The brain receives blood from two sources: the internal carotid arteries, which arise at the point in the neck where the common carotid arteries bifurcate, and the vertebral arteries . The internal carotid arteries branch to form two major cerebral arteries, the anterior and middle cerebral arteries. The right and left vertebral arteries come together at the level of the pons on the ventral surface of the brainstem to form the midline basilar artery. The basilar artery joins the blood supply from the internal carotids in an arterial ring at the base of the brain (in the vicinity of the hypothalamus and cerebral peduncles) called the circle of Willis. The posterior cerebral arteries arise at this confluence, as do two small bridging arteries, the anterior and posterior communicating arteries. Conjoining the two major sources of cerebral vascular supply via the circle of Willis presumably improves the chances of any region of the brain continuing to receive blood if one of the major arteries becomes occluded

1. Blood supply of Brain
Dr Upendra Bharadwaj
Neurosurgery Deptt
Apollo Hospital new delhi

2. • 15% of the cardiac output
• 25% of the total oxygen.
• Cerebral blood flow is approximately 50
ml/g/min.
• Supplied by two internal carotid arteries
• Two vertebral arteries.

7. CERVICAL PART
No Branch

8. Petrous PART
C2 : Branches from the petrous portion
Caroticotympanic arteries
Artery of pterygoid canal (vidian artery)

9. Lacerum part
C3
No Branchs

10. CAVERNOUS PART

11. Cavernous Part
C4: Branches from the cavernous portion
Branches of the meningohypophyseal trunk:
Tentorial basal branch
Tentorial marginal branch
Meningeal branch - helps supply blood to the
meninges of the anterior cranial fossa
Clivus branches - tiny branches that supply the
clivus
Inferior hypophyseal artery

12. Capsular branches - supplies wall of cavernous
sinus
Branches of the inferolateral trunk:
Branches to trigeminal ganglion - provide blood
to trigeminal ganglion
Artery of the foramen rotundum
Branches to nerves

13. Clenoid Part C5
No Branches

14. Ophthalmic Part C6
Branches from the ophthalmic
portion
Ophthalmic artery
Superior hypophyseal artery

15. CEREBRAL Part C7

16. Branches from the communicating portion
Posterior communicating artery
Anterior choroidal artery
Anterior cerebral artery (a terminal branch)
Middle cerebral artery (a terminal branch)

17. OPHTHALMIC ARTERY
1st intradural branch of ICA
Supplies globe, orbit,frontal and
ethmoidal sinuses, & frontal scalp
Central retinal A, Long & Short posterior
ciliary branches
Branches of Ophthalmic A anastamose
with Maxillary A branches - potential for
collateral flow in cases of proximal
carotid occlusion

18. VERTEBRAL ARTERY
V1: (extraosseous-origin to
c6): Segmental cervical
muscular and spinal branches -
• V2( foraminal- C6 TO C1):
: meningeal/muscular/spinal
branches
• V3 (extraspinal-C1-
dura): Posterior meningeal
artery
• V4: (intradural)
– Anterior and sometimes posterior
spinal arteries
– Perforating branches to medulla
– PICA: gives off perforating
medullary, choroid, tonsillar,
cerebellar branches

19. • BASILAR ARTERY
• 1.The pontine arteries
• 2. The labyrinthine
• -the internal ear.
• - often arises as a branch of the anterior inferior cerebellar artery.
• 3. The anterior inferior cerebellar artery
• the anterior and inferior parts of the cerebellum .
• A few branches pass to the pons and the upper part of the medulla
oblongata.
• 4. The superior cerebellar artery arises close to the termination of
the basilar
• artery
• the superior surface of the cerebellum, pons, the pineal gland, and
the
• superior medullary velum, tela chorde of third ventricle.
• 5.The posterior cerebral (in interpeduncular cistern)

21. CIRCLE OF WILLIS
-In the interpeduncular fossa at the base of
the brain.
- It is formed by the anastomosis between
the two internal
carotid arteries and the two vertebral
arteries

22. perforating arteries from the circle of
Willis or from vessels near
• four principal groups
• 1.anteromedial group-the optic chiasma; lamina
terminalis;
• anteriorpreoptic and supraoptic areas of the
hypothalamus;
• septum pellucidum; paraolfactory areas; anterior
columns of
• the fornix; cingulate gyrus; rostrum of the corpus
callosum;
• anterior part of the putamen and head of the caudate
• nucleus.

