Neuroanatomy

Arterial Supply of the Brain

• The brain receives its blood supply from 2 sources:
A- Internal carotid system .
B- Vertebro-basilar system .

A- Internal Carotid System:

• Origin: Each internal carotid artery (ICA) arises in the neck as one of the 2
terminal branches of the common carotid artery (CCA).
• Course:
▪ Each ICA enters the skull through the carotid canal to reach the
cavernous sinus .
▪ It leaves the cavernous sinus by piercing the dura mater and then pierces
the arachnoid mater to reach the subarachnoid space in the
interpeduncular cistern.
▪ In the subarachnoid space each ICA gives off:
1-The ophthalmic artery to supply the orbit.
2-The posterior communicating artery to join the posterior cerebral A.
sharing in the formation of the arterial circle of Willis.
3-The anterior choroidal artery
• End: After giving origin to the anterior choroidal artery. the ICA terminates
below the anterior perforated substance by dividing into 2 terminal
branches:
a- Anterior cerebral artery (small).
b- Middle cerebral artery (is larger and is nearly in direct line with the main
trunk of ICA).
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B- The Vertebro-basilar system: (2 vertebral arteries and basilar artery).

• Origin: Each vertebral artery arises at the root of the neck from the first part of
the subclavian artery.
• Course:
▪ The vertebral arteries enter the skull through the foramen magnum.
▪ Inside the skull, the vertebral arteries (4th parts) run upward, forwards and
medially on the anterior surface of the medulla oblongata till they reach
the lower border of the pons where the 2 vertebral arteries unite together
forming the basilar artery.
▪ The basilar artery ascends in the basilar groove on the anterior surface of
the pons .
• End: The basilar artery ends at the upper border of the pons by dividing into 2
terminal branches ; right and left posterior cerebral arteries.

• Branches of the ICA:

1. The anterior choroidal artery:
▪ It arises from the ICA.
▪ It passes backwards along the optic tract around the cerebral peduncle
as far as the lateral geniculate body.
▪ It ends by entering the inferior horn of lateral ventricle to supply the
choroid plexus of the inferior horn.
▪ It supplies also the optic tract, lateral geniculate body, the posterior part
of the posterior limb of the internal capsule, retrolentiform and
sublentiform parts of the internal capsule.
2. The posterior communicating artery: see the circulus arteriosus.
3. The anterior cerebral artery: see later.
4. The middle cerebral artery: see later.
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• Branches of the Vertebro-Basilar System:

I. Branches of the vertebral artery:
1- The posterior inferior cerebellar artery:
▪ It is the largest and the main branch of the vertebral artery.
▪ It runs backwards around the medulla oblongata to reach the inferior
surface of the cerebellum where:
▪ It ends by dividing into 2 terminal branches to supply:
a- The inferior vermis.
b- The major posterior part of the inferior surface of the cerebellar
hemisphere.
c- Branches to supply the lateral and dorsal parts of the medulla
oblongata (dorsal to the olivary nucleus) .
- It is an important artery; thrombosis in it results in a well defined syndrome
called the posterior inferior cerebellar artery syndrome.
2- The posterior spinal artery:
▪ It is the first branch of the vertebral artery after it enters the skull.
▪ It descends to the spinal cord along the line of the posterior roots of the
spinal nerves.
3- The anterior spinal artery:
▪ It arises from the uppermost part of the vertebral artery.
▪ The two anterior spinal arteries run obliquely downwards and medially in
front of the medulla and unite to form a single median anterior spinal
artery which descend along the anterior median fissure of the spinal
cord down to the filum terminale.
▪ Branches : supply the anterior part of the medulla oblongata &
anterior 2/3 of the spinal cord .
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Branches of the basilar artery:

1- The anterior inferior cerebellar artery:
▪ It passes laterally and backwards around the lower border of the pons.
▪ It ends by supplying the anterior small part of the inferior surface of the
cerebellar hemisphere.
2- The internal auditory arteries:
▪ Accompany the 7th and 8th cranial nerves into the internal auditory
meatus to supply the internal ear.
3- The pontine branches:
▪ These are many small twigs which supply the pons, the middle cerebellar
peduncles and the roots of the trigeminal nerve.
4- The superior cerebellar artery:
▪ It arises from the basilar artery close to its end.
▪ It passes laterally and backwards around the lower part of midbrain to
reach the superior surface of the cerebellum and ends by supplying it.
5- The posterior cerebral arteries: are the two terminal branches: see later.

