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Review
. 2024 Jun;46(6):829-842.
doi: 10.1007/s00276-024-03359-0. Epub 2024 Apr 17.

A primer to vascular anatomy of the brain: an overview on anterior compartment

Diego Morales-Roccuzzo  1 , Mohammadmahdi Sabahi  2 , Michal Obrzut  2 , Edinson Najera  2 , David Monterroso-Cohen  2 , Shadi Bsat  2 , Badih Adada  2 , Hamid Borghei-Razavi  2
Affiliations
Review

A primer to vascular anatomy of the brain: an overview on anterior compartment

Diego Morales-Roccuzzo et al. Surg Radiol Anat. 2024 Jun.

Abstract

Purpose: Knowledge of neurovascular anatomy is vital for neurosurgeons, neurologists, neuro-radiologists and anatomy students, amongst others, to fully comprehend the brain's anatomy with utmost depth. This paper aims to enhance the foundational knowledge of novice physicians in this area.

Method: A comprehensive literature review was carried out by searching the PubMed and Google Scholar databases using primary keywords related to brain vasculature, without date restrictions. The identified literature was meticulously examined and scrutinized. In the process of screening pertinent papers, further articles and book chapters were obtained through analysis and additional assessing of the reference lists. Additionally, four formalin-fixed, color latex-injected cadaveric specimens preserved in 70% ethanol solution were dissected under surgical microscope (Leica Microsystems Inc, 1700 Leider Ln, Buffalo Grove, IL 60089 USA). Using microneurosurgical as well as standard instruments, and a high-speed surgical drill (Stryker Instruments 1941 Stryker Way Portage, MI 49002 USA). Ulterior anatomical dissection was documented in microscopic images.

Results: Encephalic circulation functions as a complex network of intertwined vessels. The Internal Carotid Arteries (ICAs) and the Vertebral Arteries (VAs), form the anterior and posterior arterial circulations, respectively. This work provides a detailed exploration of the neurovascular anatomy of the anterior circulation and its key structures, such as the Anterior Cerebral Artery (ACA) and the Middle Cerebral Artery (MCA). Embryology is also briefly covered, offering insights into the early development of the vascular structures of the central nervous system. Cerebral venous system was detailed, highlighting the major veins and tributaries involved in the drainage of blood from the intracranial compartment, with a focus on the role of the Internal Jugular Veins (IJVs) as the primary, although not exclusive, deoxygenated blood outflow pathway.

Conclusion: This work serves as initial guide, providing essential knowledge on neurovascular anatomy, hoping to reduce the initial impact when tackling the subject, albeit the intricate vasculature of the brain will necessitate further efforts to be conquered, that being crucial for neurosurgical and neurology related practice and clinical decision-making.

Keywords: Anterior cerebral artery; Internal carotid artery; Middle cerebral artery; Neurovascular anatomy; Vascular compendium.

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Conflict of interest statement

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Figures

Fig. 1
Fig. 1
3D reconstruction of a cerebral angiogram from left Internal Carotid Artery, which depicts its segmentation (Bouthillier’s classification) and unveils an incidental aneurysm of C6 segment. ACA anterior cerebral artery, MCA middle cerebral artery
Fig. 2
Fig. 2
Posterior view of the Circle of Willis’ anterior half. Acom ACommA, anterior communicating artery, AChoA anterior choroidal artery, LICA left ICA, MCA middle cerebral artery, PCA posterior cerebral artery, PCP posterior clinoid process, RAH recurrent artery of Heubner, RICA right ICA
Fig. 3
Fig. 3
Terminal ICA bifurcation into A1 and M1, deep in the carotid cistern. It is shown the utilized direction of dissection of the Silvian Cistern's arachnoid
Fig. 4
Fig. 4
Schematically illustrated territories and deep brain structures supplied by the anterior choroidal artery and the main blood supply territories and structures nurtured by perforating arteries arising from A1 and M1. Recurrent Artery of Heubner not depicted, although crucial for midline supply of Central Core structures. SN substantia nigra, RN red nucleus, LGB lateral geniculate body
Fig. 5
Fig. 5
In situ anatomy of the Anterior Cerebral Artery with its segments. Worth noting, an ealy Supracallosal artery is observered supplying the cingulum, whilst the remaining main segments of the ACA continue their path above the corpus callosum. Some of the main neural structures have been carefully depicted for educational purposes, including the divisions of the cerebral peduncles (Cortico-spinal, Cortico-bulbar, Cortico-pontine, Parieto-occipito-temporo-pontine, and Fronto-pontine projections). FPA fronto-polar artery, CMA callosal-marginal artery, SCA supracallosal artery
Fig. 6
Fig. 6
Anterior Cerebral Artery Segmentation
Fig. 7
Fig. 7
Bifurcation of Middle Cerebral Artery into superior and inferior trunks
Fig. 8
Fig. 8
Middle Cerebral Artery Segmentation
Fig. 9
Fig. 9
A view of cortical branches of Middle Cerebral Artery, especially opercular branches, and the Superficial Middle Cerebral Vein receiving drainage from Vein of Labbé. Shown is the segmentation according to stem artery territories, as discussed in the text
Fig. 10
Fig. 10
Deep structures of the Central Core, Corpus Callosum and Brainstem from a lateral view, many of which are supplied anteriorly by perforators arising from A1, ACommA and M1, through the anterior perforated substance. White matter dissection was conducted in order to demonstrate the projection of nervous fibers
Fig. 11
Fig. 11
Surgical view of main neurovascular structures through a right Fronto-Temporal approach
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References

    1. Baldoncini M, Campero A, Perez Cruz JC, Recalde R, Parraga R, Sanchez Gonzalez FJ, et al. Microsurgical anatomy and approaches to the cerebral central core. World Neurosurg. 2019;129:e23–e34. doi: 10.1016/j.wneu.2019.04.139. - DOI - PubMed
    1. Benson JC, Shahid A, Larson A, Brinjikji W, Nasr D, Saba L, et al. Carotid artery tortuosity and internal carotid artery plaque composition. Clin Neuroradiol. 2023 doi: 10.1007/s00062-023-01302-1. - DOI - PubMed
    1. Bouthillier A, van Loveren HR, Keller JT. Segments of the internal carotid artery: a new classification. Neurosurg. 1996;38:425–432. doi: 10.1097/00006123-199603000-00001. - DOI - PubMed
    1. Campero A, Ajler P (2019) Neuroanatomía quirúrgica: Ediciones Journal,
    1. Chung BS, Ahn YH, Park JS. Ten triangles around cavernous sinus for surgical approach, described by schematic diagram and three dimensional models with the sectioned images. J Korean Med Sci. 2016;31:1455–1463. doi: 10.3346/jkms.2016.31.9.1455. - DOI - PMC - PubMed

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