Загрузил Kutman Jakypbekov

Anatomy of the intracranial vessels and vascular territories - Jager

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Outline
Anatomy of Intracranial Vessels and
Vascular Territories
ECNR 2018
Intracranial ICA and its branches
Circle of Willis and variants
Cortical territories (ACA, MCA, PCA)
Perforating vessels arising form Circle of Willis
Vetebro-basilar system
UCL Institute of Neurology
Queen Square, London
Bouthillier classification of ICA
Bouthillier classification of ICA
1. cervical segment
2. petrous (horizontal) segment
1.
cervical segment
3. lacerum segment
2.
petrous (horizontal) segment
4. cavernous segment
3.
lacerum segment
4.
cavernous segment
5.
clinoid segment
6.
ophthalmic (supraclinoid) segment
7.
communicating (terminal) segment
5. clinoid segment
6. ophthalmic (supraclinoid) segment
7. communicating (terminal) segment
1 cervical
2 ascending intra-petrous
3 horizontal intra-petrous
4 ascending foramen lacerum
5 horizonantal intracavernous
6 clinoid
7 termination
Proximal Branches ICA
MHT
ILT
PCOM Infundibulum and PCOM Aneurysm
Enlarged Meningohypohyseal Trunk Meningioma
MHT branches: 1. marginal tentorial a. (Bernasconi-Casanari artery)
2. clival branches
3. inferior hypophyseal a.
Enlarged Meningohypohyseal Trunk: AVM
Anterior Choroidal Artery
DWI
ADC
FA
3D TOF MRA MPR
Circle of Willis
Thomas Willis (1621-1675)
It is not a circle but a nonagon!
Cerebri Anatome cui Accessit Nervorum Descriptivo et Usus (1664)
Common Variations of Circle of Willis
Common Variations of Circle of Willis
20%
Foetal PCA
Variations of Circle of Willis
10%
Bilateral Foetal PCA
Absent left A1 , Foetal origin PCA
Complete circle
42% of general Western population (1)
90% of Japanese population (2)
27% in Chinese population (3)
(1) Krabbe Hartkamp 1998; (2) Tanaka 2006; (3) Qi Li 2011
Basilar Artery In Presence of R Foetal PCA
Cortical Territories
10%
Absent A1
Cortical Territories
Anterior Cerebral Artery
Anterior Cerebral Artery
Anterior Cerebral Artery
A3
A3
A2
A2
A1
A1 horizontal segment
Lt ACA Infarct
A2 vertical segment
A3 callosal segment
Bilateral ACA Infarct
Middle Cerebral Artery
MCA Variations
M4
M3
M2
M1
M1 Horizontal segment
M2 Insular segment
M3 Opercular segment
M4 Cortical segment
MCA Variants
Fenestration of M1segment
Left MCA Infarct
Duplication of MCA
Left MCA Infarct
Posterior Cerebral Artery
P4
P3
P2
P1
P1 pre-communicating segment P3 Quadrigeminal segment
P2 brainstem segment
P4 Cortical segment
PCA Infarct
Posterior Cerebral Artery Infarct
T2 FSE
DWI
PCA- Splenium of Corpus Callosum
Borderzone Territories
Mangla Radiographics 2011
ACA/ MCA Borderzone
15 volunteers
Hendrikse et al Radiology 2007
Right Borderzone Infarcts
Variations in Perfusion Territories
Van der Zwan & Billen, Stroke, 1991;22:1078-1084
Van der Zwan et al., J Neurosurg, 1992;77:927-940
Territorial Arterial Spin Labeling
Normal Population: Non-variant Type COW
68 subjects
100%
0%
Hendrikse et al. Stroke 35 (2004)
Van Laar et al. Neuroimage 29:136
Normal Population
Missing A1 segment (right)
144 (2006)
Normal Population
Unilateral foetal type PCA (right)
8 subjects
100%
100%
Left
ICA
Left
ICA
Right
ICA
Right
ICA
VBA
Van Laar et al. Neuroimage 29:136
0%
144 (2006)
19 subjects
VBA
Van Laar et al. Neuroimage 29:136
0%
144 (2006)
Perforating Arteries of Circle of Willis
Textbook Perfusion Territories of the BG
Medial Perforators
(incl Heubner)
Lateral Perforators
Thalamoperforators
Thalamogeniculate
Images from The Radiology Assistant ,
http://www.radiologyassistant.nl/en/484b8328c
b6b2
Lenticular and Perforating Arteries
Lenticulostriate Arteries
Images from The Radiology Assistant ,
http://www.radiologyassistant.nl/en/484b8328c
b6b2
Lenticulostriate Territory Infarct
Recurrent Artery of Heubner
Otto Heubner 1848-1926
Artery of Percheron Aneurysm and Infarct
Thalamoperforators
AOP- artery of
Percheron
G. Percheron. 1973
Hopital de la
, Paris.
Lazzaro AJNR 2010 31: 1283-1289
Perfusion Territories of the BG
Vertebrobasilar Sytem
Non-variant Circle of Willis
Perforators
SCA
Hypoplastic L A1
Foetal R PCA
AICA
PICA
Ant Spin A.
Hendrikse et al. Radiology 254(3):867-875 (2010)
Vertebrobasilar Sytem Lateral View
Haemodynamic Balance between AICA and PICA
AICA/PICA Haemodynamic Balance
PICA dominant
AICA dominant
Duplication of R SCA
R AICA dominant
L PICA dominant
L PICA Infarct
Brainstem Perforators : Medulla
Lateral = PICA
Medial = Vertebral
Brainstem Perforators Territories
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