PROGRESS IN BRAIN RESEARCH ADVISORY BOARD W. Bargmann Kiel H. T. Chang Shanghai E. De Robertis Buenos Ares J. C. Eccles Canberra J. D. French Los Angeles H. Hydkn Goteborg J. Ariens Kappers Amsterdam S. A. Sarkisov Moscow J. P. SchadC Amsterdam F. 0.S chmitt Brookline (Mass.) T. Tokizane Tokyo J. Z. Young London PROGRESS IN BRAIN RESEARCH VOLUME 30 CEREBRAL CIRCULATION EDITED BY W. LUYENDIJK Professor of Neurosurgery, Division of Neurosurgery, Academic Hospital Leyden, The Netherlands ELSEVIER PUBLISHING COMPANY AMSTERDAM / LONDON / NEW YORK 1968 ELSEVIER PUBLISHING COMPANY 335 JAN VAN GALENSTRAAT, P.O. BOX 21 1, AMSTERDAM, THE NETHERLANDS ELSEVIER PUBLISHING CO. LTD. BARKING, ESSEX, ENGLAND AMERICAN ELSEVIER PUBLISHING COMPANY, INC. 52 VANDERBILT AVENUE. NEW YORK. N.Y. 10017 LIBRARY OF CONGRESS CARD NUMBER 68-12472 STANDARD BOOK NUMBER 44440691-3 WITH 229 ILLUSTRATIONS AND 95 TABLES COPYRIGHT 0 1968 BY ELSEVIER PUBLISHING COMPANY, AMSTERDAM ALL RIGHTS RESERVED THIS BOOK OR ANY PART THEREOF MUST NOT BE REPRODUCED IN ANY FORM, WITHOUT THE WRITTEN PERMISSION OF THE PUBLISHER, ELSEVIER PUBLISHING COMPANY, AMSTERDAM, THE NETHERLANDS PRINTED IN THE NETHERLANDS List of Contributors JACOBA BRAHAMD,e partment of Pathology, Dartmouth Medical School, Hanover, N.H. (U.S.A.). B. ALLIEZ,T he Neuro-Surgical Clinic, Faculty of Medicine, Marseille (France). N. 0. AMELID, epartment of Neurosurgery, University of Tehran, Tehran (Iran). A. I. ARUTIUNOTVh, e N.N. Burdenko Research Institute of Neurosurgery, Academy of Medical Science, Moscow (U.S.S.R.). J. J. BARCIA-GOYANVEaSle, ncia (Spain). J. L. BARCIA-SALORVIOal,e ncia (Spain). J. BARKERI,n stitute of Neurological Science, Killearn Hospital, Glasgow (Great Britain). M. BERARDT, he Neuro-Surgical Clinic, Faculty of Medicine, Marseille (France). E. BETZ,P hysiological Institute, University of Marburg, Marburg/Lahn (Germany). G. AF BJORKESTENNe, urosurgical Clinic, Toolo Hospital, Helsinki (Finland). M. BROCKD, epartment of Neurosurgery, University of Mainz, Mainz (Germany). C. C. CABEZASC,l inique Neurochirurgicale du Groupe hospitalier PitiC-SalpStritre, Paris (France). A. CAPONC, linique MCdicale de l’H8pital Brugman, UniversitC de Bruxelles, Brwel- les (Belgium). RAULC ARREAC, entro de Investigaciones Neurolbgicas and Servicio de Neuro- cirurgia, Hospital de Niiios, Buenos Aires (Argentina). ORLANDOCA RVALHON,e urologist, Lisbon Civil Hospitals, Lisbon (Portugal). M. E. CLARKD, epartment of Theoretical and Applied Mechanics, College of Engi- neering, University of Illinois, Urbana, Ill. (U.S.A.). H. CLEEMPOECLl,i nique MCdicale de l’H8pital Brugman, UniversitC de Bruxelles, Bruxelles (Belgium). A. COMBALBERDTe, partment of Neuroradiology, Neurobiological Research Unit, INSERM, Marseille (France). R. COOPERD, epartment of Neurological Surgery, Frenchay Hospital, Bristol (Great Britain). S. CRONQVISTD,e partment of Neurosurgery and Neuroradiology, University of Lund, Lund (Sweden). MARCELD AVIDC, linique Neurochirurgicale du Groupe hospitalier Pitit-SalpStritre, Paris (France). M. DE VLIEGERM, unicipal Hospital Dijkzigt, Rotterdam (The Netherlands). H. W. DICKE,D epartment of Surgery, Leyden University Hospital, Leyden (The