Top of the Basilar Artery Syndrome (TOBS)

Neuro Vascular System

Top of the basilar artery syndrome (TOBS) is a special type of ischemic cerebrovascular disease. It's a type of posterior cerebral ischemia.

Main causes: cardiogenic embolism, arterial - arterial embolism.

Other causes: thrombosis, arteritis, tortuosity of intracranial segment of vertebral artery and base artery, etc.

Vertebral artery intracranial segment and basilar artery extension, tortuous, vascular blood flow is slow, the most prone to be involved in the distal branch of the tiny blood vessels, can cause insufficient blood supply; At the same time, the blood flow is slow, the blood vessel wall is easy to form the micro thrombus, if the thrombus falls off, the blood vessel will be blocked.

Basis of vascular anatomy

The basilar artery apex is located at the site of 5 vascular openings within 2cm centered on the basilar artery apex.

The five vessels are the left and right posterior cerebral artery, the left and right superior cerebellar artery and the basilar artery.

The basilar artery is the axis of the posterior circulation in the brain. It is formed by the confluence of bilateral vertebral arteries at the junction of pons and bulbar medulla, located in the ventral side of the pons, running through the entire pons, and giving off the median branch, parmedian branch, short circumflex branch and long circumflex branch.

posterior cerebral circulation, also known as vertebrobasilar artery system, is composed of vertebral artery, basilar artery and posterior cerebral artery and its branches, mainly supplying blood to the brain stem, cerebellum, thalamus, hippocampus, occipital lobe, part of temporal lobe and spinal cord.

The terminal branch of the basilar artery is the posterior cerebral artery (PCA), which supplies blood to the midbrain, thalamus, medial temporal lobe, and occipital lobe.

Near the bifurcation of the PCA, the basilar artery also gives off the superior cerebellar artery, which supplies blood to the pontine, the lateral part of the middle brain, and the upper cerebellum.

Apex basilar artery occlusion is associated with multiple infarcts in the blood supply area, including the thalamus, midbrain, cerebellum, occipital lobe, temporal lobe, upper pontine, and hypothalamus, often in a bilateral symmetrical distribution.

A deep perforating branch of the basilar artery supplying blood to the thalamus and the midbrain, with thin branches and poor collateral circulation. Therefore, the ischemic symptoms of the thalamus and midbrain were the most common TOBS.