The Three Cerebral Arteries

A- The Anterior Cerebral artery:

• Begins: Below the anterior perforated substance as the smaller of the 2
terminal branches of the ICA.
• Course:
▪ It passes forwards and medially to reach the anterior part of the median
longitudinal cerebral fissure where it becomes in close relation with its fellow
of the opposite site. At this site the two anterior cerebral arteries become
connected to each other by a short anterior communicating artery.
▪ Then, the anterior cerebral artery turns sharply upwards in the median
longitudinal fissure to reach the medial surface of the cerebral hemisphere
where it runs in the callosal sulcus, curves around the corpus callosum the
splenium where it ends.
• Ends: by turning upwards anterior to the parieto-occipital sulcus becoming a
terminal cortical artery.
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• Branches:
1- Cortical branches: To supply:
▪ The medial surface of the hemisphere from the frontal pole back to the
parieto-occipital sulcus.
▪ The upper 1 inch of the lateral surface of the cerebral hemisphere.
▪ The medial 1/2 of the orbital surface of the cerebral hemisphere.
2- Central branches: Penetrate the anterior perforated substance to supply:
▪ The anterior part of the corpus striatum.
▪ The anterior part of the anterior limb of internal capsule.
3- Branches to the septal region: Including septum pellucidum.
4- Callosal branches: To supply all parts of the corpus callosum except the
splenium (which is supplied by the posterior cerebral artery).
• Clinical importance: Anterior cerebral artery supplies three importance regions:
a- The motor and sensory areas for the lower limb and perineum.
b- The septal region: (where a small lesion may result in prolonged
unconsciousness).
c- The corpus callosum: lesion to the corpus callosum may result in apraxia
(inability to do purposeful movements while the muscles concerned in the
movements are not paralysed).

B- The Middle Cerebral Artery:

• Begins: Below the anterior perforated substance as the larger of the 2
terminal branches of the ICA. It is also in more direct continuation with ICA
(therefore, small emboli which pass through the ICA go more frequently to the
middle cerebral than to the anterior cerebral artery).
• Course:
▪ It runs laterally in the stem of lateral fissure then continued backwards
in the posterior ramus of lateral fissure crossing over the surface of the
insula where it ends.
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• Ends: By breaking up into many terminal cortical branches which emerge

from the posterior ramus of lateral fissure and appear on the lateral surface of the
cerebral hemisphere.
• Branches:
1- Cortical branches: To supply: (i), (ii) and (iii):
i. The whole lateral surface of the hemisphere except:
a- One inch in breadth along the superior border of the hemisphere
back to the parieto-occipital sulcus which is supplied by the anterior
cerebral artery.
b- Lateral surface of the occipital lobe and a narrow strip of the
temporal lobe along the inferior border of the hemisphere which are
supplied by branches of the posterior cerebral artery.
ii. The temporal pole and the insula.
iii. The lateral 1/2 of the orbital surface of frontal lobe.
2- Central branches::
▪ They penetrate the anterior perforated substance to supply:
- The posterior part of corpus striatum.
- The posterior part of anterior limb, the genu and the anterior
part of posterior limb of the internal capsule.
▪ One large branch of these arteries is called the artery of cerebral
haemorrhage which frequently ruptures causing intracerebral
haemorrhage and causes pressure on the motor fibres in the internal
capsule producing hemiplegia .
• Clinical importance: Middle cerebral artery supplies the following importance
areas:
a- The motor and sensory areas for the whole body, except the lower limbs.
b- The auditory area, in the superior temporal gyrus.
c- The motor area of speech in the inferior frontal gyrus (Broca's area).
d- The internal capsule.
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C- The Posterior Cerebral Artery:

