Yun Peng Huang

Radiologic anatomy of the brain

1. Cerebral Hemisphere.- 1. Fissures and Sulci (G. S.).- I. Anatomic Study of the Fissures and Sulci of the External Surface of the Cerebral Hemisphere.- 1. Principal or Interlobar Fissures.- 2. Sulci of the External Surface.- a) Sulci of the Frontal Lobe.- b) Sulci of the Parietal Lobe.- c) Sulci of the Occipital Lobe.- d) Sulci of the Temporal Lobe.- II. Anatomic Study of the Fissures and Sulci of the Internal Surface of the Cerebral Hemisphere.- 1. Fissures of the Internal Surface.- 2. Sulci of the Internal Surface.- III. Anatomic Study of the Fissures and Sulci of the Inferior Surface of the Cerebral Hemisphere.- 1. Fissure of the Inferior Surface-Sylvian Fissure.- 2. Sulci of the Inferior Surface.- a) Sulci of the Orbital Surface of the Frontal Lobe.- b) Sulci of the Inferior Surface of the Temporal and Occipital Lobes.- IV. Radiologic Study of Fissures and Sulci.- 2. Lateral Ventricles (G. S.).- I. Anatomic Study of the Lateral Ventricles.- 1. Frontal Horn of the Lateral Ventricle.- 2. Body of the Lateral Ventricle.- 3. Atrium of the Lateral Ventricle.- 4. Occipital Horn of the Lateral Ventricle.- 5. Temporal Horn of the Lateral Ventricle.- II. Radiologic Study of the Lateral Ventricles.- 1. Frontal Horn of the Lateral Ventricle.- 2. Body of the Lateral Ventricle.- 3. Atrium of the Lateral Ventricle.- 4. Occipital Horn of the Lateral Ventricle.- 5. Temporal Horn of the Lateral Ventricle.- 3. Cortical Arteries (G. S.).- A. Anterior Cerebral Artery.- I. Anatomic Study of the Anterior Cerebral Artery.- Branches of the Anterior Cerebral Artery.- a) Branch to the Orbital Surface of the Frontal Lobe.- b) Branches to the Internal Surface of the Frontal Lobe.- c) Branch to the Paracentral Lobule.- d) Branches to the Internal Aspect of the Parietal Lobe.- e) Branches to the Corpus Callosum.- II. Radiologic Study of the Anterior Cerebral Artery.- B. Middle Cerebral Artery.- I. Anatomic Study of the Middle Cerebral Artery.- 1. Patterns of Division of the Middle Cerebral Artery within the Sylvian Fissure.- 2. Frontal Branches of the Middle Cerebral Artery.- 3. Parietal Branches of the Middle Cerebral Artery.- 4. Temporal and Temporo-Occipital Branches of the Middle Cerebral Artery.- 5. Insular Branches.- II. Radiologic Study of the Middle Cerebral Artery.- C. Anterior Choroidal Artery.- I. Anatomic Study of the Anterior Choroidal Artery.- II. Radiologic Study of the Anterior Choroidal Artery.- D. Posterior Cerebral Artery.- I. Anatomic Study of the Posterior Cerebral Artery.- II. Radiologic Study of the Posterior Cerebral Artery.- 4. Basal Cerebral Vein (Y. P. H.).- A. Normal Anatomy.- I. First Segment of the Basal Cerebral Vein and Its Tributaries.- 1. Deep Middle Cerebral Vein.- 2. Inferior Striate Veins.- 3. Olfactory Vein.- 4. Fronto-Orbital Veins.- 5. Anterior Cerebral and Pericallosal Veins.- 6. Veinlets from the Optic Chiasm, Optic Tract, and Adjacent Structures.- II. Second Segment of the Basal Cerebral Vein and Its Tributaries>.- 1. Peduncular Vein.- 2. Inferior Ventricular Vein.- III. Third Segment of the Basal Cerebral Vein and Its Tributaries.- 1. Lateral Mesencephalic Vein.- 2. Lateral Atrial Vein.- 3. Medial Temporal and Occipitotemporal Cortical Veins.- 4. Posterior Longitudinal Hippocampal Vein.- 5. Posterior Thalamic Veins.- B. Anatomic Variations.- 2. Mesencephalic Region, Diencephalic Region, and Basal Ganglia.- 1. Third Ventricle and Suprasellar Cisterns (G. S.).- I. Anatomic Study of the Third Ventricle and Suprasellar Cisterns.- 1. Third Ventricle.- 2. Suprasellar Cisterns.- II. Radiologic Study of the Third Ventricle and Suprasellar Cisterns.- 2. Aqueduct of Sylvius (G. S.).- I. Anatomic Study of the Aqueduct of Sylvius.- II. Radiologic Study of the Aqueduct of Sylvius.- 3. Arteries of the Basal Ganglia and the Posterior Choroidal Arteries (G. S.).- I. Anatomic Study of the Perforating Arteries of the Basal Ganglia and of the Posterior Choroidal Arteries.- 1. Perforating Branches of the Carotid System.- a) Perforating Branches of the Anterior Cerebral Artery.- b) Perforating Branches of the Middle Cerebral Artery.- c) Perforating Branches of the Anterior Choroidal Artery.- 2. Perforating Branches of the Vertebrobasilar System.