NEUROVASCULAR
ANATOMY
MS CURRICULUM
Pankaj Sharma, MD
Assistant professor
Department of Neurology
Aortic Arch And Great Vessels
3 vessel aortic arch configuration seen in 80 %
Brachiocephalic artery
LCCA
Left subclavian artery
Arterial Supply
The arterial supply of brain is derived from Two major systems
1. The carotid system also referred as anterior circulation.
2. The posterior circulation also referred as vertebrobasilar circulation.
CIRCLE OF WILLIS
ACOM connects ACA bilaterally and PCOM connects ICA and posterior cerebral artery.
Lies in base of brain
MRA : MIP Images
Variations are very common
Typical circle of Willis is present in 21 %
Common variations
Fetal PCA ( 22 to 26%)
Hypoplastic PCOM ( 30 %)
Hypoplasia of A 1 segment
Hypoplasia of ACOM
Many other possible variations
Carotid Arteries
RCCA originates from Brachiocephalic trunk
Divide in to ECA and ICA at C 4 level
ICA enters skull through carotid canal
ICA has no branches in neck
ECA has 8 major branches
Sup thyroid Facial STA
ASC pharyngeal Lingual Post Auricular
Occipital MMA
ACA- precommunicating segment to ACOM
Post communicating segment courses in to interhemispheric fissure around Corpus
callosum
Vascular Territory
Corpus callosum, Head of caudate, anterior and medial Putamen
Anterior limb of internal capsule
Inferomedial frontal lobe
Anterior 2/3 of medial surface
Cerebral convexity
Middle Cerebral Artery
Larger Terminal branch of ICA
Divided in to Horizontal ( M1) and Insular M2 segment and Cortical (M4)
Vascular Territory
Lateral surface of cerebral hemisphere
Ant surface of temporal lobe
Lenticulostriate branches supply basal ganglia
Vertebrobasilar system
Right and left VA arises from Right and Left SCA
VA enters in to Vertebral foramen of 6 cervical vertebra
Exit from C 2 and enters in to foramen magnum and dura
Two VA joins to form a Basilar artery
Superior cerebellar, Anterior inferior cerebellar and PICA arises from BA
VA give rise to a single anterior and two posterior spinal arteries
Posterior Cerebral Artery
Basilar artery bifurcates in to right and left PCA
Vascular Territory
Midbrain, post part of thalamus, posterior limb of IC
Splenium of corpus callosum
Optic tract, visual cortex
Posterior 1/3 of Medial cerebral hemisphere
Inferior temporal lobe
Vascular Territory
ASA: Anterior spinal cord, Inferior medulla
PSA : Dorsal spinal cord
PICA: Lateral medulla and lateral cerebellar surface
AICA: Anterior and lateral cerebellum, IAC, CN 7 and 8
BA : perforators to pons, medial midbrain and medulla
SCA : Superior vermis, Sup cerebellar peduncle, Superior and
medial surface of cerebellar cortex.
Important Variants
Artery of Percheron
Thalamus on either side is supplied predominantly by multiple small branches arising
from ipsilateral posterior communicating artery and P 1 and P2 segments of posterior
cerebral artery.
Artery of Percheron (AOP): single, unpaired thalamoperforating artery trunk arises from
the first part of the PCA and supplies bilateral medial thalami, with variable contribution
to the rostral midbrain
Artery of Heubner
Medial perforating branch arise form ACA, can arise from A
1, A 2 or at the junction of ACA and ACoA
Runs parallel to proximal segment of ACA
Vascular Territory
• Head of caudate and medial portion of GP
• Anterior limb of internal capsule
• Anterior hypothalamus
Venous anatomy
Dural Venous Sinus : Endothelial lined trabeculated channels enclosed
within reflection of dura
Cerebral Veins : Thin walled, Valve-less, drains in to dural sinus
Superior Sagittal Sinus (SSS) The SSS arises anteriorly at the junction of the falx cerebri,
with the dura lining the inner table of the calvarium. At this level, the SSS communicates with
veins of the nasal cavity and with the facial vein. It extends on the midline posteriorly,
following the calvarium, forming a typical upward convex curve, and ends in the torcular
herophili.
Inferior Sagittal Sinus (ISS) The inferior sagittal sinus (ISS) is a relatively small channel, running within
the inferior free margin of the falx cerebri.
Straight Sinus (SS) The SS is formed by the confluence of the vein of Galen and the ISS. Occasionally,
the BV drains directly into it.
Transverse Sinus (TS) The TS begins at the internal occipital protuberance at the torcular herophili, and
it runs laterally and slightly anteriorly along the groove of the squamous portion of the occipital bone.
Sigmoid Sinus (SiSs) This is the direct continuation of the TS. The sigmoid sinus curves inferiorly and
medially behind the inferior part of the petrous temporal bone, reaching the jugular foramen, where it ends
in the jugular vein.
