脑动脉供血分布图（收藏） / 四六文摘

Front Neurol Neurosci

仅供学习交流，转载请注明出处！

本文展示了脑干、小脑和大脑半球所在不同供血区域的图谱。这些区域被绘成应用于临床的神经影像断层切面。图谱展示了24个连续层面的模式图。脑干和小脑（第1~12部分）层厚为4mm，而大脑半球（第13~24章）层厚为8mm。

这24个部分的形状学数据来源于Duvernoy解剖图集^[1–3]。这些动脉区域图谱的绘制是基于对大脑血供的解剖结构研究的详细概述，此概述包括了血管灌注研究和脑动脉的微解剖研究，且这些方面在其它地方阐述更详尽^[4–6]。对于大脑半球，主要详细介绍三支主要脑动脉支配不同皮质区，并根据解剖研究基线定义最小和最大的皮质供应区域^[7]。本章的目的是为大脑动脉的解剖提供一个图形化的概述，更深入的研究可在其它地方查找^[8]。

脑干动脉供血区

脑干的供血动脉包括椎动脉、基底动脉、脊髓前动脉和脊髓后动脉、小脑后下动脉、小脑前下动脉、小脑上动脉、大脑后动脉和脉络膜前动脉。这些动脉根据其对实质的穿透力被分为四的组群（前内侧、前外侧、外侧、后侧），每一组都在脑干相应的动脉区域供血。动脉区域在脑干的不同水平上延伸范围不同。

延髓供血区

椎动脉和小脑后下动脉为延髓供血，并发出延髓外侧支，下方由脊髓前动脉和脊髓后动脉供血。

脑桥供血区

脑桥有不同的动脉供血，包括椎动脉，小脑前下动脉，还有延髓外侧分支、小脑上动脉及基底动脉的分支，脑桥前内侧区由基底动脉不同层次的不同动脉供血，这一点对于了解脑桥梗死综合征的临床症状至关重要。

中脑供血区

5支动脉供应中脑：小脑上动脉（主要是内侧分支），丘脑穿通动脉，脉络膜后内动脉，由大脑后动脉发出的脚间窝中间支和颈动脉系统发出的脉络膜前动脉。

小脑供血区

小脑由三支较长的小脑动脉供血，小脑后下动脉，小脑前下动脉和小脑上动脉。

小脑后下动脉起源于椎动脉，分出内侧支和外侧支，供应小脑下蚓部以及小脑半球的下部和背侧部。小脑后下动脉还形成了髓质的外侧和背后组，或通过其主干或通过其内侧分支。

小脑前下动脉通常起源于基底动脉底部的三分之一处，供应小脑半球前部、上下半月小叶以及绒球。大多数情况下，它还发出内听动脉。小脑前下动脉还供应小脑中脚和脑桥被盖下半部分。

小脑上动脉也称为前小脑动脉——分为内侧和外侧分支，并提供小脑半球和小脑蚓部的上半部分以及齿状核。小脑上动脉区域通常包括脑桥被盖上部。

大脑半球供血区

大脑半球动脉分为深穿支和皮质支。穿通动脉（或穿支动脉）起源于Willis环或其直接分支，并直接穿入脑实质。颈内动脉、脉络膜前动脉、前交通动脉、大脑前动脉、大脑中动脉、后交通动脉和大脑后动脉均发出穿支动脉。

皮质动脉（也称为软脑膜动脉）由大脑前、中、后动脉的末端分支组成，它们形成了一个在脑半球表面的吻合网络，它们的分支穿过皮层、白质和纤维。其中最深的分支形成髓质（表面穿支）并参与半卵圆中心供血。

关于大脑半球的动脉循环的几个问题仍然需要阐明，包括半卵圆中心或岛叶周围区的血管组织。

大脑动脉的分支

颈内动脉的深穿支：一部分穿支动脉起源于颈内动脉的床突段，穿过前穿质供应内囊膝部，临近的苍白球和内囊后肢。

脉络膜前动脉的分支：这些动脉的分支起源于颈内动脉的床突段，包括内囊下半部分的后2/3和晶状体部分，临近的视辐射，听辐射，内侧苍白球和尾状核尾部。

前交通动脉分深穿支：这支动脉的血管区包括终板、下丘脑、透明隔、部分前连合和穹隆、终板旁回包括中隔核以及次胼区、胼胝体前部和扣带回。

大脑前动脉的深穿支：大脑前动脉的直接分支由近端前交通段及其回返动脉发出，这些动脉供应尾状核头部、内囊前肢的前部和下部，相邻的壳核和苍白球，胼胝体和前连合内侧。

大脑中动脉的深穿支：由大脑中动脉的基底部发出的豆纹动脉，分为内侧动脉和侧动脉。这些深穿支的分支供应尾状核头部和体部，外侧苍白球，壳核，内囊背侧半部分和前连合外侧半部分。

