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Arterial and venous supply of brain part2
1. The document describes the anatomy and branches of the major cerebral arteries including the anterior, middle, and posterior cerebral arteries. 2. It discusses the typical branching patterns and territories supplied by each artery and their segments. 3. Variations in arterial anatomy are also summarized such as fenestrations, duplications, hypoplasia.
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Arterial and venous supply of brain part2
- 1.
- 2. Cerebral arteries Vertebral artery Basilar artery
- 3. Distal ICA Anterior cerebral artery Middle cerebralartery Basilar artery Posterior cerebral artery
- 4. A1 horizontal segment • FromACA origin to ACoA junction. • Inferior br – supply superior surface of optic nerve and chaisma. • Superior br – anterior hypothalamus , septum pellucidum , anterior commisure , fornix , anterior inferior portion of corpus straitum.
- 5. Arise from A1 segment-perforating branches. • Pass cephalad thro anterior perforated substance. • Supply head of caudate nucleus and anterior limb of IC, putamen .
- 6. • Largest ofthe perforating branches. • May arise from A1 or A2 segment. • A1 – 44% • Proximal A2 – 50% • ACoA – less common • Derives its name from the fact that it doubles back on its parent artery at an acute angle to join lenticulostriate vessel. • Lies parallel to A1 .
- 7. From ACoA junction Ascendin front of 3rd ventricle in cistern of lamina terminalis br –Orbitofrontal, frontopolar Curves around corpus callosum genu gives terminal branches A2 terminal branches- Pericollasal Collasomarginal
- 8. • Supply theanterior 2/3rds of medial hemispheric surface + small superior area over the convexities. • Callosomarginal a.– lies in cingulate gyrus supplies medial frontal lobe • Pericallosal a.– course along the posterior aspect of corpus callosum and supplies it and medial parietal lobe
- 10. Lateral DSA midarterial phase A1 A2 A3 orbitofrontal Callosomarginal Pericollasal Medial lenticulostriate Recurrent artery heubner Pericollasal A2 Orbitofrontal Frontopolar A3 Callosomarginal AP DSA mid arterial 3D MRA A2 Pericollasal Callosomarginal
- 11. ACoA -Partof COW - not a true branch of ACA Branches – perforating Supply –Lamina terminalis , Hypothalamus , Anterior commissure , Fornix, Septum pellucidum , Para olfactory gyrus , Subcellosal region , Anterior part of cingulate gyrus
- 12. ACA –ACoA complex – normal 1/3rd anatomy dissection Absent , duplicate or multichannel ACoA – 10-15%
- 13. • Hypoplasia orabsent A1 ACA segment-distal segments fill preferentially from other side via ACoA.
- 14.
- 15. Single trunkfrom confluence of A1 segments of right n left ACAs- supplies both hemispheres . Assc with lobar holoprosencephaly, saccular aneursym
- 16. • Normally A1 segmentruns over the optic nerve. • Here it runs below the optic nerve. • Assc with aneurysms . • Recognised before surgeries.
- 17. Variable branches toC/L hemisphere. Separate right n left ACA. 1 ACA is dominant than other and it sends branches to other hemisphere. Other ACA is hypoplastic – terminate as orbitofrontal or frontopolar branch.
- 18. M1 horizontal Origin -Laterallyfrom ICA bifurcation Till its bi/trifurcation at sylvian fissure. Br – Lateral Lenticulostriate branch course superiorly Anterior temporal artery Supplies-Lentiform nucleus Part of IC , caudate nucleus M2 insular At its genu divides into branches Loop over insula pass laterally to exit from sylvian fissure M3 opercular Emerge from sylvian fissure Ramify over hemispheric surface Supplies –cerebral cortex and white matter
- 21. 1. Orbitofrontal artery (lateralfrontobasal ) 2. Prefrontal arteries 3. Precentral (prerolandic ) 4. Central sulcus (rolandic) 5. Postcentral sulcus (anterior parietal) artery 6. Posterior parietal artery 7. Angular artery 8. Posterior temporal 9. Temporooccipital artery 10. Medial temporal
- 22. AP DSA midarterial phase AP DSA early arterial phase
- 23. Early arterial phase LateralDSA Mid arterial phase
- 24. Lateral •M1 horizontal •MCA bifurcation •M2insular •M3 opercular CT
- 25.
- 26. • Origin -M1 • Supplies – • Part of head and body of caudate • Globus pallidus • Putamen • Posterior limb of internal capsule
- 27. • Supplies • Inferolateral frontallobe • Insular cortex • Parietal lobe • Temporal lobe
- 28. Supplies – • Lateral cerebrum •Insula • Ant- lateral temporal lobe
- 29. Less frequent Fenestration and duplication Single trunk Accessory arteries All uncommon ≤5 %
- 31. • It iseither hypertrophied RA heubner or medial ACA perforator. • To be called accessory MCA it should have cortical branches.
- 32. PCA origin frombifurcation of basilar artery in interpeduncular cistern. Lies above occulomotar nerve. Circles midbrain above tentorium cerebelli.
