Vessels of brain and spinal cord

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Vessels of brain and spinal cord

MUDr. Veronika Němcová, CSc.

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Falx cerebri overbridging vein

periosteum SSS arachnoid granulations

dura mater

subdural space

arachnoid subarachnoid space

pia mater overbridging

vein

(6)

Obaly míchy

Spinal cord - meninges

Endorhachis

Cavitas epiduralis – žilní pleteně Dura mater spinalis

Cavum subdurale

Arachnoidea – lig. denticulatum Cavitas subarachnoidalis

Pia mater spinals

(7)

Spinal cord

meninges

Denticulate

ligament

(8)

Vertebrobasilar system

(9)

Cévy cieculus

Brain arteries Willis circuit

• Communication between vertebral and a. carotis interna systems

• Anterior and posterior communicating arteries allow blood to flow

between both systems (PCA) or between right and left vessels (ACA)

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CT – AG, 3-D

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Basal ganglia supplying

arterie lenticulostriaticae

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Cerebral arterial territories

a.cerebri anterior

a.cerebri media

a. cerebri posterior

a. choroidea anterior

a.cerebellaris superior

a.cerebellaris inferior posterior a.cerebellaris inferior anterior

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Circulus arteriosus

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Circulus arteriosus Willisi –aneurysmas

1

3

5 6 2

4 8

7A. cerebelli sup.

9 A. cerebelli inf. ant.

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Aneurysmata lokalization

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Aneurysma - treatment

Endovascular occlussion Clip

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Aneurysma – stent, recoiling

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Intravascular coiling

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• : Transaxial CT scan of the brain. Knife entering the superolateral aspect of the left nasal cavity (blue arrow).

45-year-old patient walking around the ER complaining of a

headache

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• Transaxial CT scan of the brain. Knife traversing the midline (blue arrow)

Injured petrous internal carotid with proximal

occlusion and clot from stab wound

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Transaxial CT scan of the

brain. Knife traverses the carotid canal with tip at the level of the internal auditory canal (blue arrow

Transaxial CT scan of the

brain. Postoperative pneumocephalus (yellow arrow) and posttraumatic

infarction in the distribution of the right middle cerebral artery (green

arrow). Knife has been removed

(27)

Angiogram of the right internal carotid artery in an oblique projection. Knife tip in close proximity to the right internal carotid artery with little flow seen intracranially (blue

arrow). Spasm noted at the catheter tip in the internal carotid artery (yellow arrow).

Angiogram of the right internal carotid artery in an AP

projection. The knife traverses the midline with the knife tip in the right carotid canal.

(28)

A-V malformation

peroperative

(29)

Cranial nerve origins and arteries on the ventral part of the

brainstem

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MRI – angoigraphy sagittal section

1 - a.carotis interna 2 - a.vertebralis 3 - sinus cavernosus 4 - canalis caroticus 5 - a.cerebri anterior 6 - a.cerebri posterior

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Thomas Willis

(1621–1675)

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The home of Thomas Willis from 1657 to 1667

.

Oxford, Beam Hall

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Thomas Willis

• Neuroanatomical terms coined by Willis

• Pathologies recognized by Willis

• Achalasia of the cardia (achalasia of the oesophagus) | Akathisia (restless legs syndrome, Ekbom's syndrome) | Symptoms of

myasthenia gravis | Paracusis Willisii. Occurs in deaf patients whose hearing improves in the presence of noise, indicating osteosclerosis

| Diabetes mellitus | Abnormalities of the brains of patients with congenital mental retardation | Unilateral degeneration of the

cerebral peduncle in a case of long-standing unilateral paralysis | Symptoms of malaria | Distinctions between typhoid and puerperal fevers

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Cisternae

subarachnoidales

cerebellomedularis

Cisterna fossae lateralis cerebri Cisterna pontis

Cisterna laminae quadrigeminae Cisterna corporis callosi

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Granulationes arachnoidales

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5 Vena anastomotica sup.

(Trolard)

6 Vena anastomotica post.

(Labbé)

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Brain veins - % of thrombosis

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Trombosis of sinus sagittalis

superior

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Trombosis of superior cerebral

veins

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Labbé

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superior sagittal sinus

internal cerebral veins

vein of Labbé

sphenoparietal sinus

Cerebral Venous territories

„rough guide“

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1. Epidural hemorhage

2. Subdural hemorhage

3. Subarachnoidal hemorhage

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Epi

Subd

Subar

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Spinal cord arteries

Yoshioka K et al. Radiographics 2003;23:1215-1225

Artery of Adamkiewicz (a. radicularis magna) from the a. intercostalis post.

at the level Th9–L1

a. iliolumbalis

lumbal artereries

aa. sacralis lateralis vertebral art.

(50)

Longitudinal system

Segmental (radicular) system

(51)

Spinal cord -arteries

vasocoronae

5 longitudinal truncs

r. spinalis

a. spinalis anterior

aa. spinales posteriores

(52)

Vertebral veins

(53)

basivertebral veins

basivertebral vein

Anterior external vertebral venous plexus Internal

vertebral venous plexus Posterior

external vertebral venous plexus

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no valves

anastomoses spreading of infection and cancer

Vertebral veins

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Illustration of intradural-extradural venous anastomosis. Daniels after Netter.

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Vertebral venous plexuses

• no valves, a lot of anastomoses

• anastamoses with venous plexus around sacrum and pelvis

• 1) in the vertebral canal in the epidural space (plexus venosi vertebrales interni)

• 2) outside the spine (plexus venosi vertebrales externi)

• 3) in the bodies of vertebrae (venae basivertebrales)

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Liquor cerebrospinalis

Produced by the choroid plexus

Ventricles and subarachnoid space 140 ml

Physical support of the brain (floats within the fluid) Channel for chemical communication within the CNS

(neurons- fluid- walls of ventricles – neurons)

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Liquor circulation

MRI

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Dural sheaths

Kořenové pochvy

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Dural sheaths

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CEREBRAL VENTRICLES

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Choroidal plexus – lateral ventricles, 3rd ventricle, 4th ventricle

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Absorbtion of liquor

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MRI – T2

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Cornu frontale ventriculi lateralis

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Pars centralis a cornu temporale

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III. ventricle

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cirkumventrikular organs

eminentia mediana area postrema

organum subfornicale eminentia mediana neurohypophysis corpus pineale

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60-year woman with worsening cognitive

impairment and gait disturbance

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Substantial enlargement of the 3rd, 4th, and lateral ventricles.

Relative normal appearance of sulci for age.

No evidence of substantial vascular pathology.

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• Classical clinical triad of dementia, gait disturbance, and urinary incontinence is seen with normal pressure hydrocephalus.

• Symptoms result from distortion of white matter by distended ventricles.

• Patients commonly have a history of prior SAH or meningeal infection.

• Gradient between ventricular system and subarachnoid space due to incomplete subarachnoid block.

• Radiographic key: Diffuse ventriculomegaly out of proportion to sulcal prominence.

• Not a radiographic diagnosis. Diagnosis made by improvement of symptoms after shunting.

• Radioisotope cisternogram shows early entry into the lateral ventricles with persistence at 24-48 hours and delayed ascent to parasagittal regions.

• Flow void can be seen through the aqueduct of Sylvius on MR due to increased flow velocity

Vessels of brain and spinal cord