Topographic Syndromes Paciaroni M, Agnelli G, Caso V, Bogousslavsky J (eds): Manifestations of Stroke. Front Neurol Neurosci. Basel, Karger, 2012, vol 30, pp 99-110 Arterial Territories of the Human Brain Laurent Tatu®® - Thierry Moulin « Fabrice Vuillier-¢ « Julien Bogousslavsky* *Laboratoire Anatomie, UER Sciences Médicales et Pharmaceutiques, Université de Franche-Comté, Besancon, Service Explorations et Pathologies Neuromusculaires, et ‘Service de Neurologie 2, CHU Jean Minjoz, Besancon, France; Center for Brain and Nervous System Disorders, and Neurorehabiltation Services, Genolier Swiss Medical Network, Clinique Valmont, Montreux, Switzerland Abstract We present a brain map of the areas supplied by vari (ous arteries in the brainstem, cerebellum and cerebral hemispheres. Arterial territories are depicted in a form that is directly applicable to neuroimaging slices in clini- ‘al practice. The arterial territories are outlined based on. an extensive overview of anatomical studies of cerebral, blood supply. For arterial territories of the hemispheres, we present the variability of the cortical territories of the three main cerebral arteries and define the minimal and ‘maximal cortical supply areas. Copyright © 2012, Karger AG, Basel In this chapter, we present a brain map of the areas, supplied by various arteries in the brainstem, cer- ebellum and cerebral hemispheres. Arterial terri- tories are depicted in a form that is directly appli- cable to neuroimaging slices in clinical practice. ‘The map is presented on a series of 24 templates, based on a bicommissural plane passing through the center of the anterior and posterior commis- sures, The sections of the brainstem and cerebel- lum (sections I-XII) are 4 mm thick, whereas those of the cerebral hemispheres (sections XIII— XXIV) are8 mm thick. The anatomical structures are shown on the right side of the sections and the arterial territories appear on the left. Morphological data for the 24 sections are based on anatomical atlases by Duvernoy [1-3]. The arterial territories are outlined based on an extensive overview of anatomical studies of ce- rebral blood supply. This overview included ei- ther vascular injection studies or microanatomic studies of the cerebral arteries, and is developed in more detail elsewhere [4-6]. For arterial territo- ries of the hemispheres, we have chosen to explain in detail the variability of the cortical territories of the three main cerebral arteries and to define the minimal and maximal cortical supply areas with reference to a baseline anatomical study [7]. This chapter is intended to provide a graphical overview of the anatomy of the cerebral arteries. A more detailed approach can be found elsewhere [8]. Arterial Supply of the Brainstem Arterial trunks supplying the brainstem include the vertebral artery, basilar artery, anterior and posterior spinal arteries, posterior inferior cer- ebellar artery, anterior inferior cerebellar ar- tery, superior cerebellar artery, posterior cere- bral artery, and anterior choroidal artery. The collaterals of these arteries are divided into fourSection Section v jet vrtoin HE sacr entry Fig. 1. Sections IX arterial territories mapping: brainstem and cerebellum. For abbreviations and color codes see pp. 105-107. 100 Tatu-Moulin- aller -Bogousslavskyso, Hisar sans pone wets Steamed eee, atc orc eee erecta te Section X1 Fig. 1. Continued ‘Arterial Territories of the Human Brain 101Section Xin Section XIV Fig. 2. Sections XIlI-XXIV: arterial territories mapping: cerebral hemispheres. For abbreviations and color codes see pp. 105-107. 102 Tatu: Moulin-Wuilie: Bogousslavskymee sn Fig. 2. Continued Arterial Teritories ofthe Human Brain 103Section XX! Section Xx Section XXII Fig. 2. Continued 104 Tatu: Moulin- Vuiller-BogousslavskyAbbreviations: Anatomical structures of the brainstem and the cerebellum (sections I-XIl) 10 u 13 4 15 16 7 18 19 20 a 22 23 24 25 26 7 28 29 30 31 32 33 34 35 36 37 38 39 40 4 Corticospinal tract Medial lemniscus Medial longitudinal fasciculus Spinothalamic tract Spinal trigeminal tract and nuclei Gracile and cuneate nuclei Nucleus of the solitary tract Dorsal motor vagal nucleus Hypoglossal nucleus Inferior olivary nucleus Inferior cerebellar peduncle Vestibular nucleus Facial nucleus Superior olivary nucleus Abducens nucleus Pontine nuclei Motor trigeminal nucleus Principal sensory trigeminal nucleus Nucleus coeruleus Superior cerebellar peduncle Sustantia nigra Inferior colliculus Trochlear nucleus Superior colliculus Oculomotor nucleus Red nucleus Mamillary body Optic tract Lateral geniculate body Medial geniculate body Tonsil Biventer lobule Inferior semilunar lobule Pyramid of vermis Uvula Superior semilunar lobule Tuber of vermis Middle cerebellar peduncle Dentate nucleus Folium of vermis Nodulus 42 Flocculus 43 Declive 44 Simple lobule 45 Culmen 46 Quadrangular lobule 47 Central lobule 48 Alaof the central lobule Vv ‘Trigeminal nerve VIL Facial