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vascular supply of brain
- 1. VASCULAR ANATOMY OF BRAIN DR. J K PATIL Prof. department of Radio-diagnosis, DY Patil medical college, hospital & research institute Kolhapur
- 2. Circle of Willis • Vessels comprising the circle of Willis include: • anterior circulation • left and right ICA • horizontal (A1) segments of the left and right anterior cerebral arteries (ACA) • single anterior communicating artery (ACOM) • posterior circulation • left and right posterior communicating arteries (PCOM) • horizontal (P1) segments of left and right posterior cerebral arteries (PCA) • single basilar artery (tip)
- 4. C1 (cervical)segment C2(petrous) segment C3(lacerum) segment C4(cavernous)segment C5(clinoid)segment C6(ophthalmic) segment C7 ( communicating) segment Internal carotid artery
- 6. • C1 segment: no branches in neck • C2 segment: gives rise to vidian artery caraticotympanic artery supplies middle ear C3 segment: no branches C4 cavernous segment: abducens nerve is inferolateral to ICA. has 2 branches Meningohypophyseal trunk- supplies pituitary gland ,tentorium Inferolateral trunk- supplies cranial nerves CS dura
- 7. • C5 segment: no branches • C6 segment : gives 2 branches Ophthalmic artery and superior hypophyseal artery( supplies ant pit lobe, infundibular stalk, optic chiasm) C7 segment: gives anterior choroidal artery.
- 8. •Anterior cerebral artery • A1 segment: from origin to anterior communicating artery and gives rise to medial lenticulostriate arteries(inferior parts of the head of the caudate and the anterior limb of the internal capsule) • A2 segment: from anterior communicating artery to bifurcation in pericallosal artery and calloso marginal artery • A3 segment: major branches, excluding terminal branches, which supply the medial portions of frontal lobes, superior medial part of parietal lobes, anterior part of the corpus callosum.
- 10. Middle cerebral artery • The MCA is divided into four segments: • M1: sphenoidal or horizontal segment • originates at the terminal bifurcation of the internal carotid artery • courses laterally parallel to the sphenoid ridge • terminates at one of two points • at the genu adjacent to the limen insulae • at the main bifurcation • M2: insular segment • originates at the genu/limen insulae or the main bifurcation • courses posterosuperiorly in the insular cleft • terminates at the circular sulcus of insula, where it makes a right angle to hairpin turn • M3: opercular segment • originates at the circular sulcus of the insula • courses laterally along the frontoparietal operculum • terminates at the external/superior surface of the Sylvian fissure • M4: cortical segment • originates at the external/top surface of the Sylvian fissure • courses superiorly on the lateral convexity • terminates at their final cortical territory
- 12. Posterior cerebral artery Major terminal branches of distal basilar artery • P1 SEGMENT: from basilar artery bifurcation to the junction with PCoA. Gives post thalamo-perforating arteries. • P2(AMBIENT SEGMENT): extends from p1-pcoa junction runs in the ambient cistern as it sweeps postero-laterally around midbrain. BRANCHES: • Anterior and posterior temporal arteries • Thalamogeniculate artery • Medial and lateral posterior choroidal artery P3 (QUADRIGEMINAL) SEGMENT Begins behind the midbrain and ends where the pca enters the calcarine fissure of occipital lobe P4 (CALCARINE SEGMENT) Terminates within the calcarine segments & it divides into 2 trunks (med & lat) Gives medial and lateral occipital artery, parieto Occipital artery, calcarine artery and posterior Splenial
- 14. Basilar artery • The basilar artery is part of the posterior cerebral circulation. It arises from the confluence of the left and right vertebral arteries at the base of the pons as they rise towards the base of the brain • Branches • Before terminating at the upper pontine border where it divides into the two posterior cerebral arteries it provides several paired branches: • anterior inferior cerebellar artery (AICA) • labyrinthine artery (variable origin; more commonly a branch of AICA) • pontine arteries • superior cerebellar artery (SCA)
- 18. Summary
- 19. VENOUS SYSTEM OF BRAIN It has 2 major components : dural venous sinuses and cerebral veins. DURAL VENOUS SINUSES • Superior sagittal sinus • Inferior sagittal sinus • Straight sinus • Sinus confluence( trocular herophili) • Transverse sinuses • Sigmoid sinuses • Jugular bulb
- 22. THANK YOU
Editor's Notes
- The basilar artery divides at the upper border of the pons to form the left and right PCAs. From each ICA, a PCOM arises at the anterior perforated substance and runs back through the interpeduncular cistern to join the ipsilateral PCA. Each ICA also gives off an ACA. The ACAs are united by the ACOM, a small vessel that runs in the chiasmatic cistern
- Posterior limb of the internal capsule
- A1 medial lenticulostriate arteries anterior communicating artery medial and superior parts of frontal lobe A2 recurrent artery of Heubner (may arise from distal A1 segment or proximal A2 )corpus striatum globus pallidus and antr crus of IC orbitofrontal artery frontopolar artery A3 pericallosal artery callosomarginal artery (runs in the cingulate sulcus)
- Sagittal MIP of CTA shows A2 segments of both ACAs ſt ascending in interhemispheric fissure in front of 3rd ventricle, A3 segments curving around corpus callosum genu ACA vascular territory (green) includes the anterior two-thirds of the medial surface of the hemisphere ſt, a thin strip of cortex over the top of the hemisphere vertex , and a small wedge along the inferomedial frontal lobe
- Limen insulae-anteroinferior aspect of the insular cortical surface.
- Submentovertex view of MRA shows M1 ſt, genu and bifurcation st, M2 segments coursing over insula , and M3 segments turning laterally to exit the sylvian fissure and course over the lateral surface of the hemisphere. (8-19) Vascular MCA territory (red) supplies most of the lateral surface of the hemisphere ſt, the anterior tip of the temporal lobe st, and the inferolateral frontal lobe
- PCA supplies most of the inferior surface of cerebral hemisphere except temporal tip and frontal lob It also supplies post 1/3rd of medial hemisphere ,corpus callosum and most of choroid plexus
- Submentovertex MRA shows the posterosubmentovertex sweep of the P2 PCAs and the medial course of the P3 segments as they pass behind the midbrain. Calcarine and P4 cortical branches are shown. (8-23) The PCA territory (purple) includes the occipital lobe and posterior third of the medial ſt and the posterolateral surfaces of the hemisphere , as well as almost the entire inferior surface of the temporal lobe st.
- middle cerebellar peduncle inferolateral portion of the pons flocculus anteroinferior surface of the cerebellum SCA whole superior surface of the cerebellar hemispheres down to the great horizontal fissure the superior vermis dentate nucleus most of the cerebellar white matter
- AP graphic depicts the vertebrobasilar system. PICAs arise from the VAs before the basilar junction and curve posteriorly around the medulla. AICAs course laterally to the CPAs. Two or more SCAs arise from the BA just below the tentorium. Perforating BA branches supply most of the pons. (8-25) AP DSA shows PICAs , AICAs , and SCAs . The SCAs and PICAs both curve posterolaterally around the midbrain
- Lateral DSA shows large PICAs and small AICAs . (8-27) Graphic shows the posterior circulation vascular territories of PICAs (tan ), AICAs (blue-green ), SCAs (yellow), medullary perforating branches of the VA ſt, and pontine perforating branches of the BA st. Thalamic perforating branches arise from the top of the BA and PCoAs. PCA territory is shown in purple .
- Fig 1 at the level of CPA fig 2 at the level of inferior cerebellum
- Vdein of troland-connects superior sag sinus & superior middle cerebral vein