뇌혈관 촬영상 후대뇌동맥과 후교통동맥의 출현에 대한 조사

Abstract

[한글]

ANGIOGRAPHIC DEMONSTRATION OF THE POSTERIOR CEREBRAL AND POSTERIOR COMMUNICATING

ARTERIES IN NORMAL AND HYDROCEPHALUS CASES

Hun Hwa Jung, M.D.

Department of Medical Science, The graduate School, Yonsei University

(Directed by Prof. Hun Jae Lee, M.D.)

Carotid angoigraphy is a most important diagnosti 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, go it is more important for an understanding of the cerebral circulation.

Early in the development of the foetal 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 cerebralartery 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, etc. Here the author has analysed the factors of age, sex,

puncture site and right or 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 asympotomatic 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 intracranial 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 bur report of a relationship of

the artery with hydrocephalus was not found.

This study comprises 2,350 conventional carotid angiographies carried out from

1967 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 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.

[영문]

Carotid angoigraphy is a most important diagnosti 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, go it is more important for an understanding of the cerebral circulation.

Early in the development of the foetal 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 cerebralartery 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, etc. Here the author has analysed the factors of age, sex, puncture site and right or 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 asympotomatic 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 intracranial 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 bur report of a relationship of the artery with hydrocephalus was not found.

This study comprises 2,350 conventional carotid angiographies carried out from 1967 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 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.