ARTERIAL AND VENOUS SUPPLY OF BRAIN
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ARTERIAL AND VENOUS SUPPLY OF BRAIN
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ARTERIAL AND VENOUS SUPPLY OF BRAIN
- 1. ARTERIAL AND VENOUS SUPPLY OF BRAIN Ariunjargal Buyanmunkh M,D
- 2. Артерийн анатоми Аортын нумаас эхэлнэ: Aortic arch Innonimate artery Left common carotid Left subclavian
- 3. Аортын нум: 3 . Innonimate artery 10. Left subclavian artery 15. Left common carotid artery
- 4. 1.Innonimate artery • Brachiocephalic салаа • Аортын нумаас салаалах эхний судас Innonimate artery Right subclavian artery Right common carotid artery
- 5. Innonimate artery 4. Right subclavian artery 5. Right common carotid artery
- 6. 1A.Right subclavian artery Right subclavian artery Right vertebral artery Internal mammary artery Thyrocervical trunk Costocervical trunk
- 7. 1A. Right Subclavian Artery : 6. Right vertebral artery 9. Internal mammary artery 16. Thyrocervical trunk 16
- 8. Баруун Subclavian артерийн хэвийн бус хэлбэр – Бүх тохиолдлын 0.5-1% – 1 биш 4 дэх судас болж аортын нумаас салаалах – Нийт ийм хэлбэрийн өөрчлөлттэй хүмүүсийн 10 %-д dysphagia lusoria буюу улаан хоолойн шахагдсанаас залгихад хүндрэл үүсдэг.
- 10. Right Vertebral Artery • Баруун subclavian artery-н эхний салаа
- 11. 1B. Right Common Carotid
- 12. 2. Left common carotid • Аортын нумын гарах 2-р салаа 15.Left common carotid Common carotid artery хүзүүний C3-C6 түвшинд external ба internal болж сална.
- 14. Left Common Cartotid Artery хэлбэрүүд : • LCCA – дутуу хөгжсөн эсвэл огт байхгүй байж болно – ECA ICA салаанууд шууд аортын нумаас салаалж болно.
- 15. 3. Left subclavian artery • Аортын нумын сүүлийн салаа Left subclavian artery Left vertebral artery Internal mammary Thyrocervical trunk Costocervicaltr unk
- 16. Left vertebral artery • Зүүн subclavian artery- н эхний салаа 11.Left vertebral artery 14.Left internal mammary
- 17. хэлбэрүүд • Left vertebral artery – шууд аортоос салаалж болно.
- 18. MRA – aortic arch RSCA LSCA Innominate artery LCCA RCCA RVA LVA
- 20. ECA – branches
- 21. ECA – branches Superior thyroid artery Lingual artery Facial artery Occipital artery Posterior auricular artery Ascending pharyngeal artery Early arterial phase of CCA angiogram
- 22. ECA – branches Late arterial phase of CCA angiogram Posterior auricular artery Occipital artery Facial artery Lingual artery Superficial temporal artery Maxillary artery Transverse facial
- 23. ECA – төгсгөлийн салаа • Дотор мaxillary артери – Салаанууд – inferior alveolar, middle meningeal, deep temporal , accessory meningeal , sphenopalatine , infraorbital , descending palatine, булчингийн салаанууд. – Цусан хангамж – Дура хальс болон гавлын ялтас.
