VASCULAR

ANATOMY OF BRAIN
BY DR. KANISHKA P. M. (JR I)
UNDER THE GUIDANCE OF DR. NIKITA MANTRI (SR)
 HEMODYNAMIC

• Brain requires 20% of total oxygen.

• Cerebral blood flow is 16% of cardiac output.
• Cerebral perfusion pressure must be greater than 50 mmHg to maintain cellular integrity.
CPP= MAP-ICP
• Irreversible brain damage occurs after 4 min of circulatory arrest.
• Components :
• Imaging technique
• Arterial supply
• -Anterior circulation
• -Circle of Willis
• -Posterior circulation

• Venous supply
IMAGING TECHNIQUE

• Computed tomography angiography (CTA)

• Magnetic resonance angiography (MRA)
• Digital subtraction angiography (DSA)
 CTA

• For anatomy and pathology

• Now a days contrast enhanced CT angiography.
• Advantages over MR angiography
• Quicker
• Easier
• Can be used in MRI contraindicated conditions.
 MRA

• Contrast enhanced MRA

• Non contrast enhanced MRA

• Advantages over CTA

• -no radiation exposure
• -can be done without contrast
 DSA

• Endovascular interventional
procedure .
• Follow-up DSA after aneurysm and
AVM treatment.
• In negative CTA , in order to exclude
small fistula.
 ARTERIAL CIRCULATION

• CCA bifurcate at the level of C4 vertebral

body into
• Internal carotid artery (ICA )
• External carotid artery (ECA)
 IENTERNAL CAROTID ARTERY (ICA)

• Started at C4 vertebral body level

• It is main arterial supply to brain
• Complex course-7 segment and 3 genu.
• C1-cervical segment
• C2 –petrous segment
• C3-lacerum segment
• C4-cavernous segment
• C5-clinoid segment
• C6-ophthalmicsegment
• C7-communicating segment
C1-CERVICAL SEGMENT

• Course-
• Crosses behind and medial to
ECA
• No named branches
 C2- PETROUS PART

• ICA is intraosseous
• Enters carotid canal in petrous part of
temporal bone.
• Exit at apex of petrous bone
• Branches:
• Vidian artery
• Carotico-tympanic artery
C3 –LACERUM SEGMENT

• No branches
 C4- CAVERNOUS SEGMENT

• Course- along the basi-sphenoidal bone

• Through cavernous sinus proper turn superiorly and posterior genu is
form when it course anteromedially into the cavernous sinus
• Form groove under the anterior clinoid process
• Curve upwards toward dural ring
• Enter the subarachnoid space
• Branches-meningo-hypophyseal trunk
• Inferolateral trunk
C5- CLINOID SEGMENT

• Course-between proximal and distal ring of dural sinus

• End as ICA enters the subarachnoid space near the anterior clinoid process
• No important branches
C6- OPHTHALMIC

• Course-extend from distal dural ring at superior clinoid to just below the posterior
communicating artery origin PCOM
• Branches
• Ophthalmic
• Superior hypophyseal artery
C7-POSTERIOR COMMUNICATING ARTERY

• Posterior communicating artery

• Join the posterior cerebral arteries.

• Anterior choroidal artery-

NORMAL ICA VARIANT

• Aberrant ICA
• Persistent stapedial artery
• Embryonic carotid basilar anastamosis
CIRCLE OF WILLIS

• Ring of vessels
• Connect the anterior
and posterior
circulation
• Important source of
collateral
circulation
• Formed by -
 ANTERIOR CEREBRAL ARTERY (ACA)
• It is medial branch of supraclinoid ICA
• Course- run in interhemispheric fissure
• Segments- total 3
- A1 (horizontal) -origin from ICA to ACOM
-14mm in length
-Branches-medial lenticulostriate artery
• A2-(vertical) –from ACOM to the bifurcation
• branches-Recurrent artery of heubner
• 2 cortical branches-orbitofrontal and
frontopolar artery
• A3-(cortical branches)-distal to bifurcation
 ACA TERRITORY

• Anterior 2/3 of the medial surface of the

cerebral hemisphere
• Small wedge area of along the inferomedial
frontal lobe
• Cortex over the top of the hemisphere vertex
 MIDDLE CEREBRAL ARTERY(MCA)

• Segments
• M1-(horizontal)-from origin to the bifurcation
• Branches-lateral lenticulostriate artery.
• M2-(insular) from bifurcation to circular sulcus of insula
• M3-(opercular branches)within the sylvian fissure
• M4- corticle segment
MCA TERRITORY

• Majority of lateral surface of the

hemisphere except the superior portion of
the parietal lobe (via ACA) and inferior
surface of the temporal and occipital lobe
by (via PCA)
 POSTERIOR CEREBRAL ARTERY (PCA)

• P1(pre-communicating /peduncular segment)-

• Course- from it’s origin at the termination of basilar artery to posterior
communicating artery within the interpeduncular cistern.
• Branches
• Posterior thalamo-perforating arteries
• Medial posterior choroidal artery

• P2(Ambient segment)
• Course -from the PCOM around the mid brain to ambient segment
• Branches-
• lateral posterior choroidal artery
• Thalamogeniculate artery
• P3(quadrigeminal segment)
• Course - cistern within the quadrigeminal cistern
• Branches-
• Inferior temporal artery
• Parietooccipital artery
• Calcarine artery
• Posterior pericallosal artery
• P4- cortical segment
PCA TERRITORY

• Occipital lobe
• Posterior 1/3 of the medial and
posterolateral surface of the
hemisphere
• Inferior surface the temporal lobe.
VARIANTS

• Hypoplasia of one or both PCOM-30%

• Hypoplastic / absent A1 segment of ACA-15%
• Absent / fenestrated ACOM -12.5%
• PCA originated from ICA with absent / hypoplastic P1 segment (fetal PCA)-20%
VERTEBRO-BASILAR SYSTEM

• V1- extra-osseous segment-enters from the C6

transverse foramen
• V2- foraminal segment
• V3- extraspinal segment
• V4-intradural segment
• Branches –
• Anterior and Posterior spinal artery
• Medullary perforating branches
• PICA
BASILAR ARTERY

• At pontomedullary junction
• Terminate in the interpeduncular cistern give 2 PCAs
• Branches:
• PCA
• AICA
• SCA
• Pontine
• Labyrinthine
TERRITORY

• Cerebellum
• Midbrain
• Occipital lobe
• Posterior thalamus
• Inferior and posterolateral surface of
temporal lobe
• Upper cervical cord
VARIANTS

• Normally left vertebral artery is dominant in 50%

• Origin from aortic arch
• No connection with basilar artery
• Partial duplication / fenestration
THANK YOU