Netherlands). D. DILENGEC, linique Neurochirurgicale de la Pitit-SalpEtrihe, Paris (France). AYKUTE RBENGDI,e partment of Neurosurgery, Mary Hitchcock Memorial Hospital, Hanover,N.H. (U.S.A.). J. ESPAGNON, eurosurgical Clinic, University Hospital Center, Toulouse (France). VI LIST OF CONTRIBUTORS J. FAURED,e partment of Neuroradiology, Neurobiological Research Unit, INSERM, Marseille (France). WILLIAMF EINDELC, one Laboratory for Neurosurgical Research, Montreal Neuro- logical Institute McGill University, Montreal (Canada). P. FIRT,I nstitute for Clinical and Experimental Surgery, Prague (Czechoslovakia). H. FISCHGOLCDl,i nique Neurochirurgicale de la Pitie-SalpStri&re,P ark (France). P. FRUGONVI,i a Aquileia 4, Padova (Italy). F. J. GILLINGHAMRo, yal Infirmary, Edinburgh (Great Britain). G. GIUDICELLDI, epartment of Neuroradiology, Neurobiological Research Unit, INSERM, Marseille (France). JULESC . GOVAERTU,n iversity of Ghent, Ghent (Belgium). W. GROTEN, eurosurgical University Hospital, Bonn (Germany). BENIAMINO GUIDETITD, epartment of Neurosurgery, University of Rome Medical School, Rome (Italy). L. HARISPEC, linique Neurochirurgicale de la Pitie-SalpStritre, Paris (France). ALBERTF . HECK,D epartment of Neurology, University of Maryland, School of Medicine, Baltimore, Md. (U.S.A.). L. HEJHALI, nstitute for Clinical and Experimental Surgery, Prague (Czechoslovakia). WILLIAMINAA. HIMWICHT, hudichum Psychiatric Research Laboratory, Galesburg State Research Hospital, Galesburg, Ill. (U.S.A.). CHARLESP . HODGEC, one Laboratory for Neurosurgical Research, Montreal Neuro- logical Institute, McGill University, Montreal (Canada). K. H. HOLBACHN,e urosurgical University Hospital, Bonn (Germany). SIDNEYA . HOLLIND, epartment of Neurosurgery, The Mount Sinai Hospital, New York,N.Y. (U.S.A.). A. HULMED, epartment of Neurological Surgery, Frenchay Hospital, Bristol (Great Britain). DAVIDH . INGVADRe,p artment of Clinical Neurophysiology, University Hospital, Lund (Sweden). JULIUSH . JACOBSO11N, Department of Surgery, The Mount Sinai Hospital, New York,N.Y.(U.S.A.). F. L. JENKNERD,e partment of Surgery, University of Graz, Graz (Austria). W. BRYANJE NNETTIn, stitute of Neurological Sciences, Glasgow ; Killearn Hospital, Glasgow (Great Britain). A. E. KAASIK, Department of Neurology and Neurosurgery of the Tartu State University, Tartu, Estonian S.S.R. (U.S.S.R.). VIJAYK . KAK, Department of Neurological Surgery, Royal Victoria Hospital, Belfast (N. Ireland). P. A. KATSIOTISD, epartments of Neurosurgery and Radiology, Saint Savas Hospital, Athens (Greece). A. KJALLQUISTN, eurosurgical Research Laboratory. University Hospital, Lund (Sweden). S. KOSTIC,N eurosurgical University Clinic, Belgrade (Yugoslavia). KRISTIANK RISTIANSEUNl, levaal Hospital, Oslo (Norway). LIST OF CONTRIBUTORS VII ZDENBKK UNCN, eurosurgical Clinic, Prague (Czechoslovakia). ADAMK UNICKIN, eurosurgical Clinic, Academy of Medicine, Cracow (Poland). E. LAINE,C linique Neuro-Chirurgicale, Lille (France). N. A. LASSEND, epartment of Clinical Physiology, Bispebjerg Hospital, Copenhagen (Denmark). G. LAZORTHENSe, urosurgical Clinic, University Hospital Center, Toulouse (France). Y. LAZORTHENSe, urosurgical Clinic, University