Juntendo Medical Journal

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The encephaloarteriography by means of the contrastmedia injection into blood vessels is applied mainly for tne photography of the anterior and middle regions of the brain under the control of the carotid artery. The posterior portion of the brain can only be photographed through injection into the vertebral artery, and the injection througn the skin for this purpose was carried out first by Kakujiro TAKAHASHI (1938). He invented his own method, but Professor TUBAKI of our laboratory doubted his description that injection into the vertebral artery could easily be done by his method, and K. SANO (1950) claimed that the injection should be done aiming at the anterior tubercle of the sixth cervical vertebra, i. e. the carotid tubercle or else 1-2 cm below that point. Prior to him, in 1937, BERCZELLER & KUGLER tried similar injection into the vertebral artery in the Sulcus arteriae vertebralis atlantis, but their trial was only experimental using cadavers. The present studies have been made in order to obtain basic information for an inventual discovery of the best method of contrastmedia injection in to the vertebral artery, and for this purpose the author have made studies of the relationship between this artery and various organs, especially the common carotid artery, atlas, etc., as well as the manner of their branching, sizes and directions. Materials consist entirely of the cadavers for students laboratory exercise, total 135 (92 males & 43 females) in number. The position of the arteries have been determined on the drawings prepared for the frontal views of these organs. The lengths and sizes of blood vessels and width of the atlas have also been measured. The results of the studies may be summarized as follows : 1. As to the beginning of the vertebral artery, the normal type is formed in 95 % of the cases while the remaining 5 % are of abnormal type. 2. The arrangement of the branch beginning at the aortic arch is usual type in 85 % of cases and of abnormal type (consisting of several types) in 20 % of cases studied. 3. With respect to the entrance into the foramen for the vertebral artery, those which enter into the sixth cervical vertebra are found in 87 % (left) and 92% (right) of the cases. The percentage is less for the fifth, seventh and fourth in the order listed. These results comfirm the results of the studies of the previous authors. The following results are entirely new and will be described in somewhat greater details, 4. Regarding the topographic relation of the vertebral artery and common carotid artery, in 50 % (left) and 30 % (right) of the cases the former runs outer side of the latter, while in 50 % (left) and 70 % (right) of the former runs either the inner side of the latter or behind it. 5. As to the direction of the vertebral artery, 22 % (left) and 70 % (right) are M-type (that which runs up and inward from below and outside), 50 % (left) and 27 % (right) are P-type (that which runs straight up) and 28 % (left) and 3 % (right) are L-type (that which runs up and outward from beIow and inside). See Fig. 4-7. 6. For the length of the vertebral artery, the shortest has been found to be 5 mm in the male (right), the longest to be 110 mm in the male (left) and the average values have been 36.4 mm (left) and 27 mm (right) in the male, 27.3 mm (left) and 21.4 mm (right) for the female. The difference between right and left is 9 mm for the male and 6 mm for the female, the left being longer than the right. As to the sex difference, it is longer in the male by 9 mm in the left and 5 mm in the right. 7. As to the size of the vertebral artery the average value is 4.5 mm at the beginning for both sides, 4 mm at the entrance, and no significant difference is found between the right.

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