VASCULATURE OF THE CNS

Describe the general aspects of the vascular supply to the brain.

Vascular supply is from two sources: the paired

internal carotid arteries and the paired vertebral
arteries.
The internal carotid and vertebral arteries are joined
at the ventral aspect of the brain by the cerebral
arterial circle (circle of Willis).

Haines, Fundamental Neuroscience Churchill Livingston/Elsevier

VASCULATURE OF THE CNS

Describe the vertebral arteries, their branches, and the structures they
vascularize.

Branch from the subclavian arteries.

Course through the transverse foramen's
of the upper six cervical vertebrae (do
not course through the seventh).
Course through the foramen magnum
and pierces the dura mater and
arachnoid mater to lie on the sides of the
medulla.
Give off branches and then fuse to form
the basilar artery.
Vertebral artery branches:
Posterior inferior cerebellar arteries
which usually give off the posterior spinal
arteries:
The posterior inferior cerebellar arteries
provide vascular supply to the inferior
surface of the cerebellum (largest vascular
supply to the cerebellum) and part of the
medulla. The posterior spinal arteries
vascularize part of the spinal cord.

Anterior spinal arteries:

Vascularize part of the spinal cord and part

of the medulla.

Medullary arteries:

Vascularize part of the medulla.

VASCULATURE OF THE CNS

Describe the formation, branches, and structures vascularized by the basilar

artery

Formed by the fusion of

the vertebral arteries.
Courses on the anterior
or ventral (basilar)
surface of the pons.
Gives off branches and
then divides into
posterior cerebral
arteries.
Basilar artery branches:
Anterior inferior
cerebellar arteries:
Vascular supply to the
inferior surface of the
cerebellum and part of
the medulla.

Pontine arteries:
Vascular supply to the
pons.
Haines, Fundamental Neuroscience Churchill Livingston/Elsevier

VASCULATURE OF THE CNS

Describe the formation, branches, and structures vascularized by the basilar

artery

Basilar artery
branches:

Superior cerebellar
arteries:
Vascular supply
to the superior
surface of the
cerebellum and
part of the
midbrain.

Posterior cerebral
arteries:
Vascular supply
to the inferior
surface of
temporal lobe;
inferior, medial,
posterior, and
lateral surfaces
of the occipital
lobe; and part of
the midbrain.
Haines, Fundamental Neuroscience Churchill Livingston/Elsevier

VASCULATURE OF THE CNS

Describe the internal carotid arteries, their branches, and the structures
they vascularize.
They branch off the common carotid arteries and ascend in the superior
portion of the neck (cervical portion).
Course through the carotid canals (petrous portion), through the
cavernous sinus (cavernous portion), then pierce the dura mater and
enters the middle cranial fossa adjacent to the sella turcica (intracranial
portion.
They then divide into middle cerebral and anterior cerebral arteries.

Haines, Fundamental Neuroscience Churchill Livingston/Elsevier

Sobotta:Anatomy.Elsevier GmbH Germany

VASCULATURE OF THE CNS

Describe the internal carotid arteries, their branches, and the structures they
vascularize.

Internal carotid artery branches:

Posterior communicating arteries:

Provide an anastomotic connection between the internal carotid and the

posterior cerebral arteries.

Middle cerebral arteries:

Vascular supply to the lateral surface of the frontal, parietal, temporal, and
occipital lobes.

Anterior cerebral arteries:

Vascular supply to the medial and superior surfaces of the frontal and
parietal lobes. The anterior cerebral arteries are joined by the anterior
communicating artery.

VASCULATURE OF THE CNS

Describe the cerebral arterial circle or Circle of Willis.

Cerebral arterial circle

or Circle of Willis:
It joins the internal
carotid and vertebral
arteries together,
forming a major
anastomotic connection
between them.
It consists of:
Anterior communicating
arteries
Anterior cerebral
arteries
Internal carotid arteries
Posterior
communicating arteries
Posterior cerebral
arteries
Basilar artery
Sobotta:Anatomy.Elsevier GmbH Germany

VASCULATURE OF THE CNS

Describe the border zones and watershed infarcts.

The areas
vascularized by the
anterior, middle, and
posterior cerebral
arteries overlap on
the lateral surface of
the cerebral
hemispheres forming
border zones. Brain
tissue in the border
zones is more
susceptible to
watershed infarcts as
a result of inadequate
perfusion (systemic
hypotension).

Haines, Fundamental Neuroscience Churchill Livingston/Elsevier

VENOUS DRAINAGE OF THE BRAIN

Describe the general aspects of the venous drainage of the brain.

The venous drainage of the

brain consists of the
superficial (external)
cerebral veins on the
lateral, medial, and inferior
surface of the brain, the
deep (internal) cerebral
veins from within the
brain, the dural venous
sinuses, and the internal
jugular veins.
Cerebral veins and dural
venous sinuses do not have
valves and do not have
smooth muscle in their
walls.