23. • 2-The posteromedial group-the hypothalamus and
pituitary and
• the anterior and medial parts of the thalamus via
• thalamoperforating arteries ,the mammillary bodies,
• subthalamus, lateral wall of the third ventricle, the
medial
• thalamus, and globus pallidus.
• 3-The anterolateral group (lenticulostriate arteries)-
posterior
• striatum, lateral globus pallidus and internal capsule.
• 4-The posterolateral -the cerebral peduncle, colliculi,
pineal
• gland and posterior thalamus and medial geniculate
body.

25. Anterior cerebral Artery
Three segments:
A1 –Pre communicating
segment
Medial lenticulostriate
branches
A2-Post communicating
segment
Recurrent artery of
Heubner
Orbitofrontal
Frontopolar
A3- distal ACA / cortical
branches
Pericallosal
Callosomarginal

26. • ACA Supply
• The cortical branches.
• -Two or three orbital branches supply the olfactory cortex, gyrus
rectus and medial
• orbital gyrus.
• -Frontal branches supply the corpus callosum, cingulate gyrus,
medial frontal
• gyrus and paracentral lobule.
• - Parietal branches supply the precuneus
• - the frontal and parietal supply a strip of territory on the
superolateral surface that
• represent the lower limb.
• CENTRAL BRANCHES:
• -they supply the rostrum of the corpus callosum, the septum
pellucidum, the anterior
• part of the putamen, the head of the caudate nucleus and adjacent
parts of the
• internal capsule

29. Middle cerebral Artery
Four segments:
• M1- horizontal / sphenoidal segment:
The stem of MCA 5-15
lenticulostriate branches
• M2- insular segment:
Runs deep in sylvian fissure and along
insula ; Superior & Inferior divisions
• M3- opercular segment:
Follows the curvature of operculum
and ends as terminal branches of MCA
• M4- cortical branches:
Terminal segment

30. Middle cerebral Artery
•M1- Horizontal segment
•Lateral Lenticulostriate
•M2- Insular segment
•M3- Opercular segment
•Opercular segment branches
•Operculofrontal artery
•M4- Cortical branches
•Lat Orbitofrontal
•Pre rolandic
•Rolandic
•Ant. parietal
•Post. parietal
•Angular
•Temporopolar
•Ant temporal
•Middle temporal
•Post. temporal

31. • MCA supply
• Cortical branches
• Frontal branches supply the precentral, middle and inferior frontal
• gyri.
• Two parietal branches are distributed to the postcentral gyrus, the
• lower part of the superior parietal lobule and the whole inferior
• parietal lobule.
• Two or three temporal branches supply the lateral surface of the
• temporal lobe.
• -motor and somatosensory cortices, with the exception of the lower
• limb, the auditory area and the insula.
• the lateral striate or lenticulostriate arteries - the lentiform
• complex and the internal capsule and the caudate nucleus

32. • Posterior cerebral artery
• • P1 or Peduncular segment
• • short segment from the basilar tip to the PComA
• – Mesencephalic br. – Cr. Nv. Nuclei 3 - 6
• – Thalamoperforating arteries - diencephalon and midbrain
• • P2 or ambient segment
• • runs in the ambient cistern from the PComA to the portion of paramesencephalic cistern
• – Thalamogeniculate br.
• – Medial posterior choroidal arteries
• – Lateral posterior choroidal arteries
• – Ant temporal
• • P3 or quadrigeminal segment
• • Runs in calcrine fissure
• – Hippocampal artery
• – middle, and posterior temporal arteries
• – Posterior pericallosal artery
• P4 –DISTAL SEGMENT
• – Parieto-occipital artery
• – Calcarine artery

33. • The artery of Percheron is a rare
variant of the posterior cerebral
circulation characterised by a solitary
arterial trunk that supplies
blood to the paramedian thalamiand
the
rostral midbrain bilaterally.

