This document provides an overview of the vascular anatomy of the brain. It describes the arteries that make up the anterior and posterior cerebral circulations, including the internal carotid, anterior cerebral, middle cerebral, posterior cerebral and vertebrobasilar arteries. It details the branches and territories of supply of these major arteries. It also discusses variants and anomalies that can occur. Finally, it reviews the venous drainage of the brain through the dural sinuses and cerebral veins.

1. VASCULAR ANATOMY OF
BRAIN
DR PRAJWITH K J RAI

3. CEREBRAL ARTERIAL ANATOMY
• ANTERIOR CIRCUILATION
• ICA
• ACA
• MCA
• ACoM
• PCoM
• POSTERIOR CIRCUILATION
• VERTEBROBASILAR TRUNK
• PCA

4. ARCH OF
AORTA
Left
CCA
Left
SCA
Right
SCA
Right
CCA

5. BRACHIO CEPHALIC TRUNK
LEFT CCA
LEFT SCA

6. RIGHT CCA
RIGHT SCA

7. RIGHT SUBCLAVIAN ARTERY

8. VERTEBRAL
ARTERY THYROCERVICAL
TRUNK
COSTOCERVICAL
TRUNK
DORSAL SCAPU
ARTERY
INTERNAL MAMARY
ARTERY

9. VERTEBRAL ARTERY
INTERNAL MAMARY ARTERY
THYROCERVICAL TRUNK

10. RIGHT SUBCLAVIAN ARTERY – VARIANTS

11. RIGHT VERTEBRAL ARTERY

12. COURSE OF VERTEBRAL ARTERY
C7
C6
C5
C4
C3
C2
C1
FROM SUBCLAVIAN ARTERY
TO C6 VERTEBRAL FORAMEN
FROM C6 VERTEBRAL FORAMEN
TO C2 VERTEBRAL FORAMEN
C 2 FORAMEN TO DURAV3
V2
V1

13. VARIANTS

14. RIGHT COMMON CAROTID ARTERY

15. VARIANTS

16. LEFT COMMON CAROTID ARTERY
• BIFURCATES AT MIDCERVICAL
• C3-C6
• ECA and ICA

17. VARIANT

19. LEFT SUBCLAVIAN ARTERY
• LAST BRANCH OF AORTIC ARCH

20. VERTEBRAL
ARTERY THYROCERVICAL
TRUNK
COSTOCERVICAL
TRUNK
DORSAL SCAPU
ARTERY
INTERNAL MAMARY
ARTERY

24. Left VERTEBRAL ARTERY
DIRECT BRANCH OF ARCHT
OF AORTA
5%
NON DOMINANT

26. ECA
• ORIGIN ANTERIOR AND MEDIAL TO ICA
• SUPPLIES EXTRACRANIAL STUCTURES
• SMALLER THAN ICA
• HIGH RESISTANCE

27. MEDIAL
CCA
ECA
ICA

28. ECA
ANTERIOR
SUPERIOR
THYROIDAL
LINGUAL
FACIAL
POSTERIOR
OCCIPITAL
POSTERIOR
AURICULAR
MEDIAL
ASCENDING
PHARYNGEAL
TERMINAL
MAXILLARY
SUPERFICIAL
TEMPORAL

29. OCCIPITAL
POST AURICULAR
LINGUAL
ASCENDING PHARYNGEAL
FACIAL

30. MAXILLARY
ARTERY
SUP TEMPORAL ARTERY

33. INTERNAL CAROTID ARTERY
1. CERVICAL
2. INTEROSSEOUS / PETROUS
3. LACERAM
4. CAVERNOUS
5. CLENOID
6. OPTHALMIC
7. COMMUNICATING

36. CERVICAL SEGMENT --C1
• NO DILATATION
• NO NARROWING
• NO BRANCHONG
• NO TAPERING

37. HORIZONTAL
GENU
VERTICAL
PETROUS SRGMENT - C2

38. MRA

39. LACERUM- C3

40. CAVERNOUS C4
1. ASCENDING (SHORT POST VERTICAL )
2. POSTERIOR GENU
3. LONG HORIZONTAL
4. ANTERIOR GENU
5. ANTERIOR VERTICAL

