White matter
vasculature plays a major role in the pathophysiology of permanent
neurological deficits following a stroke or progressive cognitive
alteration related to small vessel disease. Thus, knowledge of the
complex vascularization and functional aspects of the deep white matter
territories is paramount to comprehend clinical manifestations of brain
ischaemia.
This review provides a structured
presentation of the existing knowledge of the vascularization of the
human cerebral white matter from seminal historical studies to the
current literature. First, we revisit the highlights of prenatal
development of the endoparenchymal telencephalic vascular system that
are crucial for the understanding of vessel organization in the adult.
Second, we reveal the tangled history of debates on the existence,
clinical significance and physiological role of leptomeningeal
anastomoses. Then, we present how conceptions on white matter
vascularization transitioned from the mixed
ventriculopetal/ventriculofugal theory, in which a low-flow area was
interposed in between concurrent arterial flows, to the purely
ventriculopetal theory. The latter model explains variable white matter
sensitivity to ischaemia by various organizations of ventriculopetal
vessel terminals having different origin/length properties and
interconnection patterns. Next, arteries supplying primarily the white
matter are described according to their length and overall structure.
Furthermore, the known distribution territories, to date, are studied in
relation to primary anatomical structures of the human cerebral white
matter, emphasizing the sparsity of the ‘ground truth’ data available in
the literature. Finally, the implications for both large vessel
occlusion and chronic small vessel disease are discussed, as well as the
insights from neuroimaging.
All things
considered, we identify the need for further research on deep white
matter vascularization, especially regarding the arterial supply of
white matter fibre tracts.
© The Author(s) (2021).
Published by Oxford University Press on behalf of the Guarantors of
Brain. All rights reserved. For permissions, please email:
journals.permissions@oup.com
No comments:
Post a Comment