- 24. Superficial temporal artery • Цусан хангамж –хуйх болон чихний хэсгүүд. • салаанууд – transverse facial artery STA Middle meningeal artery hairpin turn of STA
- 25. ECA – MRA Oblique view – MRA Vertebral artery Thyrocervical trunk Facial artery Lingual artery Superficial temporal artery Occipital artery Maxillary artery
- 26. ECA – MRA Straight AP view – MRA Superficial temporal artery Hairpin turn of STA Maxillary artery Facial artery Lingual artery Vertebral artery Middle meningeal artery
- 27. нүүрний салстын судаснууд- (нүүр улайх) Oropharynx mucosal blush High nasopharynx mucosal blush Orbital mucosal blush Nasal conchae septal blush Palatal mucosal blush
- 28. Тархины гадна болон доторх судаснуудын холбоосууд Maxillary artery • Middle meningeal artery • Foramen rotundum artery • Accessory meningeal • Vidian artery • Ant / mid deep temporal ICA • Ethmoidal br of opthalmic artery • Inferlolateral trunk of ICA • Inferolateral trunk • Intratemporal ICA • Opthalmic artery
- 29. • Occipital • Ascending pharyngeal artery • Ascending pharyngeal artery • Facial artery • Posterior auricular artery • Vertebral • Vertebral C3 level • ICA (petrous and cavernous ) • ICA (opthalmic artery) • ICA (stylomastoid artery) Тархины гадна болон доторх судаснуудын холбоосууд
- 30. Internal carotid artery Left CCA Right CCA Internal carotid- carotid bulb ECA 3-D CTA
- 31. Internal carotid artery Cervical Intraosseous / petrous Lacerum Cavernous Intracranial / supraclinoid Opthalmic Communicating
- 33. Cervical segment • нарийсалгүй • Өргөсөлгүй • салаалалтгүй ICA ICA ECA
- 34. Variants – cervical segment ICA ECA
- 36. Axial NECT inferior to superior ( bone window )
- 37. MRA
- 38. Petrous – салаанууд Petrous segment of ICA • Дунд чихний цусан хангамжийг хариуцдаг Intrapetrous • Inconstant • Foramen lacerum ба vidian сувагаар ордог • ECA -тай холбогддог Vidian artery (artery of Pterygoid canal ) • Дотор дунд чихийг цусан хангамжийг хариуцдаг. Corticotympanic artery
- 39. Vidian canal Foramen lacerumVidian canal
- 41. Cavernous ICA C4 segments 1. Ascending (posterior vertical ) 2. Posterior genu 3. Horizontal 4. Anterior genu 5. Anterior vertical Салаанууд Meningohypophyseal artery Inferolateral trunk Small capsular branches
- 43. Axial CT Posterior genu as it courses anteromedially into the cavernous sinus ICA courses along the bony grooves of carotid sulcus along the basisphenoid bone • Throu cavernous sinus proper turns superiorly • Form grooves under anterior clinoid process • Anterior genu of ICA . • Curve upwards towards dural ring • Enter subarchnoid space Posterior genu Carotid sulcus Anterior genu
- 44. MRA
- 45. CECT C4 within cavernous sinus
- 46. Menigohypophyseal artery •Posterior trunk •Arises at junction of c4 and c5 •Supplies – •pituitary gland •tentorium (artery of Bernasconi and Cassinari ) •cavernous sinus • clival dura • cn3 n 4 •High quality D/FSA •Enlarges to supply dural vascular malformation / neoplasm Inferolateral trunk • Lateral mainstream artery • Arises – inferolaterally from c4 segment • Supplies – • CN 3,4,6 • gasserian ganglion CN5 • cavernous sinus dura • Anastomose with br of internal maxillary artery . Collaterals b/w ECA N ICA • DSA – lateral view • Enlarged – vascular neoplasm / malformation / collaterals to ECA
- 49. Opthalmic segment C6 CECT Anterior clinoid process C6
- 50. Opthalmic artery Origin – • Intradural •Antero-superior ICA • Medial to anterior clinoid process Course – Anterior throu optic canal Below optic nerve Crosses superomedially over the nerve Supply -globe Gives off ocular , lacrimal , muscular branches •Anastomose with ECA