43. OPHTHALMIC SEGMENT C6
• BRANCHES
• OPHTHALMIC ARTERY
• SUP HYPOPHYSEAL ARTERY

44. ANTERIOR CLENOID PROCESS

46. COMMUNICATING C7
• BRANCHES
• PCoM
• ANTERIOR CHOROIDAL ARTERY
• CHOROID PLEXUS OF LATERAL VENTRICLE
• OPTIC TRACT AND CEREBRAL PEDUNCLE
• UNCAL AND PARAHIPPOCAMPAL GYRI
• THALAMUS AND POST LIMB OF INTERNAL CAPSULE
• SUPPLY
• OPTIC CHIASMA
• PITUTARY STALK
• THALAMUS
• HYPOTHALAMUS
PCoM
PCoM

48. VARIANTS
PCoA FENESTRATION PCoA Hypoplasia

49. VARIANTS
• INFUNDICULAR DILATION AT ORIGIN (15%)
• FUNNEL OR CONICAL SHAPED
• PCoA ARISES FROM APEX

51. TERMINAL C7
• ACA
• MCA

52. ICA VARIANTS AND ANOMALIES
• ABERRANT ARTERY
• PERSISTENT STAPEDIAL ARTERY
• EMBRYONIC CORTICO BASILAR ANASTOMOSIS

53. ABERRANT ARTERY
• CONG VASCULAR ANOMALY THAT ENTERS THE POSTERIOR MIDDLE
EAR FROM BELOW AND HUGS COCHLEAR PROMONTERY AS IT
CROSES MIDDLE EAR CAVITY
• MC PRESENTS WITH PULSATILE TINITUS

55. PERSISTENT STAPEDIAL ARTERY
• EMBRYONIC STAPEDIAL ARTERY PERSISTS POSTNATALY
• ARISES FROM C2 (PETROUS )
• PASSES THROUGH STAPES FOOT PLATE
• DOUBLE THE SIZE OF ANTERIOR FACIAL NERVE SEGMENT(TYMPANIC )

57. CAROTID VERTIBROBASILAR ANASTOMOSIS
• REPRESENT PERSISTENT EMBRYONIC CIRCUILATION PATTERN
• PREMITIVE PERSISTENT TRIGEMINAL ARTERY
• PREMITIVE HYPOGLOSAL ARTERY
• OTTIC ARTERY
• CHANNELS BETWEEN
• EMBRYONIC AORTA (CAUDAL CAROTID ARTERY )
• PAIRED LONGITUDINAL NEURAL ARTERIES (BASILAR AND VERTEBRAL )

59. PERSISTENT TRIGEMINAL ARTERY

60. PERSISTENT HYPOGLASSAL ARTERY
• FROM POSTERIOR ASPECT OF CERVICAL ICA (ALONG CN 12 )
• TO JOIN BASILAR ARTERY
• I/L VERTEBRAL ARTERY AND PCoM ARE HYPOPLASTIC
• POST ICA ARISES FROM PHA ON 50 % CASES

63. ABSENT ICA

64. CIRCLE OF VILLIS

65. CIRCLE OF VILLIS

66. ACA

68. A1 HORIZONTAL SEGMENT
• ORIGIN TO ACoM
• BRANCHES
1. MEDIAL LENTICULOSTRIATE
• HEAD OF CAUDATE
• MEDIAL PUTTAMEN
• ANT LIMB OF IC
2. RECURRENT ARTERY OF HEUBNER

71. RECURRENT ARTERY OF HEUBNER
• A2 >> A1 (50% >> 43% )
• SUPPLIES INFERIOR PART OF ANTERIOR LIMB OF IC
• LIES PARALLEL TO A1

74. MEDIAL LENTICULOSTRIATE ARTERY

75. INTERHEMESPHERICS SEGMENT -- A2
• ACoM TO ROSTRUM OF CC
• ASCEND IN FRONT OF 3RD VENTRICLE IN THE CYSTERN OF LAMINA
TERMINALIS
• BRANCHES
1. ORBITOFRONTAL
2. FRONTOPOLAR

