Blood supply of the brain including venous drainage.

1. BLOOD SUPPLY OF BRAIN
PRESENTER: DR PAWAN KUMAR
DR R M L & PGIMER, 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 and two
vertebral arteries.

3. AORTIC ARCH
1.Innominate artery (IA) /
Brachiocephalic trunk
-Rt subclavian artery (SCA)-
Right vertebral artery
-Rt common carotid artery
(CCA)
2.Left Common Carotid Artery (CCA)
3.Left Subclavian Artery (SCA)- Left
Vertebral Artery (VA)

4. Major Arteries
1.INTERNAL CAROTID-
-ARCH OF AORTA-INTERNAL +EXTERNAL
CAROTID AT SUPERIOR BORDER OF
THYROID CARTILAGE
-ENTER THE BRAIN-CAROTID CANAL
2. VERTEBRAL ARTETIS
-FROM 1st PART OF SUBCLAVIAN ARTERY.
-TRAVERSE FROM C6 TO C1 –FORAMAN
MAGNUM
-UNITES TO FORM BASILAR ARTERY AT THE
LOWER BORDER OF THE PONS.

5. INTERNAL CAROTID ARTERY
• Four segments:
– Cervical
– Petrous
– Cavernous
– Cerebral / Supraclinoid
• Branches
– Meningohypophyseal trunk
– Ophthalmic artery (OA)
– Superior hypophyseal artery
– Posterior communicating artery (PComA)
– Anterior choroidal artery (AChA)
– Anterior cerebral artery (ACA)
– Middle cerebral artery (MCA) (continuation of
the ICA)

6. – Cervical segment
– From the bifurcation of CCA
– Extends to the entrance into
the carotid foramen of the
petrous temporal bone
– No branches

7. -Petrous Segment
-Extends from base of skull to
the petrous apex
-Ascending , Genu, Horizontal
-Enters cranial vault via foramen
lacerum.
-Branches - Carotico tympanic A
& A of pterygoid canal

8. Cavernous Segment
-Passes through cavernous sinus with
Abducens Nerve
-Cavernous branches-trigeminal ganglion
-Branches supply posterior pituitary
(Meningohypophyseal Artery)

9. - Cerebral part
Begins after penetration of dura,
continues until bifurcation into
ACA & MCA
3 Branches:
1.Ophthalmic A
2.Posterior Communicating A
3.Anterior Choroidal A-
-ends in the choroid plexus.
-crus cerebri, the lateral geniculate
body, the optic tract, and the internal
capsule).

10. 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

11. 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

12. 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)

14. 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

15. 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.

16. 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.

18. 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

19. 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

22. 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

23. 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

24. 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

25. 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

26. • 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.

27. 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.

29. 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

30. 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

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

34. 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

36. • 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

37. 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

38. 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

39. • 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

40. • 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.

41. • 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.

42. Thank you