nerve VIII Vestibulocochlear nerve IX Glossopharyngeal nerve Abbreviations: Anatomical structures of cerebral hemispheres (sections XIlI-XXIV) Gyri (purple) CG FI F2 FB F30p F3or F3t EMG GR LOG MOG PCu POG SCG IN PCL. PoCG PrCG AG Pl P2 SMG TL Cingulate gyrus Superior frontal gyrus Middle frontal gyrus Inferior frontal gyrus Inferior frontal gyrus pars opercularis Inferior frontal gyrus pars orbitalis Inferior frontal gyrus pars triangularis Frontomarginal gyrus Gyrus rectus Lateral orbital gyrus Medial orbital gyrus Precuneus Posterior orbital gyrus Subcallosal gyrus Insula Paracentral lobule Postcentral gyrus Precentral gyrus ‘Angular gyrus Superior parietal gyrus Inferior parietal gyrus Supramarginalis gyrus Superior temporal gyrus ‘Arterial Territories of the Human Brain 10512 Middle temporal gyrus 3 Inferior temporal gyrus Ta Fusiform gyrus TS Parahippocampal gyrus TTG — Transverse temporal gyrus O1 Superior occipital gyrus 02 Middle occipital gyrus 03 Inferior occipital gyrus 04 Fusiform gyrus 05 Lingual gyrus 06 Cuneus GD Gyrus descendens (Ecker) RSG Retrosplenial gyrus Sulci (brown) AOS Anterior occipital sulcus CaS Calcarine sulcus iS Cingulate sulcus CoS Collateral sulcus CS Central sulcus IFS Inferior frontal sulcus 10S _Intra-occipital sulcus IPS _Intraparietal sulcus LF Lateral fissure LS Lingual sulcus OS Olfactory sulcus PCS Paracentral sulcus PoCS — Postcentral sulcus POF Parieto-occipital fissure PrCS_— Precentral sulcus RCS —_Retrocalcarine sulcus SES Superior frontal sulcus SPS Subparietal sulcus STS Superior temporal sulcus (parallel sulcus) TOS Transverse occipital sulcus Internal structures (blue) Nb Caudate nucleus, body Nh Caudate nucleus, head CNt — Caudate nucleus, tail IA __ Internal capsule, anterior limb IG __ Internal capsule, genu IP Internal capsule, posterior limb NA PL PM SN cM DM LD LP Pu VA VL VPL ic CR IN Lu cc Hb Hh Ht AC Ag crc GA LB MB MT. OR Nucleus accumbens Putamen Globus pallidus, pars lateralis Globus pallidus, pars medialis Septal nuclei Anterior thalamic nucleus Centromedian thalamic nucleus Dorsomedial thalamic nucleus Lateral dorsal thalamic nucleus Lateral posterior thalamic nucleus Pulvinar Ventral anterior thalamic nucleus Ventral lateral thalamic nucleus Ventral posterolateral thalamic nucleus Claustrum Corona radiata Insula_ Limen insulae Corpus callosum Fornix Hippocampus, body Hippocampus, head Hippocampus, tail Anterior commissure Amygdala Crus cerebri Gyrus ambiens Hypothalamus Lateral geniculate body Mamillary body Medial geniculate body Mamillo-thalamic tract Optic radiations Tuber 106 Tatu: Moulin-Wulier- BogousslavskyColor codes: | Brainstem territories (sections |-X! Cerebellar territories (sections IX! PEs sonertn rotrinar coer oey [Bvt nent stercotetraa PE eorinterie crepe artery Arterial territories of cerebral hemispheres (sections KII-XXIV) PE evoreninget ranches ofthe anterior cerebral artery (ACA) | | Perforating branches of the anterior cerebral artery (ACA) PE cer rioort trans ofthe mite cereral artery MCA) [El ‘orn branches ort mite cerebral acer (MCA Leptomeningeal branches ofthe posterior cerebral artery (PCA) [Ee ee reperorting tranches Thalamogeniculate branches [Oh rose cia aris rena) [By tree choroidal artery incnad [Bh er orrencting ater scons PE 210 branches ore posterior communicating artery (CON [Be rerorainatrances ofthe intemal carouartery 10a) arterial groups (anteromedial, anterolateral, lat- eral and posterior) according to their point of penetration into the parenchyma. Each of these groups supplies the corresponding arterial ter- ritories in the brainstem. The arterial territories have a variable extension at different levels of the brainstem. Arterial Groups Supplying the Medulla The medulla is supplied by the vertebral arteries and the posterior inferior cerebellar artery, which give rise to the rami of the lateral medullary fossa, and by the anterior and posterior spinal arteries. Arterial Groups Supplying the Pons Different arterial trunks supply blood to the pons including the vertebral artery, the anterior inferi- or cerebellar artery, from which arise the rami of Arterial Teritories ofthe Human Brain the lateral medullary fossa, the superior cerebel- lar artery and the basilar artery. The anterome- dial pontine territory is supplied by distinet ar- terial sources arising from different levels of the basilar artery. These sources include foramen co- ‘ecum arteries, pontine arteries and inferior ram arising from the interpeduncular fossa arteries. This point is crucial to understanding the clinical signs of alternate pontine infarction syndromes. The posterior territory only exists in the upper part of the pons, Arterial Groups Supplying the Midbrain Five arterial trunks supply the midbrain: the supe- rior cerebellar artery (mainly the medial branch), the collicular artery, the posteromedial choroidal artery, the middle rami of the interpeduncular arteries arising from the posterior cerebral artery 107