VASCULATURE OF THE CNS

Describe the superficial cerebral and deep cerebral veins.

Superficial cerebral veins:

They are located in the

subarachnoid space
throughout most of their
course.
Drain primarily into the
superior sagittal sinus,
transverse sinuses, and
straight sinus either
directly or by way of the
basal veins, superior
anastomotic vein (of
Trolard), inferior
anastomotic vein (of
Labbe), and the superficial
middle cerebral veins.

Deep cerebral veins:

Drain into the Great Vein of

Galen (great cerebral vein)
which flows into the
straight sinus.

Haines, Fundamental Neuroscience Churchill Livingston/Elsevier

VASCULATURE OF THE CNS

Describe the dural venous sinuses.

Formed by a split in the dura mater or a

separation between the dura and the
periosteum.
Superior sagittal sinus:
Located in the dura above the falx cerebri.
Flows from anterior to posterior into the
confluence of sinuses and then into the
right transverse sinus.

Inferior sagittal sinus:

Straight sinus:

Confluence of sinuses:

Located in the free edge of the falx cerebri.

Flows from anterior to posterior into the
straight sinus.
Located in the attachment of the falx
cerebri to the tentorium cerebelli:
Receives the inferior sagittal sinus and
great cerebral vein and flows into the left
transverse sinus.
Located at the internal occipital
protuberance and is the dilated posterior
portion of the superior sagittal sinus.
Flows primarily into the right transverse
sinus but there is a communication with
the left transverse sinus.

VASCULATURE OF THE CNS

Describe the dural venous sinuses.

Transverse sinuses:

Located in the margin of the

tentorium cerebelli that is
attached to the cranial bones.
Flow into the sigmoid sinuses.

Sigmoid sinuses:

Leave the tentorium cerebelli and

flow into the internal jugular vein
(jugular foramen).

Cavernous sinuses:

Located on either side of the sella

turcica, flows into the superior
and inferior petrosal sinuses.

Superior and inferior petrosal

sinuses:
Flow into the transverse and
sigmoid sinuses respectively.

Clinical note: The dural sinuses

communicate with the veins outside
the cranium (scalp) via emissary
veins and diploic veins.

VASCULATURE OF THE CNS

Describe the anterior and posterior spinal arteries and their contribution to
the vascular supply to the spinal cord.

The majority of the vasculature

supply is provided by the anterior
spinal artery and posterior spinal
arteries.
The anterior spinal arteries branch
from the vertebral arteries and
fuse to form a single anterior
spinal artery which courses on the
anterior median sulcus. They
vascularize the anterior white
column, the central portion of the
lateral white column, and most of
the gray matter except for the tips
of the posterior horns.
The posterior spinal arteries
commonly branch from the
posterior inferior cerebellar
arteries and then course on the
posterior columns. They
vascularize the posterior white
columns, the tips of the dorsal
horn, and peripheral portion of the
lateral columns.

Haines, Fundamental Neuroscience Churchill Livingston/Elsevier

VASCULATURE OF THE CNS

Describe the spinal medullary arteries and their contribution to the

vascular supply to the spinal cord.

The vasculature supply

from the spinal arteries is
supplemented by anterior
and posterior spinal
medullary arteries that
arise from segmental
arteries (intercostals,
lumbar, etc,). The spinal
medullary arteries also
give rise to anterior and
posterior radicular arteries
that vascularize the dorsal
and ventral roots.
The artery of Adamkiewicz
is a major spinal medullary
artery usually found at the
level of L2 on the left side.

Haines, Fundamental Neuroscience Churchill Livingston/Elsevier

VASCULATURE OF THE CNS

Describe the spinal medullary arteries and their contribution to the vascular
supply to the spinal cord.

VASCULATURE OF THE CNS

Describe the venous drainage of the spinal cord.

The white and gray

mater of the spinal
cord drains via
medullary veins into
the anterior median,
posterior median, and
posterior intermediate
spinal veins.
The spinal veins drain
into anterior and
posterior spinal
medullary and anterior
and posterior radicular
veins.
The spinal medullary
and radicular veins
drain into segmental
veins.

VASCULATURE OF THE CNS

Describe the internal and external vertebral venous plexuses.

There is an internal vertebral

venous plexus (epidural
venous plexus) within the
vertebral canal outside of the
dura mater and a external
vertebral venous plexus
around the vertebral bodies.
Both of these plexuses drain
into the segmental veins.
The internal and external
venous plexuses do not have
valves and are capable of
reverse flow which is
important in metastases from
the liver, kidney, and lung to
the vertebrae and CNS.

Haines, Fundamental Neuroscience Churchill Livingston/Elsevier