

  • Quality of life in patients with intracranial gliomas: the impact of modern image-guided surgery.

    abstract:OBJECT:Outcome following brain tumor operations is often assessed by health professionals using various gross function scales. However, surprisingly little is known about how modern glioma surgery affects quality of life (QOL) as reported by the patients themselves. In the present study the authors aimed to assess chan...

    journal_title:Journal of neurosurgery

    pub_type: 杂志文章


    authors: Jakola AS,Unsgård G,Solheim O

    更新日期:2011-06-01 00:00:00

  • Effective suppression of hippocampal seizures in rats by direct hippocampal cooling with a Peltier chip.

    abstract:OBJECT:The use of focal brain cooling to eliminate epileptic discharges (EDs) has attracted increasing attention in the scientific community. In this study, the inhibitory effect of selective hippocampal cooling on experimental hippocampal seizures was investigated using a newly devised cooling system with a thermoelec...

    journal_title:Journal of neurosurgery

    pub_type: 杂志文章


    authors: Tanaka N,Fujii M,Imoto H,Uchiyama J,Nakano K,Nomura S,Fujisawa H,Kunitsugu I,Saito T,Suzuki M

    更新日期:2008-04-01 00:00:00

  • Hemorrhage after particle embolization of hemangioblastomas: comparison of outcomes in spinal and cerebellar lesions.

    abstract:OBJECT:In this study the authors compare the clinical outcomes after particle embolization of hemangioblastomas in the cerebellum and spinal cord. They also review the literature of similar cases. METHODS:Seven patients with hemangioblastomas in the spinal cord (four patients) and cerebellum (three patients) underwent...

    journal_title:Journal of neurosurgery

    pub_type: 杂志文章


    authors: Cornelius JF,Saint-Maurice JP,Bresson D,George B,Houdart E

    更新日期:2007-06-01 00:00:00

  • Neuroendoscopic findings in patients with intracranial germinomas correlating with diabetes insipidus.

    abstract:OBJECT:Intracranial germinomas commonly occur in the pineal region, the floor of the third ventricle (hypothalamus), or both, and they are often associated with diabetes insipidus (DI). The authors conducted a study to correlate preoperative DI with the endoscopic and magnetic resonance (MR) imaging evidence of tumor o...

    journal_title:Journal of neurosurgery

    pub_type: 杂志文章


    authors: Wellons JC 3rd,Reddy AT,Tubbs RS,Abdullatif H,Oakes WJ,Blount JP,Grabb PA

    更新日期:2004-05-01 00:00:00

  • Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. 1997.

    abstract::From December 1990 to July 1995, the investigators participated in a prospective clinical study to evaluate the safety of the Guglielmi detachable coil (GDC) system for the treatment of aneurysms. This report summarizes the perioperative results from eight initial interventional neuroradiology centers in the United St...

    journal_title:Journal of neurosurgery

    pub_type: 传,古典文章,历史文章,杂志文章,多中心研究


    authors: Viñuela F,Duckwiler G,Mawad M

    更新日期:2008-04-01 00:00:00

  • Proton nuclear magnetic resonance studies on brain edema.

    abstract::The water in normal and edematous brain tissues of rats was studied by the pulse nuclear magnetic resonance (NMR) technique, measuring the longitudinal relaxation time (T1) and the transverse relaxation time (T2). In the normal brain, T1 and T2 were single components, both shorter than in pure water. Prolongation and ...

    journal_title:Journal of neurosurgery

    pub_type: 杂志文章


    authors: Naruse S,Horikawa Y,Tanaka C,Hirakawa K,Nishikawa H,Yoshizaki K

    更新日期:1982-06-01 00:00:00

  • A new model of transient hindbrain ischemia in gerbils.

    abstract::A model of transient hindbrain ischemia in Mongolian gerbils is described. The vertebrobasilar junction of gerbils was exposed by a transcervical approach through the space between the atlas and occipital bone. The origin of the basilar artery was occluded by a clip, and the local cerebral blood flow (CBF) was measure...

    journal_title:Journal of neurosurgery

    pub_type: 杂志文章


    authors: Yamada K,Hayakawa T,Yoshimine T,Ushio Y

    更新日期:1984-05-01 00:00:00

  • Extended endoscopic endonasal approach for selected pituitary adenomas: early experience.

