Lecture 3

Anatomical Blood Supply to the Brain

Dr. Martin
 CEREBRAL ARTERIES
Two pairs of arteries enter the skull, delivering
blood to the brain.

• Internal Carotid and Vertebral Arteries

The arteries travel independently until entering

the cranium, where they interface with the
anastomotic arterial circle of Willis.
 INTERNAL CAROTID
• The right common carotid artery arises from the
brachiocephalic trunk, and the left arises from the aortic
arch.

• At the level of the thyroid cartilage, the common carotids

bifurcate, yielding the external and internal carotid arteries.

• The internal carotid arteries ascend through the deep neck,

the carotid canals of the petrous bones, and the cavernous
sinus.
• The ICA emit the ophthalmic and posterior
communicating arteries.

• They divide, terminating as the anterior and

middle cerebral arteries.
 VERTEBRAL ARTERIES
• The vertebral arteries are the first branches of the
subclavian arteries.

• They ascend through the transverse foramina of the

upper 6 cervical vertebrae and enter the skull through
the foramen magnum.

• They emit the posterior inferior cerebellar arteries

(PICA), which usually emit the posterior spinal
arteries.
• The vertebral arteries then emit the anterior
spinal artery before unifying to form the
basilar artery.
 BASILAR ARTERY
• The basilar artery gives rise to the anterior
inferior cerebellar arteries (AICA).

• The superior cerebellar arteries arise from

the basilar artery, just prior to its bifurcation
into the two posterior cerebral arteries near
the caudal midbrain.
 THE ARTERIAL CIRCLE OF WILLIS
• The arterial circle of Willis is formed by a
group of arteries whose perforating branches
supply deep structures.
 ANTERIOR AND MIDDLE CEREBRAL
ARTERIES
• Anterior and middle cerebral arteries are the
terminal divisions of the internal carotid artery,
also emitting the posterior communicating
artery to anastamose with the vertebral
arterial circulation.

• The anterior cerebral artery runs medially

anterior to the optic chiasm to the longitudinal
cerebral fissure to supply the frontal lobes.
• The anterior communicating artery is located
in the fissure, joining the anterior cerebral
arteries at the midline.

• Major branches of the anterior cerebral

arteries pass to the medial aspect of the
frontal and parietal lobes and corpus
callosum (often feeding all but the most
posterior zones of this commissure).
• The middle cerebral artery extends laterally
in lateral fissure over the insula, giving off
branches to the lateral aspect of frontal,
temporal, and parietal lobes.
 POSTERIOR CEREBRAL ARTERIES
• The posterior cerebral arteries are the
terminal branches of the basilar artery.

• They receive the posterior communicating

arteries from the internal carotid.

• Cerebral branches supply medial temporal,

occipital, and parietal structures.
VENTRICULAR SYSTEM
 VENTRICULAR SYSTEM
At an early stage, the embryonic brain comprises
three parts, the
• prosencephalon,
• mesencephalon and
• rhombencephalon.
• The prosencephalon splits into the
telencephalon, related to the (left and right)
lateral ventricles, and the diencephalon,
which surrounds the third ventricle.

• The mesencephalon is the cerebral aqueduct.

• The rhombencephalon splits into the

metencephalon and myelencephalon, both of
which relate to the fourth ventricle.
• The caudal myelencephalon and the myelon
(spinal cord) contain the central canal.

• The four interconnected ventricles are lined

by ependyma and filled with CSF, which is
secreted by the choroid plexus.

• The left and right lateral ventricles

communicate with the third ventricle via the
interventricular foramina (of Monro).
• The third ventricle communicates with the fourth
ventricle via the cerebral aqueduct.

• The fourth ventricle communicates directly with

the central canal of the medulla
(myelencephalon), which is continuous with the
central canal of the spinal cord.

• The spinal central canal terminates as the tiny

terminal ventricle, which is located in the conus
medullaris
 LATERAL VENTRICLES
Each lateral ventricle has four distinct parts:

• Anterior (Frontal) Horn

• Body (corpus)
• Posterior (Occipital) Horn
• Inferior (Temporal) Horn
 THIRD VENTRICLE
• The third ventricle is a thin vertical cavity,
occupying the midline between the
diencephalic hemispheres.

• Roof is formed by choroid plexus and the body

of the fornix.
 FOURTH VENTRICLE
• The fourth ventricle is a rhomboid cavity overlying
the pons and rostral medulla.

• Is connected to the third ventricle by the

mesencephalic cerebral aqueduct, which is
frequently involved in obstructive hydrocephalus.