- 51. Mid arterial phase DSA Lateral view MRA Lateral DSA
- 54. Communicating C7 C7 segment branches Posterior communicating artery Anterior choroidal artery Lateral DSA AChA PCoA 3D CTA
- 55. Posterior communicating artery •салаанууд – anterior thalamoperforating arteries •Цусан хангамж – optic chiasma, pituitary stalk , thalamus , hypothalamus. Lateral late arterial DSA MRA
- 56. Хэлбэрүүд – PCoA 1. Дутуу хөгжил – 1/3 тохиолддог 2. Infundibuli хэсэгт тэлэгдэж өргөсөх 6% д тохиолддог 3. PCoA хоёрчлогдох PCoA fenestration PCoA hypoplasia
- 57. Infundibular -PCoA •Infundibular- тэлэгдэл •Should be 2мм –с илүүгүй өргөнтэй, юүлүүр хэлбэртэй өргөсөл үүсдэг
- 58. Within suprasellar cistern under optic tract Posteromedially around temporal lobe uncus Cisternal Course : Intraventricular course: AChA angles sharply laterally Enters choroidal fissure of temporal bone Abrupt kink – plexal point AChA-origin few mms above PCoA Cisternal segment Intraventricular segment Anterior choroidal artery
- 59. Цжсан хангамж Choroidal plexus of lateral ventricle ( temporal horn and atrium ) Optic tract and cerebral peduncle Uncal and parahippocampal gyri of temporal lobe . Thalamus and posterior limb of internal capsule. AP mid arterial DSA AP Late arterial DSAMRA lateral view Choriodal blush
- 60. Terminal ICA Anterior cerebral artery Middle cerebral artery 3D CTA MCA ACA ICA 3D CTAMid arterial phase DSA
- 61. Circle of willis- circulus arteriosus 2ICAs Horizontal segment A1 of both ACAs 2 Posterior communicating arteries Anterior communicating artery Horizontal segment P1 of both PCA s Basilar artery
- 62. Холбогдсон артериуд Байрлал- их тархины доод гадаргууд, Харааны мэдрэлийн зөрлөгийн орчимд Anterior circulation 2 B/L ICAs 2ACAs Unpaired ACoA anteriorly Posterior circulation Basilar bifurcation from merged VAs 2PCAs from BAs B/L PCoAs
- 63. 3DVRT CTA MRA CT MRA 1. A1 2. P1 3. PCoA 4. ACoA
- 64. Виллисын цагираг-г шинжлэх аргууд Cerebral angiography- single injection Contrast enhanced CT – maximum intensity projection Invasive MRA- time of flight sequence with multiple overlapping thin slab technique Transcranial Doppler ultrasound Non invasive
- 65. COW – салаанууд • Medial lenticulostriate arteries • Recurrent artery of HeubnerACAs • Perforating branches – hypothalamus , optic chiasma , cingulate gyrus , corpus callosum , fornix • Large vessel – median artery of corpus callosum arises from ACoA ACoA • Anterior thalamoperforating arteriesPCoA • Posterior thalamoperforating arteries • Thalamogeniculate arteries Basilar artery, PCAs Цусан хангамж- 1.Optic chiasma and tracts 2.Infundibulum 3.Hypothalam us 4.Тархин ы суурь
- 66. Variants -COW Complete COW –only 20 – 25% Posterior circle anomalies – 50% anatomy specimens Common variants •Hypoplasia of 1 or both PCoA – 34% •Fetal origin of PCA from ICA
- 67. •Hypoplasia or absent A1 ACA segment. •Absent , duplicate or multichannel ACoA – 10-15% Variants - COW
- 68. • Cerebral arteries • Vertebral artery • Basilar artery
- 69. CEREBRAL ARTERIES Distal ICA Anterior cerebral artery Middle cerebral artery Basilar artery Posterior cerebral artery
- 70. Anterior cerebral artery A1 horizontal segment • From ACA origin to ACoA junction. • Доод салаа нь - superior surface of optic nerve and chaisma. • Дээд салаа нь – anterior hypothalamus , septum pellucidum , anterior commisure , fornix , anterior inferior portion of corpus straitum.
- 72. Recurrent Artery of Heubner • Largest of the 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.