• Begins: The right and left posterior cerebral arteries begin at the upper border
of the pons as the 2 terminal branches of the basilar artery.
• Course:
▪ Each posterior cerebral artery curves laterally and backwards around the
lower part of the midbrain above parallel to the superior cerebellar
artery with trochlear nerve in between.
▪ Then it continues to reach a position below the splenium of corpus callosum
on the medial surface of the hemisphere where it ends by dividing into
terminal cortical branches .
• Branches:
1- Cortical branches: To supply:
a- The tentorial surface of the hemisphere behind the temporal pole
(which is supplied by the middle cerebral artery).
b- The medial, lateral and inferior surfaces of the whole occipital lobe .
c- A narrow strip on the lateral surface of the temporal lobe along the
inferior border of the hemisphere.
2- Central branches:
a- Short medial group: pierce the posterior perforated substance and
supply the cerebral peduncles of the midbrain, the mammillary
bodies, the subthalamic region and the anterior part of thalamus.
b- Long lateral group: curve round the lateral side of the midbrain to
supply the lateral and medial geniculate bodies, the 4 colliculi (tectum
of midbrain), the posterior part of thalamus and the pineal body.
3- The posterior choroidal artery:
▪ Arises from the posterior cerebral artery while it is lying below the
splenium of corpus callosum.
▪ It passes forwards inside the brain in the edges of the tela choroidea of
the 3rd ventricle to supply the choroid plexuses of the 3rd and central part of
the lateral ventricle.
▪ It also supplies the thalamus through its dorsal surface.
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▪ Clinical importance: It supplies 5 important regions:

a- The whole visual cortex in the occipital lobe.
b- The centre of smell in the uncus.
c- Most of the thalamus.
d- Most of the midbrain.
e- Most of the choroid plexuses of the lateral and the 3rd ventricle.

The Circulus Arteriosus

(The Arterial Circle of Willis)
• It lies in the interpeduncular cistern at the base of the brain. It lies in the
neighbourhood of the interpeduncular fossa, around the region of the
hypothalamus.
• The circle of Willis is formed from:
a- 6 large arteries (3 on either side).
b- 3 communicating arteries (one anterior and 2 posterior).
• The six large arteries are:
1- Rt. and Lt. anterior cerebral arteries.
2- Rt. and Lt. internal carotid arteries (ICA).
3- Rt. and Lt. posterior cerebral arteries.
• The communicating arteries are:
1- Posterior communicating artery: connects the ICA with the posterior
cerebral artery of its same side.
2- Anterior communicating artery: connects the 2 anterior cerebral arteries.
• It is common that one of the arteries forming the circle of Willis may be very
small or completely absent without any clinical disturbances under
normal conditions.
• Under normal conditions little mingling of the blood of the 2 sides occurs, but if
one big artery becomes closed before it enters in the formation of the circle
of Willis, the connections may open up.
• The cortical branches of the cerebral arteries anastomose with one another
before, but not after, they enter the brain, where they become end-arteries.
• The central branches are end-arteries, i.e. they do not anastomose with
neighbouring vessels.
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Summary of the Arterial Supply of the