后交通动脉的深穿支：一部分分支由后交通动脉发出，最大的分支被称为前乳头状动脉（前丘脑动脉或结节性动脉）。这些分支供应视交叉和视束的后部分，下丘脑的后部，乳头状体，前核，丘脑前核的腹侧面最前端。

丘脑穿通动脉：丘脑穿通动脉（旁正中丘脑动脉）形成脚间窝上动脉供应丘脑，包括内侧核、髓板内核、部分背内侧核、后内侧核和腹内侧髓质。

丘脑膝状体分支：丘脑膝状体动脉（或下丘脑动脉）起于靠近膝状体的大脑后动脉，并参与周围动脉吻合网络，供应尾状丘脑外侧侧部分的主要部分，包括髓腔的横侧部分，外侧核和侧背核的后侧部分，以及腹侧后侧外侧核。

脉络膜后动脉分支：脉络膜后动脉起于大脑后动脉的前脑区，包括一个内侧和几个后外侧脉络膜动脉。内侧脉络膜后动脉供应内侧膝状体，以及内侧核和丘脑枕。后外侧脉络膜后动脉供应部分外侧膝状体，部分丘脑背内侧核和部分丘脑。

大脑动脉的皮质支

前脑皮层支：也称胼周动脉，它产生了皮质支和胼胝体缘动脉，供应胼胝体嘴，膝部，体部。大多数情况下，皮质支供应大脑半球内侧面的皮质区域并延伸至额上沟沟和顶枕沟；在眶额面的动脉区域则包括内侧眶回；皮质前动脉延伸至额下沟，仅包括额叶前部。

大脑中动脉皮质支：这些皮层支分布在大脑半球侧面，并延伸到额上沟、顶内沟和颞下回；在眶额面上，动脉的区域包括外侧眶回；最大面积覆盖了整个半球外侧面，到达了纵裂池，最小区域限于额前和颞上沟之间的区域。

大脑后动脉皮质支：这些分支包括海马体动脉和胼胝体动脉，与胼周动脉的远端吻合，供应胼胝体。这些最常见的皮质分布包括颞叶中下部和延伸至顶枕沟的枕叶，最大的区域可以延伸到颞上沟和前中央沟的上部，最小面积只延伸到枕叶的内侧面，止于枕裂。

脉络膜前动脉皮质支：脉络膜前动脉皮质支区域包括钩回，海马头部，杏仁核和外侧膝状体。

原文：

Abstract

We present a brain map of the areas supplied by various arteries in the brainstem, cerebellum and cerebral hemispheres. Arterial territories are depicted in a form that is directly applicable to neuroimaging slices in clinical practice. The arterial territories are outlined based on an extensive overview of anatomical studies of cerebral blood supply. For arterial territories of the hemispheres, we present the variability of the cortical territories of the three main cerebral arteries and define the minimal and maximal cortical supply areas. Copyright © 2012 S. Karger AG, Basel

In this chapter, we present a brain map of the areas supplied by various arteries in the brainstem, cerebellum and cerebral hemispheres. Arterial territories are depicted in a form that is directly applicable to neuroimaging slices in clinical practice. The map is presented on a series of 24 templates, based on a bicommissural plane passing through the center of the anterior and posterior commissures. The sections of the brainstem and cerebellum (sections I–XII) are 4 mm thick, whereas those of the cerebral hemispheres (sections XIII–XXIV) are 8 mm thick. The anatomical structures are shown on the right side of the sections and the arterial territories appear on the left.

Morphological data for the 24 sections are based on anatomical atlases by Duvernoy [1–3]. The arterial territories are outlined based on an extensive overview of anatomical studies of cerebral blood supply. This overview included either vascular injection studies or microanatomic studies of the cerebral arteries, and is developed in more detail elsewhere [4–6]. For arterial territories of the hemispheres, we have chosen to explain in detail the variability of the cortical territories of the three main cerebral arteries and to define the minimal and maximal cortical supply areas with reference to a baseline anatomical study [7].

This chapter is intended to provide a graphical overview of the anatomy of the cerebral arteries. A more detailed approach can be found elsewhere [8].

