Browsing by Author "Mpolokeng, Kentse"

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    A dissection and angiographic study of anatomical variations in the anterior communicating artery complex in a South African sample
    (2024) Madolo, Mbalentle; Mpolokeng, Kentse; Gunston, Geney; More, Stuart
    The anterior communicating artery complex (ACAC) consists of the A1 and A2 segments of the anterior cerebral artery (ACA) and the anterior communicating artery (ACoA). The ACAC is said to be the most frequent site of aneurysms and anterior cerebral circulation variations. Clear correlation between cerebral arterial circulation variations and aneurysm development has been reported. Cerebrovascular diseases play a significant role in the causes of morbidity in South Africa. South African data in this area of research is currently lacking and thus more knowledge is needed. This study aims to report the prevalence of variations in the ACAC and their link to the prevalence of cerebral aneurysms. For the dissection portion of this study, a total of 68 (35 female and 33 male) adult formalin fixed brains were included. These brains were from the bodies that were previously dissected in the Department of Human Biology, University of Cape Town by the medical undergraduate and honours post-graduate students. For the ang
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    A morphometric study of the brain ventricles of patients diagnosed with Chronic Hydrocephalus at Groote Schuur Hospital
    (2024) Lichaba, Reagobaka; Mpolokeng, Kentse; Shamley Delva
    Hydrocephalus (HCP) is a cerebrospinal fluid condition of the central nervous system, which when it accumulates causes an increase in ventricular enlargement and raised intracranial pressure (ICP). Raised intracranial pressure in a fixed volume space is dangerous as it presses onto the brain parenchyma and the surrounding areas and may damage them. Ventricular enlargement is a radiological indicator of hydrocephalus and has been one of the features used to diagnose the condition, with the ICP measurement used to confirm the condition. However, measuring ICP is invasive and puts the brain at risk of bleeding and infections, making it necessary to use non-invasive methods of confirming the condition. This study aims to investigate the clinical features observed on the brain scans of patients with hydrocephalus and seeks to describe the unique shape of the frontal horns and use this shape as a noninvasive diagnostic marker. The study observed the brain magnetic resonance imaging and computed tomography scans of 150 patients who were suspected or known to have hydrocephalus from the Radiology Department at Groote Schuur Hospital. These scans were then divided into three groups, namely, the controls, and chronic and acute hydrocephalus groups. The clinical features commonly observed on the brain scans of patients with hydrocephalus were evaluated, their measurements taken, and their shapes recorded. These features were the Evans Index, temporal horn width, third ventricle width and shape, callosal angle, frontal horn shape, Sylvian fissure width and periventricular white matter changes. This morphometric data was then analysed to determine their relationship with hydrocephalus. Of the clinical features, the frontal horn shape has not been described in the literature. Therefore, it was described in this study, and its association with the measurement of ICP was assessed. There was a statistically significant difference in the morphometric data between the control and chronic HCP groups. In contrast, the difference in the data between the chronic and acute HCP groups was not statistically significant. In all three groups, there was a difference in size between the left and right sides, the right side had smaller measurements than the left. There was a significant difference in frontal horn shape between the chronic and acute HCP groups. Additionally, it was evident that there was a relationship between a specific shape of the frontal horn and the measurement of ICP. The morphometric data of the clinical features were consistent with the literature, except for the Sylvian fissure width. The data in this study showed that the accumulation of CSF occurred mostly on the left side in the clinical features that compared the sides, perhaps suggesting that the condition favoured the left side. The frontal horn shape was different in the chronic and acute HCP groups, it was described as quadrilateral and round, where the quadrilateral shape correlated with the low-moderate ICP, and the round shape correlated with the high ICP reading. Therefore, the frontal horn shape has the potential to be used in the clinical space as a non-invasive imaging marker when differentiating between chronic and acute HCP patients.
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    Variations in the circulus arteriosus cerebri in a South African cadaveric sample
    (2024) Garlick, Jessica; Mpolokeng, Kentse; Louw Graham
    The circulus arteriosus cerebri (CAC) or Circle of Willis is a highly variable arterial system at the base of the brain that allows for collateral blood flow, granting a protective effect during ischaemic events. Owing to variations, it may not compensate sufficiently during such events. Some CAC variations have been associated with aneurysm formation with subsequent rupture and subarachnoid haemorrhage. It is important to know the prevalence of these variations in a population. This is a cross-sectional, observational and quantitative study approved by the UCT Human Research Ethics Committee (645/2022) and the Cadaver Research Governance Committee (2022/009) in the Department of Human Biology. The brains of 94 bodies were analysed. Patency of hypoplastic arteries was investigated and Fiji® software was used to measure the lengths and diameters of arteries. Brain volumes were compared to arterial lengths and diameters and a correction factor for human variation was determined. The intact samples (n=40) were classified according to the 5-group system of Ayre et al. (2021) and 22.5% of the sample displayed the conventional anatomical pattern. The most common pattern of variation was group 5, comprising 15 different variations not matching the descriptions of groups 1-4. Individual variations were observed (n=64 brains; 81 variations). The most frequent variations were posterior communicating artery hypoplasia (17.3%) and aplasia (14.8%). The anterior communicating artery was the most variable artery (44.4% of individual variations). The narrowest artery was usually the right posterior communicating artery (PcoA) and the artery with the greatest variation in diameter was the left PcoA. Statistically significant associations were found for arterial diameter with age and length with age. Associations that were not statistically significant included variations with age, variations with sex and arterial dimensions with sex. There were too few intracranial aneurysms to perform analyses. These variations may result in an increased risk and severity of stroke and intracranial aneurysm formation. Knowledge about CAC variations will aid neurosurgeons when planning and executing a range of neurosurgical procedures. There is little published data on this topic in a South African setting and further studies are recommended.