Different Parts of the Brain

1. Lateral surface of the cerebral hemisphere:

a- Middle cerebral artery supplies the main part.
b- Anterior cerebral artery supplies a strip about one inch adjoining the upper
border from the frontal pole till the parieto-occipital sulcus.
c- Posterior cerebral artery supplies:
▪ The occipital lobe.
▪ A narrow strip of the temporal lobe adjoining the lower border.
2. Medial surface of the cerebral hemisphere:
a- Anterior cerebral artery supplies the medial surface from the
frontal pole almost to the parieto-occipital sulcus.
b- Posterior cerebral artery supplies the area behind this sulcus (occipital lobe).
3. Tentorial surface of the hemisphere:
a- Posterior cerebral artery supplies the main part.
b- Middle cerebral artery supplies the temporal pole.
4. Orbital surface of the hemisphere:
a- Its medial 1/2: by anterior cerebral artery.
b- Its lateral 1/2: by middle cerebral artery.
5. Corpus callosum:
a- Rostrum, genu and body are supplied by anterior cerebral artery.
b- Splenium is supplied by posterior cerebral artery.
6. Choroid plexuses of the ventricles:
a- Lateral ventricle:
- Choroid plexus of the central part (body): is supplied by the posterior
choroidal artery (branch of posterior cerebral artery).
- Choroid plexus of the inferior horn: is supplied by the anterior
choroidal artery (branch of internal carotid artery).
b- Third ventricle: posterior choroidal artery.
c- Fourth ventricle: posterior inferior cerebellar artery (branch of 4th part
of vertebral artery).
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7. Corpus striatum and the internal capsule:

a- Anterior part of corpus striatum and anterior part of the anterior limb of
the internal capsule are supplied by central branches of the anterior
cerebral artery.
b- The rest of corpus striatum, posterior part of anterior limb, the genu
and the anterior part of the posterior limb of the internal capsule
are supplied by central branches of the middle cerebral artery.
c- The posterior part of the posterior limb, the retrolentiform part and
the sublentiform part of the internal capsule are supplied by the anterior
choroidal branch of ICA.
N.B.: Tail of caudate and amygdaloid nucleus are supplied by the anterior
choroidal artery (branch of internal carotid artery).

8. Thalamus: Is supplied mainly from posterior cerebral artery:

a- Posterior cerebral artery: (terminal branch of basilar artery) through its
posterior choroidal branch, medial and lateral central branches.
b- Posterior communicating artery: branch from internal carotid artery.
c- Anterior choroidal artery supplies the lateral geniculate body (LGB).
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9. Hypothalamus: Is supplied from all arteries forming the circle of Willis.

10. The cerebellum:
a- The superior surface: is supplied by superior cerebellar branch of
basilar artery.
b- The inferior surface: is supplied by:
▪ Posterior inferior cerebellar branch of vertebral artery (supplies the
major posterior part).
▪ Anterior inferior cerebellar branch of basilar artery supplies a small
anterior part.
11. The midbrain: Central branches of posterior cerebral artery (terminal branch
of basilar artery) helped by superior cerebellar artery and the posterior
communicating artery.
12. The pons:
▪ Anterior part : is supplied by the pontine branches of the basilar artery.
▪ Posterior part (tegemntum):
a- In lower pons: by the posterior inferior cerebellar artery.
b- In upper pons: by the superior cerebellar artery.
13. The medulla oblongata: It is supplied by branches of the vertebral artery:
▪ Anterolateral surface: is supplied by medullary branches of:
a- Anterior spinal artery (medially).
b- 4th part of the vertebral artery (laterally).
▪ Posterolateral surface: is supplied by the posterior inferior cerebellar
artery.
▪ Gracile and cuneate tracts and nuclei: are supplied by the posterior spinal
artery.
Veins of the Brain

I. Veins of the vertebro-basilar system:

▪ They drain the brain stem, the cerebellum and the posterior small part of
the cerebral hemisphere.
▪ They correspond to the branches of the vertebral and the basilar arteries
including the posterior cerebral arteries.
▪ They drain into basilar and the vertebral veins.
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II. Veins of the internal carotid system:

