Blood supply to the corticospinal tract: A pictorial review with application to cranial surgery and stroke

Abstract

The corticospinal tract (CST) is the main neural pathway responsible for conducting voluntary motor function in the central nervous system. The CST condenses into fiber bundles as it descends from the frontoparietal cortex, traveling down to terminate at the anterior horn of the spinal cord. The CST is at risk of injury from vascular insult from strokes and during neurosurgical procedures. The aim of this article is to identify and describe the vasculature associated with the CST from the cortex to the medulla. Dissection of cadaveric specimens was carried out in a manner, which exposed and preserved the fiber tracts of the CST, as well as the arterial systems that supply them. At the level of the motor cortex, the CST is supplied by terminal branches of the anterior cerebral artery and middle cerebral artery. The white matter tracts of the corona radiata and internal capsule are supplied by small perforators including the lenticulostriate arteries and branches of the anterior choroidal artery. In the brainstem, the CST is supplied by anterior perforating branches from the basilar and vertebral arteries. The caudal portions of the CST in the medulla are supplied by the anterior spinal artery, which branches from the vertebral arteries. The nonanastomotic nature of the vessel systems of the CST highlights the importance of their preservation during neurosurgical procedures. Anatomical knowledge of the CST is paramount to clinical diagnosis and treatment of heterogeneity of neurodegenerative, neuroinflammatory, cerebrovascular, and skull base tumors.

The neutrophil-to-lymphocyte ratio is an important indicator correlated to early neurological deterioration in single subcortical infarct patients with diabetes

“…NLR is reported to be significantly correlated with infarct volume ( 28 , 45 ). In anterior SSI, the corticospinal tract is easily injured due to a large infarct ( 46 ). The corticospinal tract, which is in the posterior circulation, can travel down the ventral surface of the brain stem, which is less affected by infarct volume ( 46 ).…”

“…In anterior SSI, the corticospinal tract is easily injured due to a large infarct ( 46 ). The corticospinal tract, which is in the posterior circulation, can travel down the ventral surface of the brain stem, which is less affected by infarct volume ( 46 ). The infarcts in posterior circulation can be fatal ( 47 ) and may cause severe inflammatory responses interfering with the NLR value.…”

Acute aortic occlusion leading to spinal cord ischemia in a 73-year-old: A case report

“…The anterior two-thirds of the spinal cord, including the anterior horns, anterior commissure, anterior funiculi, and, to a lesser extent, the lateral funiculi, are primarily supplied by the anterior spinal artery. [ 20 ] The anterior spinal artery receives blood flow from thoracic intercostal branches and lumbar radicular arteries. A large segmental posterior radicular artery, the artery of Adamkiewicz, usually arises from the intercostal vessels between T9 and T12 in roughly 75% of patients[ 8 ] and supplies perfusion to the lumbar spinal cord and the conus medullaris.…”

Assessing informative tract segmentation and nTMS for pre-operative planning

“…1 (a) Region used for nTMS stimulation. (b) The primary motor cortex is located anterior to the central sulcus and posterior to the pre-central sulcus ( Nun˜ez et al, 2021 ). The CST originates mainly from the primary motor cortex and pre-motor area, while also receiving fibers from the somatosensory cortex, cingulate gyrus, and the parietal lobe ( AbuHasan and Munakomi, 2022 ).…”