Anatomical Study of the Inferior Temporal Arteries Using Multiphase Postmortem Computed Tomography

Objective: Inferior temporal arteries (ITAs), branches of the posterior cerebral artery (PCA), are critical vascular structures encountered during subtemporal surgical approaches. Multiphase postmortem computed tomography angiography (MPMCTA) is a useful tool for analyzing cerebral vasculature that can be leveraged to efficiently define the expected course, size, and common variants of the ITAs in a large series of subjects.

Methods: Adult (≥ 18 years) cases that underwent MPMCTA during 2015–2023 and whose cause of death did not involve the cerebral circulation were included. Standardized measurements on four predefined coronal slices in relation to the posterior clinoid process (PCP) were established with references to projections in axial and sagittal planes. The main aim was to assess the presence, width, and course of the of the anterior ITA (AITA), middle ITA (MITA), and posterior ITA (PITA) vessels, particularly within the individual established quadrants of the middle cranial fossa.

Results: A total of 74 hemispheres were studied among 37 subjects with a mean age of 52 ± 20.18 years. PITA was present in 98.65% of studied hemispheres, followed by MITA in 90.67%, and AITA in 89.19%. The course of PITA was straight (65.75%) or oblique (34.25%), with significant difference in mean width (p = 0.050), branching angle (p < 0.001), distance to tentorial hiatus (p < 0.001), and distance to superior petrosal sinus (p < 0.001). A pattern of PITA-loop was defined as a twisting of its course within the collateral sulcus. A significant relationship between the presence of AITA and MITA (p < 0.001) along with the co-presence of AITA and PITA (p = 0.029) was found.

Conclusion: MPMCTA is a useful tool for anatomic study of the cerebral circulation. The ITAs consist of the AITA, MITA, and PITA, with the PITA being the largest and most consistent of the three. The PITA is found within the collateral sulcus and can follow a straight or oblique course. Preoperative identification of this artery may have important clinical implications for surgeries involving the basal temporal lobe.

Fig. 2 Observed PITA course characteristics. (A) Most common course of PITA was the straight pattern (red arrow) with <60° angle from the PCP line (65.75%). (B) Less frequently, oblique pattern (blue arrow) was identified with the angle of ≥60° (34.25%). (C) In all studied cases, PITA formed a loop within the collateral sulcus. (D) Example of PITA duplication.

Fig. 3 (A) Summary of studied PITA characteristics and PITA classification proposed in the current study. (B) Correlation matrix demonstrating relations between studied variables. TH, tentorial hiatus.

Fig. 4 Boxplots depicting difference between straight (red) and oblique (blue) PITAs in observed significant variables including (A) width (p = 0.050), distance from PITA to SPS in (B) Q3 and (C) Q4 and (D) PITA angle to PCP line (all p < 0.001).

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Artikel online veröffentlicht:
05. Februar 2024