▪ They drain the major part of the cerebral hemisphere.
▪ They differ from the arteries in being arranged in two sets:
A- Superficial veins draining the cortex:
i. Veins on the lat. surface of the hemisphere:
1- Superior cerebral veins: drain the upper part of the lateral surface
of the hemisphere and run upwards to end in the superior sagittal
dural venous sinus.
2- Superficial middle cerebral vein: lies on the posterior ramus of
lateral fissure and receives the veins of the middle part of the lateral
surface. It then passes medially in the stem of lateral fissure to end
in the cavernous venous sinus.
3- Inferior cerebral veins: drain the lowest part of the lateral surface
and end in the transverse venous sinus.
ii. Veins on the medial surface of the hemisphere:
1- Veins from the upper part drain into both superior and inferior
sagittal venous sinuses.
2- Veins from the lower part drain into the anterior cerebral vein which
lies alongside the anterior cerebral artery. This vein begins near the
splenium, runs forwards over the upper surface of the corpus
callosum, then downwards around the genu and ends near the
anterior perforated substance into the basal vein.
B- Deep veins draining the deeper parts of the hemisphere:
1- Deep middle cerebral vein: lies in the bottom of the posterior ramus
of the lateral fissure on the surface of the insula. It winds medially in
the stem of lateral fissure to ends near the anterior perforated
substance by joining the anterior cerebral vein to form the basal vein.
2- Basal vein: (Rt. and Lt.):
- Is formed below the anterior perforated substance by union of deep
middle cerebral vein and the anterior cerebral vein.
- It curves backwards around the upper part of the lateral surface of
the midbrain till it comes below the splenium of corpus callosum.
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3- Internal cerebral veins: emerge from the tela choroidea below the
splenium of corpus callosum. They drain the choroids plexuses of both
lateral and 3rd ventricles.
4- Great cerebral vein: begins below the splenium of corpus callosum by
union of Rt. and Lt. internal cerebral veins and Rt. and Lt. basal veins
(i.e. 4 veins). The great cerebral vein then turns sharply upwards behind
the splenium to join the inferior sagittal venous sinus to form the
straight venous sinus.
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NERVES OF LOWER LIMB

Cutaneous nerves of the front of the thigh .

femoral Nerve(nerve of anterior compartment)
Origin
inside psoas major as the largest branch from lumbar
plexus posterior division of ventral ramus (L2, 3,4 nerves)
C &r
Emerges from lateral border of psoas major runs ( ) psoas &
iliacus (behind fascia iliaca) enter thigh deep to inguinal lig.
lateral to femoral artery pass in femoral 
lateral to femoral art outside femoral sheath
end
at 1.5 inch below inguinal lig by dividing into ant &post
divisions:
Branches 234
articular brs. (2)
Hip: through n. to rectus femoris
Knee: through nerves to vasti
cutaneous brs.(3)
Intermediate cu n. of thigh
Medial cu n. of thigh
Saphenous n. longest n. in body
Muscular brs. (4)
Iliacus (in abdomen)
Sartorius
Pectineus
Heads of quadriceps femoris
Obturator nerve (n .of medial compartment)
Origin inside psoas major
from lumbar plexus (L2, 3,4 nerves)
C&R
Emerges from medial border of psoas major
Runs forwards (with the obturator vessels)
on lateral wall of pelvis to reach obturator canal
Leave pelvis (with obturator vessels)
through obturator canal
- Divides at ant. end of canal into:
Ant. Division:
descend in front obturator externus,
add. brevis behind pectineus& Add. longus
Post . division: pierce obturator externus,
then behind Adductor brevis
infront Adductor magnus

Brs:
ant.Division
1) Muscular to pectineus, adductor longus, gracilis
adductor brevis
2) Articular to hip joint
3) Cutaneous to medial side of thigh
post.division
1) muscular to
Adductor brevis
Obturator externus & adductor magnus (pubic part)
2) articular br. to knee joint
(it is the terminal branch that pass through adductor hiatus
to knee joint)
Nerves of gluteal region
superior gluteal n.
inferior gluteal n.
sciatic n:
post. cut. n. of thigh
to Quadratus femoris
n. to obturator internus
pudendal n.

superior gluteal n. (L 4 , 5 inferior gluteal n. ( L 5 S1

S1) ,2 )

origin inside pelvis from origin inside pelvis from

sacral plexus sacral plexus
-pass through greater sciatic -pass through greater sciatic
foramen above piriformis foramen below piriformis
-pass ( ) gluteus mediud & -supply gluteus maximus
minimus
-supply gluteus medius &
minimus & tensor fascia lata
 SCIATIC NERVE
• It is a one of 2 terminal branches of sacral plexus arises from the
ventral & dorsal divisions of the anterior primary rami L4, 5 & S1,
2, 3).

