Background: The perforating arteries in the dorsolateral zone of the midbrain play a crucial role in the functions of the brain stem. Their damage due to herniation, pathological lesions, or surgery, favored by the narrow tentorial incisura, can lead to hemorrhages or ischemia and subsequently to severe consequences for the patient. Objective: In literature, not much attention has been directed to the perforating arteries in the lemniscus; in fact, no reports on the perforators of this anatomical region are available. The present study aims to a detailed analysis of the microanatomy and the clinical implications of these perforators, in relation to the parent vessels. We focused on the small vessels that penetrate the midbrain's dorsolateral surface, known as lemniscal trigone, to understand better their microanatomy and their functional importance in the clinical practice during the microsurgical approach to this area. Methods: Eighty-seven alcohol-fixed cadaveric hemispheres (44 brains) without any pathological lesions provided the material for studying the perforating vessels and their origin around the dorsolateral midbrain using an operating microscope (OPMI 1 FC, Zeiss). Measurements of the perforators' distances, in relation to the parent vessels, were taken using a digital caliper. Results: An origin from the SCA could be found in 70.11% (61) and from the PCA in 27.58% (24) of the hemispheres. In one hemisphere, an origin from the posterior choroidal artery was found (4.54%). No perforating branches were discovered in 8.04% of specimens (7). Conclusion: The perforating arteries of the lemniscal trigone stem not only from the superior cerebellar artery (SCA), as described in the few studies available in literature, but also from the posterior cerebral artery (PCA). Therefore, special attention should be paid during surgery to spare those vessels and associated perforators. A comprehensive understanding of the lemniscal trigone's perforating arteries is vital to avoid infarction of the brainstem when treating midbrain tumors or vascular malformations.

中文翻译：

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丘月三角区的穿支动脉：显微外科神经解剖学描述。


背景：中脑背外侧区的穿动脉在脑干的功能中起着至关重要的作用。由于疝气、病理性病变或手术造成的损伤，由于狭窄的小脑幕切迹，可能会导致出血或缺血，从而给患者带来严重的后果。目的：在文献中，对丘系穿支动脉的关注不多。事实上，还没有关于该解剖区域的穿支的报告。本研究旨在详细分析这些穿支与载瘤血管相关的显微解剖结构和临床意义。我们重点关注穿透中脑背外侧表面的小血管（称为丘系三角区），以更好地了解其显微解剖结构及其在该区域显微外科手术过程中在临床实践中的功能重要性。方法：87 个酒精固定的尸体半球（44 个大脑）没有任何病理损伤，为使用手术显微镜（OPMI 1 FC，Zeiss）研究中脑背外侧周围的穿支血管及其起源提供了材料。使用数字卡尺测量穿支相对于母血管的距离。结果：70.11%（61）个半球起源于 SCA，27.58%（24）个半球起源于 PCA。在一侧半球，发现了脉络膜后动脉的起源（4.54%）。 8.04% 的标本中未发现穿孔分支 (7)。 结论：如文献中少数研究所述，丘系三角区的穿支动脉不仅起源于小脑上动脉（SCA），而且还起源于大脑后动脉（PCA）。因此，手术期间应特别注意保护这些血管和相关的穿支。在治疗中脑肿瘤或血管畸形时，全面了解丘系三角区的穿支动脉对于避免脑干梗塞至关重要。