Arterial Supply of the Brainstem

Arterial trunks supplying the brainstem include the vertebral artery, basilar artery, anterior and posterior spinal arteries, posterior inferior cerebellar artery, anterior inferior cerebellar artery, superior cerebellar artery, posterior cerebral artery, and anterior choroidal artery. The collaterals of these arteries are divided into four arterial groups (anteromedial, anterolateral, lateral and posterior) according to their point of penetration into the parenchyma. Each of these groups supplies the corresponding arterial territories in the brainstem. The arterial territories have a variable extension at different levels of the brainstem.

Arterial Groups Supplying the Medulla

The medulla is supplied by the vertebral arteries and the posterior inferior cerebellar artery, which give rise to the rami of the lateral medullary fossa, and by the anterior and posterior spinal arteries.

Arterial Groups Supplying the Pons

Different arterial trunks supply blood to the pons including the vertebral artery, the anterior inferior cerebellar artery, from which arise the rami of the lateral medullary fossa, the superior cerebellar artery and the basilar artery. The anteromedial pontine territory is supplied by distinct arterial sources arising from different levels of the basilar artery. These sources include foramen coecum arteries, pontine arteries and inferior rami arising from the interpeduncular fossa arteries. This point is crucial to understanding the clinical signs of alternate pontine infarction syndromes. The posterior territory only exists in the upper part of the pons.

Arterial Groups Supplying the Midbrain

Five arterial trunks supply the midbrain: the superior cerebellar artery (mainly the medial branch), the collicular artery, the posteromedial choroidal artery, the middle rami of the interpeduncular arteries arising from the posterior cerebral arterand the anterior choroidal artery arising from the carotid system.

Arterial Supply of the Cerebellum

The cerebellum is supplied by the three long cerebellar arteries: posterior inferior cerebellar artery, anterior inferior cerebellar artery and superior cerebellar artery.

The posterior inferior cerebellar artery originates from the vertebral artery. It gives off medial and lateral branches and supplies the inferior vermis as well as the inferior and posterior surfaces of the cerebellar hemispheres. The posterior inferior cerebellar artery also forms part of the lateral and posterior groups of the medulla, either via its common stem or its medial branch.

The anterior inferior cerebellar artery usually arises from the bottom third of the basilar artery and supplies the anterior surface of the simple, superior and inferior semilunar lobules as well as the flocculus. In most cases, it gives rise to the internal auditory artery.The anterior inferior cerebellar artery contributes to the supply of the middle cerebellar peduncle and often the lower part of the pontine tegmentum.

The superior cerebellar artery – also known as the anterior superior cerebellar artery – divides into medial and lateral branches and supplies the superior half of the cerebellar hemisphere and vermis as well as the dentate nucleus. The superior cerebellar artery territory often includes the upper part of the pontine tegmentum.

Arterial Supply of Cerebral Hemispheres

The cerebral arteries are divided into perforating and cortical arteries. The perforating arteries (or deep perforating arteries) arise from the arterial circle of Willis or from its immediate branches and directly penetrate the brain parenchyma. The internal carotid artery, anterior choroidal artery, anterior communicating artery, anterior cerebral artery, middle cerebral artery, posterior communicating artery and posterior cerebral artery all give rise to perforating arteries.

The cortical arteries (also known as leptomeningeal, superficial or pial) consist of the terminal branches of the anterior, middle and posterior cerebral arteries, which form an anastomotic network on the surface of the hemispheres. Their branches penetrate the cortex, subjacent white matter and U-fibers. The deepest of these branches form the medullary (or superficial perforating) arteries and participate in centrum ovale vascularization.

Several points relating to the arterial circulation of the cerebral hemispheres still need to be elucidated including the vascular organization of the centrum ovale or the peri-insular region.

Perforating Branches of the Cerebral Arteries

Perforating Branches of the Internal Carotid Artery

Some perforating arteries arise from the supraclinoid portion of the internal carotid artery, pass through the anterior perforated substance to supply the genu of the internal capsule, the adjacent part of the globus pallidus and the contiguous posterior limb of the internal capsule.

Perforating Branches of the Anterior Choroidal Artery

The perforating territory of this artery, arising from the supraclinoid portion of the internal carotid artery, includes the lower part of the two posterior thirds and the retrolenticular part of the internal capsule, the adjacent optic radiations and acoustic radiations, the medial globus pallidus and the tail of the caudate nucleus.

Perforating Branches of the Anterior Communicating Artery

The vascular territory of this artery includes the lamina terminalis, the anterior hypothalamus,the septum pellucidum, part of the anterior commissure and of the fornix, the paraterminal gyrus including the septal nuclei and occasio nally the subcallosal region, the anterior part of the corpus callosum and the cingulate gyrus.

