The controversy of the periventricular white matter circulation: a review of the anatomic literature.

Over the past several decades, neuroscientists have become progressively aware of a group of cerebrovascular diseases in which the deep structures of the cerebrum are affected in preference to the cortex. Examples include subcortical dementia, subcortical infarction, intracerebral hemorrhage, and neonatal germinal matrix/intraventricular hemorrhage. To understand the pathogenesis of the diseases of the deep cerebral or periventricular white matter, many studies have focused on the microvascular anatomy of this region. The preceding article by Nelson et al. [1] is one of the most recent of this type. The authors primarily reemphasize the absence of ventriculofugal arteries in an important attempt to put an end to the popular and probably incorrect model of a "ventriculofugaljventriculopetal" vascular border zone of the periventricular white matter. The background for this paper lies in earlier work done by van den Bergh [2] and deReuck [3). The concept of human ventriculofugal cerebral arteries of the periventricular white matter was introduced by van den Bergh as early as 1961 [2, 4, 5). The human cerebral angioarchitecture was, until then, thought to be centripetal or ventriculopetal (i.e., toward the center of the brain or toward the ventricle), in which arteries arising from the leptomeninges penetrate the cortex and the base of the brain at right angles to the surface of the brain, branching to supply the capillary beds of the cerebral parenchyma throughout the course of the arteries toward the ventricle [6-8]. However, van den Bergh described certain human cerebral arteries that origi-