77. CALLOSAL SEGMENT --- A3
• CURVES AROUND CC GENU
• GIVES TERMINAL BRANCH
1. PERICALLOSAL
2. CALLOSOMARGINAL

81. TERRITORY
• CORTICAL ACA BRANCHES
• ANT 2/3RD OF CEREBRAL CONVEXITY ADJACENT TO INTERHEMISPHERIC FISSURE
• ANT 2/3RD OF MEDIAL HEMISHPHERE AND CC
• INFERO MEDIAL SURFACE OF FRONTAL LOBE
• PENETRATING BRANCHES
• MEDIAL BASAL GANGLIA
• GENU OF CC
• ANT LIMB OF INTERNAL CAPSULE

85. ACoM
• LAMINATERMINALIS
• HYPOTHALAMUS
• ANT COMMISURE
• FORNIX
• SEPTUM PELLUSIDUM
• PARA OLFACTORY GYRUS
• SUBCALLOSAL REGION
• ANT PART OF CIGULATE GYRUS

87. VARIANT (15%)
• ABSENT
• DUPLICATE
• MULTICHANNEL

91. AZYGOUS ACA – SOLITARY UNPAIRED VESSEL
• SINGLE TRUNK FROM CONFLUENSE OF A1 SEGMENTS OF RIGHT AND
LEFT ACA SUPPLIES BOTH HEMESPHERES
• A/W
• HOLOPROCENCEPHALY
• SACCULAR ANEURYSM

93. MCA

100. SUPPLY
• MOST OF THE SURFACE OF CEREBRAL HEMESPHERE INCLUDING
INSULA
• PENETRATING BENACH – LATERAL BASA L
• ANT TIP TEMPORAL LOB
• INF LATERAL FRONTAL LOBE

103. ACESSORY MCA

104. PCA

109. PRECOMMUNICATING / PEDUNCULAR --P1
• BASILAR BIFURCATION TO PCoA
• BRANCHES
• POST THALAMO PERFORATING
• THALAMUS AND MIDBRAING
• MEDIAL POST CHOROIDAL ARTERY (ANT MEDIALLY ALONG ROOF OF 3RD VENTRICLE )
• TECTAL PLATE
• MIDBRAIN
• THALAMUS POSTERIOR
• PENIAL GLAND
• PERICHOROIDAE OF 3RD VENTRICLE

110. AMBIENT / CRURAL --- P2
• PCA – PCoA JUNCTION POSTERIOR
• ABOVE TROCHLEAR NERVE AND TENTORIAL INSICURA
• THALAMOGENICULATE ARTERIES
• MGB
• PULVINAR
• BRACHIUM SUPERIOR COLLICULUS
• CRUS CEREBRI
• LATERAL GENECULATE BODY
• LATERAL POST CHOROIDAL ARTERY
• PULVINAR
• LATERAL VENTRICULAR CHOROID PLEXUS

111. QUADRIGEMINAL – P3
• BEHIND MIDBRAIN IN QUADRIGEMINAL CYSTERN
• BRANCHES
• INFERIOR TEMPORAL ARTERY
• MCA ANASTOMSE
• PARIETO OCCIPITAL ARTERY
• POST 1/3RD OF INTERHEMISPHERE FISSURE
• ACA ANASTOMOSE
• CALCARINE ARTERY (P4)
• VISSUAL CORTEX
• OCCIPITAL POLE
• POSTERIOR PERICALLOSAL ARTERY (SPLENIAL)
• SPLENIUM OF CC
• ACA ANASTOMOSES

112. CALCARINE --- P4
• IN CALCARINE SULCUS

116. VARIANT
• FETAL ORIGIN OF PCA FROM ICA INSTEAD OF BASILAR (20%)

118. VERTEBRO BASILAR ARTERY

121. BASILAR ARTERY
• VA FUSE NEAR PONTOMEDULLARY JUNCTION TO FORM BA
• COURSES SUPERIORLY IN THE PREPONTINE CYSTERN BTN CLIUS AND
PONS
• IN INTERPEDUNCULAR FOSSA DIVIDE INTO 2 PCA
• BRANCHES
• AICA
• SCA (2-4)