Perforating Branches of the Anterior Cerebral Artery

The direct perforators of the anterior cerebral artery usually arise from the proximal pre- communicating segment, and the recurrent artery of Heubner from the proximal post- communicating segment. These arteries supply the anterior and inferior part of the head of the caudate nucleus, the anterior and inferior portions of the anterior limb of the internal capsule, the adjacent part of the putamen and globus pallidus, the caudal rectus gyrus, the subcallosal gyrus and the medial part of the anterior commissure.

Perforating Arteries of the Middle Cerebral Artery

These are the lenticulostriate arteries arising from the basal segment of the middle cerebral artery. They are usually classified into two groups: the medial and the lateral arteries. These perforating branches supply the superior part of the head and the body of the caudate nucleus, the lateral segment of the globus pallidus, the putamen, the dorsal half of the internal capsule and the lateral half of the anterior commissure.

Perforating Branches of the Posterior Communicating Artery

Some branches arise from the posterior communicating artery. The largest branch is termed the premamillary artery (anterior thalamoperforating artery or tuberothalamic artery). These branches supply the posterior portion of the optic chiasm and optic tract, the posterior part of the hypothalamus, the mamillary body, the nucleus anterior and the polar part of the nucleus ventralis anterior of the thalamus.

Thalamoperforating Branches

The thalamoperforating arteries (or paramedian thalamic arteries) form the superior rami of the interpeduncular arteries and contribute to the supply of the thalamus. They supply the medial nuclei, the intralaminar nuclei, part of the dorsomedial nucleus, the posteromedial portion of the lateral nuclei and the ventromedial pulvinar.

Thalamogeniculate Branches

The thalamogeniculate arteries (or inferolateral thalamic arteries) usually arise from the posterior cerebral artery segment in proximity to the geniculate bodies and take part in the surrounding arterial anastomotic network. They supply a major part of the lateral side of the caudal thalamus including the rostrolateral part of the pulvinar, the posterior part of the lateral nuclei and lateral dorsal nucleus, and the ventral posterior and ventral lateral nuclei.

Perforating Branches of the Posterior Choroidal Arteries

The posterior choroidal group usually arises from perimesencephalic segments of the posterior cerebral artery and includes one medial and several lateral posterior choroidal arteries. The medial posterior choroidal artery supplies the medial geniculate body, as well as the posterior part of the medial nucleus and of the pulvinar. The lateral posterior choroidal artery supplies part of the lateral geniculate body, part of the thalamic dorsomedial nucleus and part of the pulvinar.

Cortical Branches of the Cerebral Arteries

Cortical Branches of the Anterior Cerebral Artery

These branches arise from the distal segment of the anterior cerebral artery, also called the pericallosal artery, which gives rise to cortical and callosal branches. The callosal branches supply the rostrum, genu and body of the corpus callosum. In most cases, the cortical branches supply the cortical area of the medial surface of the hemisphere extending to the superior frontal sulcus and the parieto- occipital sulcus. On the orbitofrontal surface, the arterial territory includes the medial orbital gyri. At most the cortical anterior cerebral artery territory reaches the inferior frontal sulcus and at least, it includes only the anterior part of the frontal lobe.

Cortical Branches of the Middle Cerebral Artery

These cortical branches most commonly distribute to the area on the lateral surface of the hemisphere that extends to the superior frontal sulcus, the intraparietal sulcus and the inferior temporal gyrus. On the orbitofrontal surface, the arterial territory includes the lateral orbital gyri. The maximum area covers the whole lateral surface of the hemisphere, reaching the interhemispheric fissure and the minimum area is confined to the territory between the inferior frontal and the superior temporal sulci.

Cortical Branches of the Posterior Cerebral Artery

These branches include the hippocampal arteries and the splenial artery which anastomose with the distal part of the pericallosal artery to supply the splenium of the corpus callosum. The most common cortical distribution of these arteries includes the inferomedial surfaces of the temporal and the occipital lobes extending to the parieto- occipital fissure. The maximum area can extend as far as the superior temporal sulcus and the upper part of the precentral sulcus, and the minimum area extends only as far as the medial face of the occipital lobe limited by the parieto- occipital fissure.

Cortical Branches of the Anterior Choroidal Artery

The cortical territory of the anterior choroidal artery includes part of the uncus, part of the head of the hippocampus, part of the amygdaloid nucleus and the lateral part of the lateral geniculate body.

《完》

您可能感兴趣的文章：

1.中枢神经系统瘤样脱髓鞘病变影像学特征

2.“内囊预警综合征”发病机制及治疗相关研究

10.认识眼震性质是识别眩晕疾病的重要方式