- 73. A2 segment- Interhemispheric segment From ACoA junction Ascend in 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
- 74. Cortical A3 segment • Supply the anterior 2/3rds of medial hemispheric surface + small superior area over the convexities. • Callosomarginal a.– lies in cingulate gyrus supplies medial frontal lobe
- 75. Cortical branches – territories
- 76. Lateral DSA mid arterial 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
- 77. ACA– ACoA complex • ACoA -Part of 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
- 78. Duplication ACA Fenestration / duplication of ACA
- 79. Azygous ACA – solitary unpaired vessel Single trunk from confluence of A1 segments of right n left ACAs- supplies both hemispheres . Assc with lobar holoprosencephaly, saccular aneursym
- 80. • Normally A1 segment runs over the optic nerve. • Here it runs below the optic nerve. • Assc with aneurysms . • Recognised before surgeries. Infraoptic origin of ACA
- 81. Variable branches to C/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. Bihemispheric ACA
- 82. Middle cerebral artery M1 horizontal Origin -Laterally from 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
- 85. Cortical branches 1. Orbitofrontal artery (lateral frontobasal ) 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
- 86. AP DSA mid arterial phase AP DSA early arterial phase
- 87. Early arterial phase Lateral DSA Mid arterial phase
- 88. Lateral •M1 horizontal •MCA bifurcation •M2 insular •M3 opercular CT
- 89. MRA
- 90. Lateral Lenticulostriate Artery • Origin - M1 • Supplies – • Part of head and body of caudate • Globus pallidus • Putamen • Posterior limb of internal capsule
- 91. Sylvian segment territory • Supplies • Inferolateral frontal lobe • Insular cortex • Parietal lobe • Temporal lobe
- 92. Cortical segment territory Supplies – • Lateral cerebrum • Insula • Ant- lateral temporal lobe
- 93. Variants- MCA • Less frequent • Fenestration and duplication • Single trunk • Accessory arteries All uncommon ≤5 %
- 94. MCA fenestration
- 95. Accessory MCA • It is either hypertrophied RA heubner or medial ACA perforator. • To be called accessory MCA it should have cortical branches.
- 96. PCA origin from bifurcation of basilar artery in interpeduncular cistern. Lies above occulomotar nerve. Circles midbrain above tentorium cerebelli. Posterior cerebral artery
- 97. Posterior cerebral artery 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
- 99. P3 quadrigeminal Behind midbrain in 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
- 100. AP DSA AP DSA mid arterial phase
- 101. Early arterial phase Lateral DSA Mid arterial phase
- 102. MRA CTA
- 103. Cortical territory • Supply – • Medial +posterior temporal lobe • Medial parietal lobe • Occipital lobe
- 104. Variant – PCA • Fetal origin of PCA from ICA instead of basilar – 15- 20 % • Carotid basilar anastomosis – supply PCA via trigeminal artery or other persistent channels
- 105. Vertebral artery V1 Courses –Cephalad to 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%
- 106. Extracranial VA branches 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
- 107. Intracranial VA branches Vertebral artery Anterior spinal artery 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
- 109. Lateral DSA AP DSA V1- extraosseous V2 –foraminal V3 – extraspinal V4 – intradural
- 110. At c7 level At C6 level
- 111. At C1 C2 level At spinal cord and pons level
- 112. Posterior inferior cerebellar artery • Front of medullaAnterior 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
- 114. Lateral DSA early arterial Lateral DSA late arterial
- 116. Anterior medullary segment Posterior medullary segment Lateral medullary segment
- 117. •Choroid plexus of 4th ventricle. •Posterolateral medulla. •Cerebellar tonsil. •Inferior vermis. •Posteroinferior cerebellar hemisphere. Supplies PICA territory
- 118. Variants – • Persistent vertebrobasilar anastamosis • Left VA – aortic arch origin – 5% • Hypolastic VA – 40 % Hypoplastic VA
- 119. Hypoplastic VA terminating as PICA VA terminates in PICA – 1%
- 120. Duplicated VA Orange arrow – duplicated VA Red – original VA from subclavian VA duplication- ocassionally
- 121. Fenestrated VA VA fenestration – occasionally
- 122. Extracranial PICA Extradural origin of PICA PICA from VA below foramen magnum
- 123. Basilar artery Right and left VA 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
- 124. BA - Branches 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
- 125. BA –branches 2. SCA- Superior Cerebellar 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
- 126. AP DSA
- 128. MRA
- 129. Variants - Nonfused basilar
- 132. Variants -SCA origin from PCA / ICA directly SCAs- can arise from P1 segment
Editor's Notes
- Vascualr structurs sbranching from the right side of superior aortic arch – aberrant rt sca
- Transverse facial – branch of sta
- Pterygoid muscle divede into 3 parts
- Larger of two 2 terminal icas
- 9 glosso 10 vagus 1 1 spinal accessory