Hospital Center, Toulouse (France). A. LENAERSC, linique MCdicale de I'H6pital Brugman, UniversitC de Bruxelles, Bruxelles (Belgium). W. S. LOCKHARJTR., , Department of Neurosurgery, University of Miami School of Medicine, Miami, Fla. (U.S. A.). F. LOEWU, niversitatsklinik, 665 Homburg/Saar (Germany). N. LUNDBERGD,e partments of Neurosurgery and Neuroradiology, University of Lund, Lund (Sweden). W. C. MACCARTYJR,. , Department of Radiology, Mary Hitchcock Memorial Hospital, Hanover, N.H. (U.S.A.). D. G. MCDOWALLU, niversity Department of Anaesthesia, Western Infirmary, Glasgow (Great Britain). GEORGME ARGOLIDS,e partment of Pathology, Dartmouth Medical School, Hanover, N.H. (U.S.A.). GIOVANNMI ARrNI, Neurosurgical Clinic of the University of Milano, Milano (Italy). PH. MARTIN,C linique MCdicale de l'H6pital Brugman, UniversitC de Bruxelles, Bruxelles (Belgium). J. MARTING IRADOC, entro de Investigaciones Neurol6gicas and Servicio de Neuro- cirurgia, Hospital de Niiios, Buenos Aires (Argentina). PAOLOE . MASPESN, eurosurgical Clinic of the University of Milano, Milano (Italy). R. MESSIMYC, linique Neurochirurgicale de la Pitit-SalpCtrikre, Paris (France). J. METZGERC, linique Neurochirurgicale de la Pitit-SalpCtritre, Paris (France). G. MORELLOIs, tituto Neurologico di Milano, Milano (Italy). A. MURRAYH ARPERW, ellcome Surgical Research Laboratory, University of Glasgow, Glasgow (Great Britain). G. NORL~NSa, hlgrenska Sjukhuset, Goteborg (Sweden). D. OECONOMOASt,h ens (Greece). JOHNO 'LOUGHLIND, epartment of Neurosurgery, Mary Hitchcock Memorial Hospi- tal, Hanover, N.H. (U.S.A.). J. E. PAILLAST, he Neuro-Surgical Clinic, Faculty of Medicine, Marseille (France). R. M. PEARDODNO NAGHYM, ary Fletcher Hospital, Burlington, Vermont (U.S.A.). L. PERRIAI,m presa di Elettrofisiologia del C.N.R., Genova (Italy). H. W. PIA, Neurosurgical Clinic of the University of Giessen/Lahn, Giessen/Lahn (Germany). U. PONTBND, epartment of Neurosurgery, University of Gothenburg, Gothenburg (Sweden). J. T. POSADAC, linique Neurochirurgicale du Groupe hospitalier Pitie-SalpEtrike, Paris (France). VIII LIST OF CONTRIBUTORS E. RAUDAMD,e putment of Neurology and Neurosurgery of the Tartu State Univer- sity, Tartu, Estonian S.S.R. (U.S.S.R.). 0. M. REINMUTHD, epartment of Neurology, University of Miami School of Medicine, Miami, Fla. (U.S.A.). ALANE . RICHARDSOND, epartment of Neurosurgery, Atkinson Morley's Hospital, Wimbledon (Great Britain). T. ~CHERNTe,u rosurgical Clinic, University of Freiburg i.Br., Freiburg i.Br. (Germany). G. ROSADINCI, linica Neurochirurgica dell'universita, Genova (Italy). G. F. Rossr, Clinica Neurochirurgica dell'Universit8, Genova (Italy), P. ROT-CGEN53, Bonn-V., Heinr.-Fritsch-Str. 16 (Germany). M. SACHS,C linique Neurochirurgicale du Groupe Hospitalier Pitid-SalpEtrikre, Paris (France). G. SALAMOND, epartment of Neuroradiology, Neurobiological Research Unit, INSERM, Marseille (France). P. SCHEINBERDGe, partment of Neurology, University of Miami School of Medicine, Miami, Fla. (U.S.A.). R. SEDAN,T he Neuro-Surgical Clinic Faculty of Medicine, Marseille (France). F. A. SERBINENKTOhe, N.N. Burdenko Research Institute of Neurosurgery, Academy of Medical Science, Moscow (U.S.S.R.). M. N. SHALITD, epartment of Neurosurgery, Hadassah University Hospital, Jerusa- lem (Israel). S. SHIMOJYDOe, partment of Neurology, University of Miami School of Medicine, Miami, Fla. (U.S.A.). A. A. SHLYKOVTh, e N.N. Burdenko Research Institute of Neurosurgery, Academy of Medical Science, Moscow (U.S.S.R.). B. K. SIESJO, Neurosurgical Clinic, University of Gothenburg, Gothenburg (Swede. LUCJANST EPIEN7, 1/4 Wilcza Street, Warszawa (Poland). MICHAELH . SUKOFFD, epartment of Surgery, The Mount Sinai Hospital, New York,N.Y. (U.S.A.). THORALMF . SUNDTJ,R ., Mayo Graduate School of Medicine, University of Min- nesota, Rochester, Minn. (U.S.A.). LINDSAYS YMOND, epartment of Neurosurgical Studies, The National Hospital, Queen Square, London, W.C. 1 (Great Britain). J. N. TAPTASD, epartments of Neurosurgery and Radiology, Saint Savas Hospital, Athens (Greece). ALEXR . TAYLORD, epartment of Neurological Surgery, Royal Victoria Hospital, Belfast (N. Ireland). M. TOGA, The Neuro-Surgical Clinic, Faculty of Medicine, Marseille (France). EDUARDTOO LOSAP, lat6n 20, Barcelona (Spain). H. TROUPPN, eurosurgical Clinic, TOO16 Hospital, Helsinki (Finland). R. VAN DEN BERGH,D epartment of Neurology and Neurosurgery, University of Louvain, Louvain (Belgium). LIST OF CONTRIBUTORS IX H. VANDERE ECKEND, epartment of Anatomy and Neuro-psychology, University of Ghent, Ghent (Belgium). H. VERBIESNT,e urosurgical Clinic, University of Utrecht, Utrecht (The Netherlands). M. VINK,D epartment of Surgery, Leyden University Hospital, Leyden (The Nether- lands). A. WACKENHEICMli,n ique Neurologique, H8pital Civil, Strasbourg (France). A. EARLW ALKERU, niversity of Ghent, Ghent (Belgium). ARTHURG . WALTZC, erebrovascular Clinical Research Center, Section of Neurology, Mayo Clinic, Rochester, Mo. (U.S.A.). J. WAPPENSCHMINDeTu, rosurgical University Hospital, Bonn (Germany). Y. LUCAS YAMAMOTOCo, ne Laboratory for Neurosurgical Research, Montreal Neurological Institute, McGill University, Montreal (Canada). GAZIY ASARGILM, ary Fletcher Hospital, Burlington, Vermont (U.S.A.). PETER0 . YATESD, epartment of Pathology, University of Manchester, Manchester (Great Britain). J. 0. ZADEHN, eurosurgical Clinic, University Hospital Center, Toulouse (France). B. G. ZIEDSEDSE S PLANTESR, ontgen Laboratory, Wilhelmina Gasthuis, University of Amsterdam, Amsterdam (The Netherlands). L. ZOLTANB, udapest (Hungary). K. J. ZULCH,O stmerheimer Str. 200, 5 Koln-Merheim (Germany). R. ZUPPINGD, epartment of Neurology and Neurosurgery of the Tartu State Uni- versity, Tartu, Estonian S.S.R. (U.S.S.R.). N. ZWETNOWN, eurosurgical Research Laboratory, University Hospital, Lund (Sweden). Preface Cerebral Circulation and its Disorders was chosen as the main subject for the IIIrd European Congress of Neurosurgery which took place in Madrid in April 1967. The increasing interest in vascular conditions, the progress in diagnostic procedures, together with the clinical application of new methods for studying the cerebral blood flow and the development of various neurosurgical techniques for the management of these patients, led the Organization Committee of the Congress to initiate a general reassessment and discussion of