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Journal of Korean Neurosurgical Society > Volume 3(1); 1974 > Article
Journal of Korean Neurosurgical Society 1974;3(1): 7-14.
Angiographic Demonstration of the Posterior Cerebral and Posterior Communicating Arteries in Normal and Hydrocephalus Cases.
Hun Hwa Jung, Hun Jae Lee
Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.
Carotid angiography is a most important diagnostic procedure for investigation of intracranial lesions and for understanding the cerebral circulation. Of the cerebral arteries, only the posterior cerebral artery is, both functionally and anatomically, a border artery between the carotid and vertebral circulatory systems, so it is more important for an understanding of the cerebral circulation. Early in the development of the fetal circulation, the posterior cerebral artery arises from the internal carotid artery(carotid segment), with the connection to the basilar artery(basilar segment) developing later. In many cases, however, it derives its supply from both systems simultaneously. Angiographic demonstration of the posterior cerebral artery is influenced by certain pressure factors of the intracranial cavity and other technical factors, for example, site of puncture, needle size, injection time and force used and position of the head, ect. Here the author has analysed the factors of age, sex, puncture site and right of left side and a degree of hydrocephalus. Carotid angiography has been performed for definite indication, hence, no cerebral angiography has been performed on any entirely asymptomatic subject. The normal controls used in this investigation consist of angiographies done in subjects with symptoms but no evidence of vascular lesions or other abnormality. The author found a high incidence of the posterior cerebral arteries demonstrated in hydrocephalus, in spite of increased pressure and changed courses of the cerebral arteries. So, the cerebral arteriograms of normal cases are compared with those of hydrocephalic subjects and the chances of demonstrating the posterior cerebral artery in both groups are analysed. Engeset A.(1948), Saltzman(1959), Yasargil & Krayenbuhl(1964) and others reported the demonstration of the posterior cerebral artery but report of a relationship of the artery with hydrocephalus was not found. This study comprises 2,350 conventional carotid angiographies carried out from 1968 to 1973 in the neurosurgery department of Severance Hospital, Seoul, Korea. Out of these 2,350 angiographies, 1,288 were normal and 160 were indicative of hydrocephalus. The incidence of angiographic demonstration of the posterior cerebral artery in normal Koreans is 34.2% and in hydrocephalus, 45.6%. This is a higher incidence than is reported in the literature concerning conventional carotid angiography. The number of cases where the posterior communicating artery alone was filled was so small that there was no point in separating them according to age and sex, etc. Generally the hydrocephalic group showed a higher incidence of the posterior cerebral and posterior communicating arteries than the normal group. In all cases, the effect of sex difference is not significant but the effect of age is. The posterior cerebral artery was more visible in the younger groups and occurred most frequently in the youngest group, while the incidence dropped slightly in the higher age groups, in both normal and hydrocephalus groups. Filling of the posterior cerebral arteries in subjects aged 10-30 is markedly more frequent than in the 40-60 age range in both the normal and hydrocephalus groups. The posterior cerebral artery was demonstrated in 148 out of 384(38.6%) internal carotid arteriograms and in 292 out of 904(32.3%) common carotid arteriograms. This difference is highly significant and is similar to the results of Saltzman(1959). No significance of the right or left side difference could be found. The increasing tendency of the filling of the posterior cerebral artery in the more severe forms of hydrocephalus compared with the milder types was noted. In this report, the statistical significance was evaluated by means of the z-test.
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