    abstract:OBJECT:Whereas most pituitary adenomas are removable via the transsphenoidal approach, certain cases, such as dumbbell-shaped or suprasellar adenomas and recurrent and/or fibrous tumors, remain difficult to treat. The authors present their experience with the extended endoscopic endonasal approach to the suprasellar ar...

    journal_title:Journal of neurosurgery

    pub_type: 杂志文章


    authors: Di Maio S,Cavallo LM,Esposito F,Stagno V,Corriero OV,Cappabianca P

    更新日期:2011-02-01 00:00:00

  • Hyperprolactinemia, intrasellar pituitary tissue pressure, and the pituitary stalk compression syndrome.

    abstract::The intrasellar pressure has been studied in a consecutive series of 24 patients undergoing transsphenoidal surgery for pituitary adenoma. The mean intrasellar pressure for the group was 23 +/- 2.5 mm Hg (+/- standard error of the mean), with a mean pulse pressure of 3.5 +/- 1 mm Hg. The waveform partly resembled the ...

    journal_title:Journal of neurosurgery

    pub_type: 杂志文章


    authors: Lees PD,Pickard JD

    更新日期:1987-08-01 00:00:00

  • Risk factors for postoperative neurosurgical wound infection. A case-control study.

    abstract::A case-control analysis was performed to evaluate the association of 15 potential risk factors with postoperative infection in neurosurgical patients. All infections that developed postoperatively on the neurosurgical service at the University of Minnesota from January, 1970, to March, 1984, were identified. Among the...

    journal_title:Journal of neurosurgery

    pub_type: 杂志文章


    authors: Mollman HD,Haines SJ

    更新日期:1986-06-01 00:00:00

  • Response of malignant glioma cell lines to epidermal growth factor and platelet-derived growth factor in a serum-free medium.

    abstract::The use of a serum-free culture system for assessing the growth factor responsiveness of malignant glial cells is described. The mitogenic properties of epidermal growth factor (EGF) and platelet-derived growth factor (PDGF) were examined in three human malignant glioma cell lines (T98G, U87, and U138). Each of the th...

    journal_title:Journal of neurosurgery

    pub_type: 杂志文章


    authors: Pollack IF,Randall MS,Kristofik MP,Kelly RH,Selker RG,Vertosick FT

    更新日期:1990-07-01 00:00:00

  • A microsurgical study of the anatomy and course of the ophthalmic artery and its possibly dangerous anastomoses.

    abstract:OBJECT:The authors studied the microsurgical anatomy of the ophthalmic artery (OphA), paying particular attention to its possibly dangerous anastomoses with the middle meningeal artery (MMA). METHODS:The microsurgical anatomy of the OphA and its anastomoses with the MMA were studied in 14 vessels from seven adult cada...

    journal_title:Journal of neurosurgery

    pub_type: 杂志文章


    authors: Perrini P,Cardia A,Fraser K,Lanzino G

    更新日期:2007-01-01 00:00:00

  • Flow diversion treatment of complex bifurcation aneurysms beyond the circle of Willis: complications, aneurysm sac occlusion, reabsorption, recurrence, and jailed branch modification at follow-up.

    abstract:OBJECTIVE:The purpose of this study is to present the authors' medium-term results, with special emphasis on complications, occlusion rate of the aneurysm sac (digital subtraction angiography [DSA] and MRI), and the fate of cortical branches and perforating arteries covered ("jailed") by the flow diverter (FD) stent. ...

    journal_title:Journal of neurosurgery

    pub_type: 杂志文章


    authors: Michelozzi C,Darcourt J,Guenego A,Januel AC,Tall P,Gawlitza M,Bonneville F,Cognard C

    更新日期:2018-12-21 00:00:00

  • Delayed onset of hemidystonia and hemiballismus following head injury: a clinicopathological correlation. Case report.

    abstract::The authors report the case of a young man who suffered multiple injuries in a motor vehicle accident, the most significant of which arose in the brain, creating an unusual clinical syndrome. After experiencing an initial coma for several days, the patient was found to have a right-sided homonymous hemianopsia and a r...

    journal_title:Journal of neurosurgery

    pub_type: 杂志文章


    authors: King RB,Fuller C,Collins GH

    更新日期:2001-02-01 00:00:00

  • Intracranial desmoplastic small round cell tumor presenting as a suprasellar mass.