34. • POSTERIOR CEREBRAL ARTERY SUPPLIES
• The cortical branches.
• Temporal branches-to the uncus and the parahippocampal, medial
• and lateral occipitotemporal gyri.
• Occipital branches- the cuneus, lingual gyrus and posterolateral
• surface of the occipital lobe.
• Parieto-occipital branches -cuneus and precuneus.
• -the visual areas of the cerebral cortex and other structures in the
• visual pathway.
• The central branches
• the anterior thalamus, subthalamus, globus pallidus and lateral
• geniculate body .
• the choroid plexus of the third and lateral ventricles and the fornix.
• supply the peduncle and the posterior thalamus, superior and
• inferior colliculi, pineal gland and medial geniculate body.

36. Blood supply of internal capsule
• Striate branches of anterior cerebral
artery. (recurrent artery of Huebner). -
genu and anterior limb
• Medial and lateral striate branches of the
middle cerebral artery. (Charcot‘s artery
of cerebral haemorrhage). -the posterior
limb of the internal capsule.
• Central branches of the anterior choroidal
artery -sublentiform part.
• Some direct branches from the internal
carotid artery -genu.
• Central branches of the posterior
communicating artery.
• Posterolateral central branches of the
posterior cerebral artery -retrolentiform
and sublentiform parts

37. • Mid brain blood supply
• • Most of the blood supply is derived from
• branches of the basilar artery.
• • Posterior cerebral
• • Superior cerebellar
• • Posterior communicating
• • posterior choroidal

42. • Pons blood supply
• The pons is supplied by the following arteries:
• • Numerous (pontine) branches from the
basilar
• artery.
• • Superior cerebellar artery.

45. • Medulla blood supply
• • The medulla is supplied by the following
• arteries:
• • Two vertebral arteries.
• • Anterior and posterior spinal arteries.
• • Anterior and posterior inferior cerebellar
• arteries.
• • Basilar artery

52. • • Branches of the vertebrobasilar
• system and of the internal carotid
• artery and P2 segment of the
• posterior cerebral artery
• • Lateral choroidal arteries -the
• lateral and third ventricles.
• • Posterior inferior cerebellar
• arteries - choroid plexus in the
• fourth ventricle .
• • Anterior inferior cerebellar
• arteries- choroid plexus of the
• foramen of Luschka
• BLOOD SUPPLY
• OF VENTRICLES

54. • Venous Drainage of The Brain
• features
• -does not follow the arterial pattern.
• - thin-walled due to absence of muscular tissue
in
• their walls.
• -no valves.
• -runs in the subarachnoid space.
• -superficial and deep

55. • sinuses of the dura mater
• (1) a postero-superior at the upper and back
• part of the skull.
• 1 Superior Sagittal
• 2 Straight sinus
• 3 Inferior Sagittal
• 4 Two Transverse.
• 5 Occipital
• (2) an antero-inferior at the base of the
• skull.
• 1 Two Cavernous
• 2 Two Superior Petrosal
• 3 Two Intercavernous
• 4 Two Inferior Petrosal
• 5 Two sphenoparietal

56. • • Thalamostriate vein +
• Choroidal vein+Septal
• = Internal cerebral vein
• • Internal cerebral vein +
• Basal Vein of Rosenthal
• = Great vein of Galen
• • Great vein of Galen +
• ISS = Straight sinus

58. • • Superior cerebral
• vein drain to SSS
• • SSS connects to
• superficial middle
• cerebral vein by
• Troland’s vein.
• • Transverse sinus
• to superficial
• middle cerebral
• vein by vein of
• Labbe’.
• • SSS + straight
• sinus + Occipital
• sinus = Transverse
• sinus
• • Transverse sinus
• later drain into
• sigmoid sinus and
• then to IJV.

60. • • Inferior cerebral vein drain
• to superficial middle
• cerebral vein terminates to
• cavernous sinus
• • Transverse sinus to
• superficial middle cerebral
• vein by vein of Labbe’.
• • Anterior cerebral vein +
• Deep middle cerebral Vein
• + Striate veins = Basal Vein
• of Rosenthal
• • Cavernous sinus drain to
• transverse/sigmoid sinus
• via superior and inferior
• petrosal sinus.

62. •Thank you,
• for giving me such a
nice opportunity.