Basic Vascular Neuroanatomy of the Brain and Spine: What the General Interventional Radiologist Needs to Know

Abstract

This article is intended to provide a review of clinically relevant neurovascular anatomy. A solid understanding of the vascular anatomy of the brain and spine are essential for the safe and effective performance of neurointerventional radiology. Key concepts to master include collateral pathways and anastomoses between the external and internal carotid circulation, the Circle of Willis as a route to otherwise inaccessible intracranial vascular distributions, and the origin of spinal arterial blood supply. These concepts will be highlighted using clinical angiographic examples with discussion of relevant embryology and pathology as needed.

Keywords

angiography - neurointerventional radiology - neuroanatomy - interventional radiology

• References

• 1 Idowu OE, Shokunbi MT, Malomo AO, Akang EEU. Anomalies, aneurysm and histology of the middle cerebral artery in Nigerian Africans. Int J Morphol 2008; 26 (4) 1023-1027
• 2 Krishnaswamy A, Klein JP, Kapadia SR. Clinical cerebrovascular anatomy. Catheter Cardiovasc Interv 2010; 75 (4) 530-539
• 3 Yang C, Shu C, Li M, Li Q, Kopp R. Aberrant subclavian artery pathologies and Kommerell's diverticulum: a review and analysis of published endovascular/hybrid treatment options. J Endovasc Ther 2012; 19 (3) 373-382
• 4 Meila D, Tysiac M, Petersen M , et al. Origin and course of the extracranial vertebral artery: CTA findings and embryologic considerations. Clin Neuroradiol 2012; 22 (4) 327-333
• 5 Geibprasert S, Pongpech S, Armstrong D, Krings T. Dangerous extracranial-intracranial anastomoses and supply to the cranial nerves: vessels the neurointerventionalist needs to know. AJNR Am J Neuroradiol 2009; 30 (8) 1459-1468
• 6 Tubbs RS, Hansasuta A, Loukas M , et al. Branches of the petrous and cavernous segments of the internal carotid artery. Clin Anat 2007; 20 (6) 596-601
• 7 Lee N, Jung JY, Huh SK, Kim DJ, Kim DI, Kim J. Distinction between intradural and extradural aneurysms involving the paraclinoid internal carotid artery with T2-weighted three-dimensional fast spin-echo magnetic resonance imaging. J Korean Neurosurg Soc 2010; 47 (6) 437-441
• 8 Cheng MY, Lyu RK, Chang YJ , et al. Concomitant spinal cord and vertebral body infarction is highly associated with aortic pathology: a clinical and magnetic resonance imaging study. J Neurol 2009; 256 (9) 1418-1426
• 9 Biglioli P, Roberto M, Cannata A , et al. Upper and lower spinal cord blood supply: the continuity of the anterior spinal artery and the relevance of the lumbar arteries. J Thorac Cardiovasc Surg 2004; 127 (4) 1188-1192
• 10 Etz CD, Kari FA, Mueller CS , et al. The collateral network concept: a reassessment of the anatomy of spinal cord perfusion. J Thorac Cardiovasc Surg 2011; 141 (4) 1020-1028
• 11 Murakami H, Kawahara N, Tomita K, Demura S, Kato S, Yoshioka K. Does interruption of the artery of Adamkiewicz during total en bloc spondylectomy affect neurologic function?. Spine (Phila Pa 1976) 2010; 35 (22) E1187-E1192
• 12 Kato S, Kawahara N, Tomita K, Murakami H, Demura S, Fujimaki Y. Effects on spinal cord blood flow and neurologic function secondary to interruption of bilateral segmental arteries which supply the artery of Adamkiewicz: an experimental study using a dog model. Spine (Phila Pa 1976) 2008; 33 (14) 1533-1541
• 13 Ueda Y, Kawahara N, Tomita K, Kobayashi T, Murakami H, Nambu K. Influence on spinal cord blood flow and function by interruption of bilateral segmental arteries at up to three levels: experimental study in dogs. Spine (Phila Pa 1976) 2005; 30 (20) 2239-2243
• 14 Struhal W, Seifert-Held T, Lahrmann H, Fazekas F, Grisold W. Clinical core symptoms of posterior spinal artery ischemia. Eur Neurol 2011; 65 (4) 183-186