• It is the thickest nerve in the body.

• It ends at the upper angle of popliteal fossa by dividing into tibial &
common fibular nerves.

• Important relations :
▪ It leaves the pelvis through the greater sciatic foramen below the
pirifomis.
▪ It runs down in the gluteal region & then in the back of thigh
under cover of gluteus maximus then long head of biceps.
▪ It descends to enters the back of the thigh midway between the
greater trochanter and the ischial tuberosity.
▪ Deeply it is related to the 6 lateral rotators ( except pyriformis &
obturator externus ) then ischeal part of adductor magnus .
▪ It is separated from the back of hip joint by obturator internus
with the two gemelli and the quadratus femoris .
• Branches:
a ) Muscular : Hamstrings & ischeal part of add. Magnus .
b ) Articular : to hip joint & knee .
 Sciatic nerve Sciatic nerve
(superficial relations and branches) (Course, end, and deep relations)
 Applied anatomy :
I ) Injury of sciatic nerve:
 Aetiology : posterior dislocation of hip joint , fracture neck of
femur or wrong intramuscular injection in the gluteal region .
 Motor effects: paralysis of hamstrings and all muscles of leg
and foot leading to foot drop deformity .
 Sensory effects: loss of cutaneous sensation below the knee in
the leg and foot except on the medial side (supplied by saphenous
nerve from femoral nerve ) and on the back of the calf region
(supplied by posterior cutaneous nerve of thigh).
II ) Sciatica:
 It is the pain felt along the distribution of the sciatic nerve ( from
gluteal region to sole of foot ) which can be caused by prolapse of an
intervertebral disc , with pressure on one or more of its nerve roots.
 Intrapelvic tumour pressing on the sciatic nerve or inflammation of
the nerve can cause sciatica.
III ) Any disease in the hip joint may appears by pain in the knee and
vise versa because both joints have same nerve supply from femoral ,
obturator and sciatic nerves therefore both joints should be examined
in any complaint in the hip or knee joints .
1V) A small artery passes inside the sciatic nerve , this artery should
be ligated during above knee amputation but no nerve fibres should
be included in the ligation.
 Popliteal artery
Popliteal vein
Tibial nerve

Common peroneal
nerve

Contents of popliteal fossa

 TIBIAL NERVE
(MEDIAL POPLITEAL nerve)
• It begins at the upper angle of popliteal fossa as the larger of 2
terminal branches of sciatic nerve .

• It ends deep to flexor retinaculum by dividing into medial and

lateral plantar nerves .

• Important relations :
▪ It traverses the popliteal fossa (from the upper to lower angle).
 It descends vertically, superficial to the popliteal vessels and
crossing them from lateral to medial with the vein intervening
between the nerve and the artery throughout its course.
 It pass superficial to popliteus muscle then enter the back of the
leg deep to the tendinous arch of soleus muscle .
 It descend deep in the upper 2/3 of back of the leg between
tibialis posterior ( deep) & soleus ( superficial ) .
 In the lower 1/3 of leg the nerve is superficial , lies directly on
posterior surface of tibia .
 The tibial nerve crosses behind the posterior tibial artery from
medial to lateral ( triple relations ) .
 It passes deep to flexor retinaculum ( Tom Does Very Nice Hat )
• Branches:
a) Muscular: All muscles of back of leg .
b) Articular: Three genicular branches to the knee & branches to
ankle joint.
c) Cutaneous :
▪ Sural nerve (it runs in the back of leg & lateral side of foot with
short saphenous vein & supplies the skin of back of leg &
lateral side of foot ).
▪ Medial Calcanean branches.
 Applied anatomy : injury of tibial nerve:
a) Motor effects :paralysis of all muscles of back of leg & sole of
foot leading to talipes calcaneo-valgus deformity ( dorsi-flexion &
eversion deformity of the foot ).
b) Sensory effects : sensory loss in area of skin on the back of the
leg and lateral side of the foot (supplied by sural nerve ) & sole of
foot ( supplied by plantar nerves ).
Posterior tibial nerve and artery
 COMMON FIBULAR NERVE
(common peroneal = lateral popliteal)
• It begins at the upper angle of popliteal fossa as the smaller of 2
terminal branches of sciatic nerve .
• It ends on the lateral aspect of neck of fibula inside the substance of
fibularis longus muscle by dividing into superficial fibular & deep
fibular nerves .

