Base of The Brain

&
Blood Supply of Brain
Base Of The Brain
• The base of the
brain presents:
• Orbital and
tentorial surfaces
of the frontal and
temporal lobes of
both the cerebral
hemispheres
• Interpeduncular
fossa
• Ventral aspects of
the midbrain,
pons, medulla
oblongata and
Cerebellum
• Superficial
attachment of the
cranial nerves
 Interpeduncular Fossa
• Rhomboidal space
• Boundaries
• Either side
• By the crus cerebri of cerebral peduncles
• Anteriorly
• By optic chiasma and optic tracts
• Posteriorly
• By the pons.
• Contents
• Mammillary bodies
• Two small spherical bodies
• Tuber cinereum
• A raised area of grey matter lying anterior to the mammillary bodies
• Infundibulum
• A narrow stalk which connects the hypophysis cerebri with the tuber cinereum
• Posterior perforated substance
• Layer of grey matter in the angle between the crus cerebri and is pierced by the central
branches of the posterior cerebral arteries
• The oculomotor nerve
• Emerges immediately dorsomedial to the corresponding crus.
 Blood Supply of Brain
• Regarding blood supply of brain
• Most metabolically active organs of the body
as it depends on aerobic metabolism of
glucose.
• Constitutes only 2% (1/50) of the total body
weight but receives 20% (1/5) of the total
cardiac output
• Consumes 20% of the total O2 used by the
body.
• The cerebrovascular diseases (thrombosis,
embolism ,and hemorrhage) are the third most
common cause of death and the neurological
signs depend on the site of lesion.
 Blood supply of Brain
• The vertebrobasilar arteries
• The internal carotid arteries.
• The internal carotid arteries
• Arise in the neck from the common carotid
arteries.
• The cervical part of the artery ascends
vertically through the neck, without
branching, to the cranial base.
• Each internal carotid artery enters the
cranial cavity through the carotid canal in
the petrous part of the temporal bone.
• Intrapetrous Part Intracranial Course of I C Artery
• Ascends in the carotid canal and enters the middle
cranial fossa through the upper opening of the
foramen lacerum.
• Gives off superior and inferior carotico-tympanic
branches, which enter the middle ear
• Intracavernous Part
• From foramen lacerum the artery courses forwards
in the floor of the cavernous sinus, where it is in
close relation to the abducent nerve.
• Gives off branches to trigeminal ganglion,
hypophyseal branches to the pituitary and the
meningeal branches
• Supraclinoid Part
• After the artery pierces the dural roof of the
cavernous sinus it bends sharply backwards and
upwards to terminate at the vallecula of cerebrum
into middle and anterior cerebral arteries.
• Branches
• Ophthalmic artery
• Posterior communicating artery
• Anterior choroidal artery.
 Vertebral Arteries
• Begin in the root of the neck as the first
branches of the first part of the
subclavian arteries.
• The cervical parts of the vertebral
arteries ascend through the transverse
foramina of the first six cervical
vertebrae.
• The atlantic parts of the vertebral
arteries perforate the dura and
arachnoid and pass through the
foramen magnum.
• The intracranial parts of the
vertebral arteries unite at the
caudal border of the pons to
form the basilar artery.
• The basilar artery, ascends the
clivus, through the
pontocerebellar cistern to the
superior border of the pons.
• It ends by dividing into the two
posterior cerebral arteries.
• Branches of the Cranial Part of
Vertebral Artery
• Posterior spinal artery
• Posterior inferior cerebellar artery
• Anterior spinal artery
• Meningeal branches
• Medullary arteries
• Branches of the Basilar Artery
• Pontine branches
• Anterior-inferior cerebellar artery
• Labyrinthine artery
• Superior cerebellar artery
• Posterior cerebral artery
 Arterial Supply Of Cerebrum
• The cerebrum is
supplied by three
pairs of cerebral
arteries
• Anterior cerebral
arteries
• Middle cerebral
arteries
• Posterior cerebral
arteries.
• The cerebral arteries
give three types of
branches
• Cortical branches.
• Central branches.
• Choroidal branches.
• Cortical branches
• Supply the outer portion of the cerebrum
• Freely anastomose and form a network
in the pia mater on the surface of the
cerebral cortex.
• Once they enter the cortex, they become
the end arteries
• Choroidal branches
• Form a network of capillaries which
project into the ventricles after
invaginating the layers of pia mater and
ependyma forming choroid plexuses.
• Anterior choroidal artery.
• Posterior choroidal artery.
• Central branches
• Supply the centrally located parts of the
cerebrum
• End arteries.
• Four groups:
• Anteromedial group
• Supply the anterior hypothalamus.
• Anterolateral group (lateral striate
arteries)
• A large medial striate artery called
recurrent artery of Heubner, supply the
head of caudate nucleus, part of putamen,
anterior limb of the internal capsule
including the genu.
• The lateral striate arteries are, part of
anterior limb of internal capsule, part of
posterior limb of internal capsule, caudate
nucleus, putamen and part of globus
pallidus.
• Posteromedial group
• Supplies interpeduncular structures
• Posterolateral group
• Supply the caudal half of thalamus,
geniculate bodies and most of the lateral
nuclear mass of thalamus.
 Arterial Supply of Superolateral Surface
• Middle cerebral artery:
• Supplies most of the superolateral surface (about
2/3rd)
• The greater parts of primary motor and sensory
areas, and frontal eye field.
• Supplies the Broca and Wernicke’s speech areas
in the left hemisphere.
• Anterior cerebral artery:
• Supplies a narrow strip of the cerebral cortex
(about 2.5 cm in width) adjoining superomedial
border up to the parieto-occipital sulcus
• The upper parts of primary motor and sensory
areas lie in this region.
• Posterior cerebral artery:
• Supplies a narrow strip along the lower border of
temporal lobe (excluding temporal pole) and
occipital lobe
• The posterior parts of visual area fall in this
area.
Arterial Supply of Medial Surface
• Anterior cerebral
artery:
• Supplies most of the
medial surface
(anterior 2/3rd)
• Supplies parts of motor
and sensory areas
(paracentral lobule)
concerned with
perineum, leg, and foot.
• Middle cerebral artery:
• Supplies temporal pole
of the temporal lobe
• Posterior cerebral
artery:
• Supplies occipital lobe
Arterial Supply of Inferior Surface
• Posterior cerebral
artery:
• Supplies most of the
inferior surface
except the temporal
pole
• Middle cerebral
artery:
• Supplies lateral part
of the orbital surface
of the frontal lobe
and temporal pole of
the temporal lobe
• Anterior cerebral
artery:
• Supplies medial part
of the orbital surface
of the frontal lobe
 Arterial Supply Of Other Parts Of The Brain
• The corpus striatum and internal capsule
• Mainly by the central branches of middle cerebral artery and to some extent by
the central branches of anterior cerebral artery.
• The thalamus
• Mainly by the central branches of posterior communicating, posterior cerebral,
and basilar arteries.
• The midbrain
• By the posterior cerebral, superior cerebellar, and basilar arteries.
• The pons
• By the basilar, superior cerebellar, and anterior inferior cerebellar arteries.
• The medulla oblongata
• By the vertebral, anterior spinal, posterior spinal, posterior inferior cerebellar,
and basilar arteries.
• The cerebellum
• By the superior, anterior inferior, and posterior inferior cerebellar arteries.
 Circle of Willis