129. PICA
• CHOROID PLEXUSOF 4TH VENTRICLE
• POSTEROLATERAL MEDULLA
• CEREBELLAR TONSIL
• INFERIOR VERMIS
• PICH

131. AICA
• INFEROLATERAL PONS
• MIDDLE CEREBELLAR PEDUNCLDE
• FLOCCULUS
• ANTEROLATERAL CEREBELLAR HEMESPHERE

133. SCA
• SUPERIOR SURFACE OF VERMIS AND CEREBELLAR HEMESPHER
• DEEP CEREBELLAR WHITE MATTER
• DENTATE NEUCLEUS

135. VARIANT

139. VENOUS DRAINAGE OF BRAIN
• DURAL VENOUS SINUSES
• CEREBRAL VEINS

140. • CEREBRAL VEINS
• EXTERNAL VEINS
• SUPERIOR CEREBRAL VEIN
• SUPERFICIAL MIDDLE CEREBRAL VEIN
• DEEP MIDDLE CEREBRAL VEIN
• INTERNAL VEINS
• THALOMOSTRIATAL VEINS
• CHOROIDAL VEINS
• OTHERS
• VEINS DRAINING FROM MIDBRAIN
• VAINS DRAINING FROM PONS
• VEINS DRAINING FROM MEDULLA AND CEREBELLU
• DURAL VENOUS SINUSES

142. DURAL VENOUS SINUSES
ANTEROINFERIOR GOUP
• SPENOPARIETAL SINUS
• CAVERNOUS SINUS
• SUP PETROSAL SINUS
• INF PETROSAL SINUS
• CLIVAL VENOUS PLEXUS
POSTERIOR SUPERIOR GROUP
• SUP SAGITAL SINUS
• INF SAGIATAL SINUS
• STRAIGHT SINUS
• CONFLUENCE OF SINUS
(TORCULAR HETEROPHILI )
• TRANSVERSE SINUS
• SIGMOID SINUS
• JUGULAR BULB

143. DURAL SINUSES

144. SUPERIOR SAGITAL SINUS

145. INF SAGITAL SINUS

146. STRAIGHT SINUS

147. TRANSVERSE SINUS

148. SIGMOID SINUS AND JUGULAR BULB

149. CAVERNOUS SINUS
• IRREGULAR SHAPED VENOUS SIUNUSES LIE ALIONG SIDE OF SELLA
TURCICA
• FORMED BY LATERAL AND THIN MEDIAL DURAL WALL
• CANTAINS
• CAVERNOUS ICA
• CN 4
• MAJOR TRIBUTARIES DRAINING
• SPHENOPARIETAL SINUS
• OPHTHALMIC VEIN
• DRAINS TO
• TRANSVERSED SINUS ( VIA SUP PETROSAL SINUS )
• JUGULAR VEINS (VIA INF PETROSAL SINUS )

151. ANTEROINFERIOR GOUP
• SPENOPARIETAL SINUS
• SUP PETROSAL SINUS
• INF PETROSAL SINUS
• CLIVAL VENOUS PLEXUS
• CAVERNOUS SINUS
• INTERCAVERNOUS CONNECTION

153. CEREBRAL VEIN

154. EXTERNAL CEREBRAL VEIN

155. SUPERFISCIAL CORTICAL VEIN
• SUPERIOR GROUP
• MIDDLE GROUP
• INFERIOR GROUP
1.Superior anastomosis = vein of trolad
2.Middle group = sup middle cerebral vein
3.Inferior anastomosis = vein of labbe

158. DEEP CEREBRAL VEIN
• MEDULLARY VEIN
• SUB EPENDYMAL VEIN
• SEPTAL VEIN
• THALAMOSTRIATE VEIN
• DEEP PARAMEDIAN VEIN
• GREAT VEIN OF GALEN ‘
• INTERNAL CEREBRAL VEIN
• BASAL VEIN OF ROSENTHAL

159. BRAIN STEM / POST FOSSA VEIN
• SUPERIOR / GALENIC GROUP OF VEINS
• PRECENTRAL CEREBELLAR VEIN
• THE SUPERIOR VERMIAN VEIN
• ANTERIOR PONTOMESENCEPHALIC VEIN
• ANTERIOR / PETROSAL GROUP
• POSTERIOR GROUP
• INF VERMIAN VEIN

164. THANK YOU