    abstract::Desmoplastic small round cell tumors (DSRCTs) are rare, aggressive neoplasms that typically arise from abdominal and pelvic peritoneum in young adults. Other primary sites are uncommon, and an intracranial origin is exceptionally rare. Here the authors report the first case of a DSRCT presenting as a primary suprasell...

    journal_title:Journal of neurosurgery

    pub_type: 杂志文章


    authors: Thondam SK,du Plessis D,Cuthbertson DJ,Das KS,Javadpour M,MacFarlane IA,Leggate J,Haylock B,Daousi C

    更新日期:2015-04-01 00:00:00

  • Stereotactic radiosurgery for intracranial hemangiopericytomas: a multicenter study.

    abstract::OBJECTIVE Hemangiopericytomas (HPCs) are rare tumors widely recognized for their aggressive clinical behavior, high recurrence rates, and distant and extracranial metastases even after a gross-total resection. The authors report a large multicenter study, through the International Gamma Knife Research Foundation (IGKR...

    journal_title:Journal of neurosurgery

    pub_type: 杂志文章,多中心研究


    authors: Cohen-Inbar O,Lee CC,Mousavi SH,Kano H,Mathieu D,Meola A,Nakaji P,Honea N,Johnson M,Abbassy M,Mohammadi AM,Silva D,Yang HC,Grills I,Kondziolka D,Barnett GH,Lunsford LD,Sheehan J

    更新日期:2017-03-01 00:00:00

  • Transtentorial transcollateral sulcus approach to the ventricular atrium: an endoscope-assisted anatomical study.

    abstract::OBJECTIVE Conventional approaches to the atrium of the lateral ventricle may be associated with complications related to direct cortical injury or brain retraction. The authors describe a novel approach to the atrium through a retrosigmoid transtentorial transcollateral sulcus corridor. METHODS Bilateral retrosigmoid ...

    journal_title:Journal of neurosurgery

    pub_type: 评论,杂志文章


    authors: Jeelani Y,Gokoglu A,Anor T,Al-Mefty O,Cohen AR

    更新日期:2017-04-01 00:00:00

  • Reduction of central nervous system ischemic injury by monoclonal antibody to intercellular adhesion molecule.

    abstract::Activated leukocytes appear to be directly involved in potentiating ischemic central nervous system (CNS) injury. Adhesion of leukocytes to endothelium is essential for their migration and requires the binding of adhesion receptors of the leukocyte (CD 18) to an intercellular adhesion molecule (ICAM) on endothelium. M...

    journal_title:Journal of neurosurgery

    pub_type: 杂志文章


    authors: Clark WM,Madden KP,Rothlein R,Zivin JA

    更新日期:1991-10-01 00:00:00

  • The prophylactic use of transluminal balloon angioplasty in patients with Fisher Grade 3 subarachnoid hemorrhage: a pilot study.

    abstract:OBJECT:Recent advances in neuroradiology have made it possible to dilate vasospastic human cerebral arteries after aneurysmal subarachnoid hemorrhage (SAH), but the time window is short and the success rate for reversal of delayed ischemic neurological deficits (DINDs) varies between 31% and 77%. In a dog model of vaso...

    journal_title:Journal of neurosurgery

    pub_type: 杂志文章


    authors: Muizelaar JP,Zwienenberg M,Rudisill NA,Hecht ST

    更新日期:1999-07-01 00:00:00

  • Systemic gamma-interferon therapy for recurrent gliomas.

    abstract::Recombinant gamma-interferon (2 mg/sq m) was administered intravenously twice weekly in 8-week courses to 14 patients with recurrent gliomas. Computerized tomography (CT) evidence of response was seen in only one patient, and stabilization for 12 to 86 weeks was recorded in three. This was a disappointing result, part...

    journal_title:Journal of neurosurgery

    pub_type: 杂志文章


    authors: Mahaley MS Jr,Bertsch L,Cush S,Gillespie GY

    更新日期:1988-12-01 00:00:00

  • Subdural versus subgaleal drainage for chronic subdural hematomas: a post hoc analysis of the TOSCAN trial.

    abstract:OBJECTIVE:The use of subdural drains after surgical evacuation of chronic subdural hematoma (CSH) decreases the risk of recurrence and has become the standard of care. Halfway through the controlled, randomized TOSCAN (Randomized Trial of Follow-up CT after Evacuation of Chronic Subdural Hematoma) trial, the authors' i...

