Venous architecture of cerebral hemispheric white matter and comments on pathogenesis of medullary venous and other cerebral vascular malformations.
The parenchymal veins, especially the deep medullary veins, of the cerebral hemispheres were studied in detail by analyzing the stereoroentgenograms of multiple brain slices of postmortem injected brain specimens (injected into the internal carotid arteries in 17 cases and into the jugular veins in 12 cases). The presence of four zones--the first (or outer), the second (or candelabra), the third (or palmate) and the fourth (or subependymal) zone--of venous convergence was confirmed within the centrum semiovale, particularly in the frontoparietal area. Other venous convergences such as those related to the optic radiation in the para-atrial area were also found. Arterial branching zones were also observed in the areas similar to those of the medullary veins. It appears that these converging zones are created by rapidly growing crossing nerve fiber tracts, i.e., projection, commissural, and association fibers which grow rapidly during intrauterine and postnatal life. Pathogenesis of medullary venous malformation is also discussed from anatomical viewpoint, venoarchitecture of the pial, parenchymal, and subependymal veins and of the dural venous sinuses. The possibility of a similar mechanism (partial, mild, repetitive venoocclusive disease developing over a long period with fluctuating venous pressure) leading to formation of most (if not all) cases of medullary venous malformation and in some, if not many, cases of cerebral vascular malformations [aside from gene abnormality (chromosome 7) in familial cavernous angiomatosis, particularly in Hispanic American or other familial hereditary conditions] has been postulated.
Huang
Y P
YP
Mount Sinai School of Medicine, Department of Radiology, New York, NY 10029, USA.
Okudera
T
T
Fukusumi
A
A
Maehara
F
F
Stollman
A L
AL
Mosesson
R
R
Lidov
M
M
Mitty
H A
HA
D002540:Cerebral Cortex / Q000098:blood supply*; D002550:Cerebral Veins / Q000033:anatomy & histology*; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000473:pathology*; D011859:Radiography