certain topics in cerebral vascular pathology. For this purpose eminent European scientists and neurosurgeons were asked to write different reports as it was felt to be desirable to present a cross section of these prob- lems in Europe today. Very short summaries of these reports already having appeared, Professor W. Luyendijk has now edited them in full length and collected them in this volume to- gether with a selection of free communications presented at the Congress. I am sure that the material assembled in this book concerning fundamental anatomi- cal and physiological studies and the more practical results obtained by diagnostic and therapeutic procedures in various vascular conditions will be of great importance for neurosurgeons and other clinicians, and specialistsi nterested in the central nervous system. DR. S. OBRADOR President of the IIIrd European Congress of Neurosurgery Section I - Anatomy/Embryology Anatomy and Embryology of Cerebral Circulation RAYMOND VAN DEN BERGH AND HENRI VANDER EECKEN Department of Neurology and Neurosurgery and Department of Neuro-anatomy (University ofLouvain, Belgium), and Department of Anatomy and Department of Neuro-psychology (University of Ghent, Belgium) INTRODUCTION The present report has unfortunately to be restricted to a concise and thus rather incomplete survey of recent data on cerebral arterial circulation. The topics to be dis- cussed have been selected because of their importance in neurosurgery. With respect to the afferent vessels, the significance of the large trunks in the estab- lishment of cerebrovascular disturbances has recently been stressed, whereas the arteries of the basis cerebri, as a consequence of the interventions on vascular mal- formations, have been subject to more precise studies in relation to their frequent anatomical variants and anomalies. The leptomeningeal arteries, spreading over the cerebral surface, have been in- vestigated in detail, mainly from the point of view of their vascularization areas and collateral circulation. The intracerebral circulation has been examined as to its irrigation of the cerebral parenchyma, its segmentation in vascular areas and its deep collateral circulation, which features are most important in stereotaxic surgery. In the first chapter comments will be given on the afferent arteries culminating in the arterial circle of Willis. Upon reaching the encephalon their basal and excentric location differs from the situation in other organs, where the afferent arteries penetrate into the center by way of an hilus. A sxond chapter will treat the leptomeningeal arteries, which start from the basic- ally located main trunks and wrap around the encephalon in a dorsal direction, an organization pattern found from the telencephalon down to the medulla oblongata. A third chapter will describe the intracerebral circulation, which is constituted by radially penetrating intraparenchymal branches of the leptomeningeal arteries. I. AFFERENT ARTERIAL TRUNKS The brain is supplied by four main afferent arterial trunks: the aa. carotides internae and the aa. vertebrales. The a. carotis interna derives, together with the a. carotis externa, from the a. carotis References p. 20-25