    journal_title:Journal of neurosurgery

    pub_type: 杂志文章


    authors: Häni L,Vulcu S,Branca M,Fung C,Z'Graggen WJ,Murek M,Raabe A,Beck J,Schucht P

    更新日期:2019-08-30 00:00:00

  • Ossification of the pterygoalar and pterygospinous ligaments: a computed tomography analysis of infratemporal fossa anatomical variants relevant to percutaneous trigeminal rhizotomy.

    abstract:OBJECTIVE:Ossification of pterygoalar and pterygospinous ligaments traversing the superior aspect of the infratemporal fossa results in formation of osseous bars that can obstruct percutaneous needle access to the trigeminal ganglion through the foramen ovale (FO), interfere with lateral mandibular nerve block, and imp...

    journal_title:Journal of neurosurgery

    pub_type: 杂志文章


    authors: Matys T,Ali T,Zaccagna F,Barone DG,Kirollos RW,Massoud TF

    更新日期:2019-05-10 00:00:00

  • Giant suprasellar aneurysm associated with optic stalk agenesis and unilateral anophthalmos. Case report.

    abstract::The authors report a patient with unilateral anophthalmos who had a large suprasellar aneurysm associated with aplasia of an optic nerve and the chiasmal commissure. The anatomical findings at craniotomy are described. ...

    journal_title:Journal of neurosurgery

    pub_type: 杂志文章


    authors: Hoff J,Winestock D,Hoyt WF

    更新日期:1975-10-01 00:00:00

  • Vasogenic edema following acute and chronic spinal cord compression in the dog.

    abstract::The T-13 spinal cord segment of dogs was compressed both acutely and chronically by means of a balloon catheter. The vascular permeability to protein was assessed using Evans blue albumin (EBA), and the dorsal column evoked potential recorded to monitor conduction failure. With acute compression sufficient to cause co...

    journal_title:Journal of neurosurgery

    pub_type: 杂志文章


    authors: Griffiths IR

    更新日期:1975-02-01 00:00:00

  • Painful supernumerary phantom arm following motor cortex stimulation for central poststroke pain. Case report.

    abstract::In this report, the authors describe a case in which the patient began to experience a supernumerary phantom arm after she received motor cortex stimulation for central pain. The patient had a history of right thalamocapsular stroke. It is speculated that the motor cortex activation triggered a response in the patient...

    journal_title:Journal of neurosurgery

    pub_type: 杂志文章


    authors: Canavero S,Bonicalzi V,Castellano G,Perozzo P,Massa-Micon B

    更新日期:1999-07-01 00:00:00

  • Biomechanical properties of expander compared with conventional screws.

    abstract:OBJECT:A pullout strength biomechanical study was performed in 20 fresh swine vertebral bodies in which titanium expander (Group 1) and conventional screws (Group 2) were placed. METHODS:The screws were inserted into the anterosuperior portion of the anterior spine, and assessment was performed after application of lo...

    journal_title:Journal of neurosurgery

    pub_type: 杂志文章


    authors: Rassi-Neto A,Shimano A

    更新日期:2002-10-01 00:00:00

  • Complement fixation by IgM and IgG autoantibodies on cultured human glial cells.

    abstract::The humoral immune response to autologous gliomas has been investigated in 16 patients using immune adherence and anti-C3 immunofluorescence assays of serum samples. Significant antiglioma antibody activity was detected in 56% of these sera. Fractionation experiments demonstrated that IgM class antibodies were more ef...

    journal_title:Journal of neurosurgery

    pub_type: 杂志文章


    authors: Garson JA,Quindlen EA,Kornblith PL

    更新日期:1981-07-01 00:00:00

  • Tuberculous brain abscess. Case report.

    abstract::An abscess was removed from the left occipital region in a 73-year-old woman with no previous history of tuberculosis. The patient later died from aspiration bronchopneumonia. Autopsy revealed a basilar tuberculous meningitis and miliary tuberculosis in the peritracheal lymphatic glands, the liver, the spleen, and in ...

    journal_title:Journal of neurosurgery

    pub_type: 杂志文章


    authors: González PR,Herrero CV,Joachim GF,Ocaña CR,Sevilla GC,Loyzaga PG

    更新日期:1980-03-01 00:00:00