• Important relations :
▪ It enters upper angle of the popliteal fossa , passes along the
medial border of biceps .
▪ It leaves the popliteal fossa at its lateral angle by crossing the
lateral head of gastrocnemius .
▪ It pierces the fibularis longus muscle .
• Branches:
a) No muscular branches.
b) Cutaneous: Sural communicating , lateral cutaneous nerve of
calf.
c) Articular: Two lateral genicular branches to knee joint.

 Applied anatomy : injury of Common fibular nerve:

A) Aetiology : fracture of head or neck of fibula or pressure from
casts or splints.
B) Motor effects:
 Plantar flexion of foot : due to paralysis of all dorsiflexors (
muscles of front of leg ).
 Inversion of the foot : due to paralysis of eversion of foot .
  This deformity is called paralytic talipes equinovarus.
C ) Sensory effects: Loss of skin sensation:
1- On the upper lateral side of leg (supplied by lateral
cutaneous nerve of calf).
2- On the front & lateral part of the lower part of leg and dorsum
of foot and 1st cleft (supplied by superficial and deep fibular
nerves).
 SUPERFICIAL FIBULAR NERVE
(superficial peroneal = musculo-cutaneous) .
• It begins as one of 2 terminal branches of common fibular nerve on
the lateral aspect of neck of fibula inside the substance of fibularis
longus .
• It ends on the dorsum of foot, by dividing into medial and lateral
cutaneous branches.

• Important relations :
▪ It descends between fibularis longus & brevis muscles.
▪ In the lower 1/3 of leg, it e pierces the deep fascia and lies in
the superficial fascia.
▪ It crosses superficial to both extensor retinacula
to enter the dorsum of the foot.
• Branches:
a) Muscular: Lateral group of muscles of leg ( evertors ) .
b) Cutaneous:
▪ Anterior & lateral part of the lower part of leg .
▪ Skin of dorsum of foot and toes except:
 Cleft between 1st and 2nd toes (supplied by deep fibular nerve )
 Lateral side of foot and little toe ( supplied by sural nerve ).
 Medial side of foot as far as the head of 1st metatarsal
supplied by saphenous nerve.
 DEEP FIBULAR NERVE
(deep peroneal = anterior tibial nerve)
• It begins as one of terminal branches of common fibular nerve on
the lateral aspect of neck of fibula inside the substance of fibularis
longus .
• It ends on the dorsum of the foot by dividing into lateral & medial
terminal branches.

• Important relations :
▪ It enters the anterior compartment of the leg by piercing the
anterior intermuscular septum & extensor digitorum longus .
▪ It then descends deeply on the interosseus membrane between
tibialis anterior (medially) and extensor digitorum longus (laterally)
accompanied by the anterior tibial artery .
▪ It lies lateral , anterior then lateral again to the anterior tibial
artery
▪ It passes in front of the ankle joint deep to the superior &
inferior extensor retinaculum to reach the dorsum of the foot
where it runs lateral to the dorsalis pedis artery ( Tom Has Very
Nice Dog & Pig ).
• Branches:
a) Muscular: To the anterior group of muscles of leg (extensors)
& extensor digitorum brevis.
b) Articular: To ankle joint & joints of foot.
c) Cutaneous: To skin of 1st cleft.
Superficial and deep fibular nerves
Deep fibular nerve &anterior tibial artery