- 33. P1 precommunicating / peduncular •Basilar bifurcation extends laterally • Junction with PCoA • Br – • Post thalamoperforating- thalamus , midbrain • Medial posterior choroidal artery – anteromedially along roof of 3rd ventricle – tectal plate , midbrain , thalamus posterior , pineal gland , tele choroidae of 3rd ventricle. P2 ambient / crural • PCA- PCoA junction posterior • Above trochlear nerve and tentorial incisura • Br – • Thalamogeniculate arteries- MGB , pulvinar , brachium superior colliculus , crus cerebri , LGB • Lateral post choroidal artery – over pulvinar of thalamus – posterior thalamus , lateral ventricular choroid plexus
- 35. P3 quadrigeminal Behind midbrainin quadrigeminal plate cistern Reciprocal relationship with MCA Inferior temporal artery • Undersurface of temporal bone • Anastamose -MCA Parietooccipital artery • Posterior 1/3rd interhemispheric surface • ACA Calcarine artery( P4 ) • Visual cortex • Occipital pole Posterior pericollasal artery (splenial) • Splenium of corpus callosum • ACA
- 36. AP DSA AP DSAmid arterial phase
- 37. Early arterial phase Lateral DSAMid arterial phase
- 38.
- 39. • Supply – •Medial +posterior temporal lobe • Medial parietal lobe • Occipital lobe
- 40. Fetal originof PCA from ICA instead of basilar – 15- 20 % Carotid basilar anastomosis – supply PCA via trigeminal artery or other persistent channels
- 41. V1 Courses –Cephaladto enter transverse foramina at C6 Ascend directly to C2 (V2) Turns laterally and superiorly thro C1 vertebral foramina Looping posteriorly along atlas V3 extraspinal Each VA passes superomedially thro foramen magnum In Posterior fossa anterior to medulla (intradural ) VAs unite to form basilar artery From subclavian arteries Left VA dominant 50%
- 42. 1. V1-Small segmental spinal/meningeal/ muscular branches. 2. V2- Anterior Meningeal artery , muscular branches. 3. V3 -Posterior Meningeal artery Courses along posterior arch of atlas. Supplies falx cerebri Variant – origin from ECA / PICA. Greatly enlarged with vascular malformations and neoplasms Posterior meningeal artery
- 43. Vertebral artery Anterior spinalartery Joins ASA from opposite VA along anteromedial sulcus of cervical cord. Medial medullary syndrome Posterior inferior cerebellar artery Arises from distal VA Lateral medullary syndrome
- 45. Lateral DSA AP DSA V1-extraosseous V2 –foraminal V3 – extraspinal V4 – intradural
- 46. At c7 levelAt C6 level
- 47. At C1 C2level At spinal cord and pons level
- 48. • Front ofmedulla Anterior medullary segment • Along side of medulla caudally to level of CN 9-11Lateral medullary segment • Around inferior half of cerebellar tonsilTonsilomedullary segment • Cleft btw tela choridae and inferior medullary velum rostrally and superior pole of tonsil caudallyTelovelotonsillar segment Cortical / hemispheric segment
- 50. Lateral DSA early arterial LateralDSA late arterial
- 52. Anterior medullary segment Posteriormedullary segment Lateral medullary segment
- 53. • Choroid plexusof 4th ventricle. • Posterolateral medulla. • Cerebellar tonsil. • Inferior vermis. • Posteroinferior cerebellar hemisphere. Supplies
- 54. Persistent vertebrobasilar anastamosis LeftVA – aortic arch origin – 5% Hypolastic VA – 40 % Hypoplastic VA
- 55. VA terminates inPICA – 1%
- 56. Orange arrow – duplicatedVA Red – original VA from subclavian VA duplication- ocassionally
- 57.
- 58. Extradural origin ofPICA PICA from VA below foramen magnum
- 59. Right and leftVA s unite – BA Course cephalad in front of pons Pontine cistern in the space delineated by lateral margin of clivus and dorsum sellae Terminates in interpeduncular cistern Divides into PCAs •Average length – 3 cm •Width 1.5- 4 mm •Diameter <4.5 mm
- 60. 1. AICA –Anterior Inferior Cerebellar Artery 1st major branch. Posterior laterally in cerebellopontine angle cistern toward the internal auditory canal. Here typically anteroinferior to facial and vestibulocochlear nerve. Few mms from origin AICA crossed by abducens nerve. Supplies- ▪ Nerves ▪ Inferolateral pons ▪ Middle cerebellar peduncle ▪ Flocculus ▪ Anterolateral cerebelllar hemisphere
- 61. 2. SCA- SuperiorCerebellar Artery – Arises from BA apex. Posterolaterally around Pons and mesencephalon below tentorial incisura and CNS 3 n 4. Supplies – ▪ Superior surface of vermis n cerebellar hemisphere. ▪ Deep cerebellar white matter. ▪ Dentate nucleus. Perforating branches – short n long segment BA – terminates into PCA s
- 62.
- 64.
- 68. SCAs- can arise fromP1 segment