• The arterial circle at the base of the

brain is an anastomosis between the
internal carotid and the vertebrobasilar
system of arteries.
• It is polygonal in shape and is located
in the interpeduncular cistern.
• Formation
• The anterior communicating
artery forms anterior part of
the circle of Willis.
• The anterior cerebral artery
forms the anterolateral part
on each side.
• The lateral part is formed by
the termination of internal
carotid artery on each side.
• The circle is completed
posteriorly by the
bifurcation of basilar artery
into the right and left
posterior cerebral arteries.
• Posterolaterally, the
posterior communicating
artery is the connecting link
between the internal carotid
and posterior cerebral
arteries.
 Arterial Supply Of Internal Capsule
• Anterior limb
• By medial striate branches
of the anterior cerebral
artery and lateral striate
branches of the middle
cerebral artery.
• Genu
• By recurrent artery of the
Heubner or direct branches
from internal carotid artery.
• Posterior limb
• By lateral striate branches
of the middle cerebral artery
and branches of the anterior
choroidal artery.
 Venous Drainage Of The Brain
• Veins of the brain drain into the
intracranial dural venous sinuses, which
eventually drains into the internal
jugular veins of the neck.
• Does not follow the arterial pattern.
• Extremely thin walled due to absence of
muscular tissue in their walls
• Possess no valves.
• Run mainly in the subarachnoid space.
• Consists of
• Cerebral veins
• External cerebral veins
• Internal cerebral veins
• Cerebellar veins
• Veins of the brainstem.
• The external cerebral veins drain the
surface (cortex) of the hemisphere and External Cerebral Veins
are divided into three groups, viz.
• Superior cerebral veins
• Middle cerebral veins
• Inferior cerebral veins
• Superior cerebral veins
• About 8–12
• Drain the upper parts of the superolateral
and medial surfaces of the cerebral
hemisphere.
• They ascend upwards, pierce the
arachnoid mater, and traverse the
subdural space to enter the superior
sagittal sinus.
• Middle cerebral veins
• Two on each side
• Superficial middle cerebral vein
• Lies superficially in the lateral sulcus
• Anteriorly, it runs forwards to drain into
the cavernous sinus while posteriorly, it
communicates with the superior sagittal
sinus via superior
• Deep middle cerebral vein.
 Internal Cerebral Veins
• There are two internal cerebral veins
located one on either side of midline in
the tela choroidea of the 3rd ventricle
• Each internal cerebral vein is formed at
the interventricular foramen (of Monro)
by the union of three veins:
• Thalamostriate vein
• Septal vein
• Choroidal vein
 Applied anatomy
A lesions of the corpus striatum give rise
• Hypertonicity or lead pipe type of muscular rigidity
• Loss of automatic associated movements & also of facial
expression
• Involuntary movements like tremors, pill rolling movement
• Lesions of the internal capsule are usually vascular, due to
the involvement of the middle cerebral artery
• They give rise to hemiplegia on the opposite side of the body (
paralysis of half of the body including the face ) it is an upper
motor neuron type of paralysis
• Thrombosis of the recurrent branch of the anterior cerebral
artery give rise to an upper motor neuron type of paralysis
of the opposite upper limb & the face
• Berry aneurysm
• Stroke
• Ischemic
• Hemorrhagic
Collateral Circulation after
Internal Carotid Artery
Occlusion
Brain Tumors
• Gliomas
• Meningiomas
• Neuromas