• This ventricle communicates with the subarachnoid

space via the two foramina of Luschka (lateral near
the cerebellopontine angle) and the foramen of
Magendie (at the caudal midline).
 CHOROID PLEXUS
Choroid Plexus occupies all ventricles:
• The Choriod Plexus is a rich network of blood
vessels of the pia mater that projects into
each ventricle to form a semi permeable filter
between arterial blood and the CSF.

• An epithelial layer of ependyma covers the

plexus and lines the ventricles.
 CEREBRO-SPINAL FLUID (CSF)
• CSF is a clear, colorless, almost protein-free filtrate of
blood that forms in the ventricles and circulates though
the subarachnoid space.

Function of CSF
• CSF serves to support and cushion the CNS against injury.
• It may serve nutritive functions and remove metabolic
waste products.
• Its normal pressure (intracranial pressure, ICP) is 65 - 200
mm H2O (5 – 15mm Hg)
 CONTENTS OF CSF
• Produced by choroid plexus, ependyma, glia, pial and
arachnoid vessels.

• Ions are actively transported with passive movement of

water (~0.5 ml/min).

• CSF is clear and low in glucose, protein, K+, Ca++ and

cells

• Na+, Cl- , and Mg++ higher than in serum.

• It is constantly formed (approximately 600-
700 ml/day).

• The total volume in the ventricles and

subarachnoid space is about 140 ml.
 CIRCULATION OF CSF
• The brain and spinal cord effectively float within a
shock-absorbing cushion of CSF.

CSF flows through the ventriclular system:

1. From the lateral ventricles into the third ventricle via
the interventricular foramina (of Monro).
2. From the third ventricle into the cerebral aqueduct.
3. From the cerebral aqueduct into the fourth ventricle.
4. Very small amounts of CSF trickle between the fourth
ventricle and thecentral canal.
• CSF exits the fourth ventricle into the subarachnoid space
via the foramina of Luschka (lateral) and Magendie
(medial).

• Extraventricular CSF follows the subarachnoid space.

• It returns to the venous system through small

membranous villi, the arachnoid granulations, located
along the superior sagittal sinus.

• The arachnoid villi react to pressure gradients between the

subarachnoid space and venous system to form one way
valves, ensuring the unidirectional movement of fluid into
the venous system.
BRAIN SINUSES AND VEINS
 BRAIN SINUSES AND VEINS
The venous dural sinuses are epithelium-lined
spaces or channels between the two layers of
dura of the brain, and drainage of blood from
the brain is chiefly into these sinuses.

The dural sinuses do not have valves and are

usually triangular in shape.
The sinuses receive blood from three major sources:
• The cerebral veins are the major source of blood
drainage

• The short midline great cerebral vein (of Galen)

forms at the junction of the two internal cerebral
veins and drains into the straight sinus.

• The diploic veins lie between the layers of cranial

bone.
• They anastomose freely with each other and
also communicate with the meningeal veins
internally and the superficial veins externally.

• The emissary veins connect extracranial and

intracranial veins.

• The venous sinuses have little tendency to

collapse as do most other veins because of the
fibrous consistency of the dura mater.
Unpaired dural venous sinuses:
• Superior longitudinal (sagittal) sinus begins as a
continuation of the nasal vein and receives
blood from cerebral, diploic, and emissary veins.

• Inferior sagittal sinus receives blood from veins

on the medial surface of the brain.

• Straight sinus occupies the area between the

falx cerebri and Tentorium cerebelli.
• The Straight sinus is the posterior continuation
of the great cerebral vein of Galen and joins the
superior sagittal sinus to form the confluence of
sinuses.

• The small occipital sinus begins near the

foramen magnum and ascends in the attached
margin of the falx cerebelli to end in the
confluence of sinuses.

• It also receives the inferior cerebellar veins.

Paired dural venous sinuses:
• Transverse sinuses receive blood from the
confluence of sinus and drain into the internal
jugular veins via the sigmoid sinuses.

• Cavernous sinuses are located lateral to the

body of the sphenoid bone, and receive blood
from the superficial middle cerebral veins and
superior ophthalmic veins.
• They communicate with each other via intercavernous
sinuses.

• Also have communication with pterygoid plexus of veins.

• These sinuses are the largest and most clinically important of

the deep interconnecting sinuses and drain into the superior
and inferior petrosal sinuses.

• Sigmoid sinuses are a continuation of the transverse sinuses.

In their S-shaped course toward the jugular foramen, they
receive blood from the inferior cerebrum, cerebellum, and
emissary veins.
• Superior and inferior petrosal sinuses drain
from the cavernous sinuses into the transverse
sinuses and internal jugular veins, respectively.

• Sphenoparietal sinuses, having received blood

from the superficial middle cerebral veins,
extend along the crest of the lesser wing of
the sphenoid bone and drain into the
cavernous sinuses.