- a) Arteries to the Inferior Surface of the Thalamus.- b) Arteries to the Posterior Surface of the Thalamus.- c) Arteries to the Superior Surface of the Thalamus.- II. Radiologic Study of the Perforating Arteries of the Basal Ganglia and of the Posterior Choroidal Arteries.- 4. Deep Cerebral Veins (Y. P. H.).- A. Internal Cerebral and Great Cerebral Veins.- B. Subependymal Veins of the Lateral Ventricle.- I. Medial Group of theSubependymal Veins.- 1. Septal Vein.- 2. Posterior Septal Vein.- 3. Medial Atrial Vein.- 4. Transverse Hippocampal Subependymal Veins.- II. Lateral Group of the Subependymal Veins.- 1. Thalamostriate Vein.- 2. Direct Lateral Vein.- 3. Inferior Ventricular Vein.- C. Choroidal Veins of the Lateral Ventricle.- D. Veins of the White Matter of the Cerebral Hemisphere-Medullary Veins.- E. Veins of the Grey Matter of the Cerebral Hemisphere.- 3. Posterior Fossa.- 1. Fourth Ventricle and Cisterns of the Posterior Fossa (G. S.).- I. Anatomic Study of the Fourth Ventricle.- 1. Floor of the Fourth Ventricle.- 2. Roof of the Fourth Ventricle t2.- II. Anatomic Study of the Posterior Fossa Cisterns.- 1. Cisterns Anterior to the Brainstem.- a) Medullary Cistern.- b) Pontine Cistern.- c) Cerebellopontine Angle Cistern.- 2. Cistern Posterior to the Medulla and Below the Inferior Vermis-Cisterna Magna.- 3. Cisterns Posterior to the Tectum and Superior to the Cerebellum.- 4. Cisterns Around the Cerebral Peduncles.- III. Radiologic Study of Posterior Fossa, Fourth Ventricle and Cisterns of the Posterior Fossa.- 2. Arteries of the Vertebrobasilar System (G. S.).- I. Anatomic Study of the Arteries of the Vertebrobasilar System.- 1. Intracranial Segment of the Vertebral Artery.- 2. Basilar Trunk.- 3. Arteries of the Brainstem.- a) Arteries of the Medulla.- b) Arteries of the Pons.- c) Arteries of the Cerebral Peduncles.- 4. Arteries of the Cerebellum.- a) Superior Cerebellar Artery-SCA.- b) Anterior Inferior Cerebellar Artery-AICA.- c) Posterior Inferior Cerebellar Artery-PICA.- II. Radiologic Study of the Arteries of the Vertebrobasilar System.- 1. Basilar Trunk and Its Branches.- 2. Anterior. Inferior Cerebellar Artery-AICA.- 3. Superior Cerebellar Artery-SCA.- 3. Veins of the Posterior Fossa (Y. P. H.).- I. Superior or Galenic Draining Group.- 1. Mesencephalic Tributaries.- 2. Cerebellar Tributaries.- II. Anterior or Petrosal Draining Group.- 1. Tributaries Related to the Anterior Aspect of the Brain Stem.- 2. Tributaries Related to the Wing of the Precentral Cerebellar Fissure.- 3. Tributaries Related to the Posterolateral Fissure.- 4. Tributaries Related to the Cerebellomedullary Fissure.- 5. Tributaries Related to the Cerebellar Hemisphere.- III. Posterior or Tentorial Draining Group.- IV. Intercommunications Among the Superior, Anterior and Posterior Draining Groups and Between the Supra- and Infratentorial Veins.- V. Circulation Times of Veins of the Posterior Fossa.- References.

Veins of the Posterior Fossa

During the development of the embryo, the first vein to appear in the posterior fossa is, according to PADGET (1956), the primitive ventral metencephalic vein since, at this stage, the cerebellar hemisphere is merely represented by a cerebellar plate. This ventral metencephalic vein, homologous to the trigeminal vein of lower vertebrates, will eventually become the petrosal vein. The proximal end of the ventral metencephalic vein becomes incorporated into the petrous crest to form the superior petrosal sinus. The primitive ventral myelencephalic vein, also called the vagal vein (PADGET, 1956), anastomoses superiorly with the ventral metencephalic vein and drains the medulla oblongata. The inferior petrosal sinus is derived from the proximal end of the ventral myelencephalic vein.

Deep Cerebral Veins

The deep cerebral venous system may be said to consists of the two internal cerebral veins and their tributaries—the subependymal, deep medullary, superior striate and choroidal veins. The basal cerebral vein, sometimes included in the deep venous system, is described elsewhere (Part 1, Chap. 4, p. 128).

Basal Cerebral Vein

The basal cerebral vein described by ROSENTHAL in 1824 has been the subject of many investigations.

Arteries of the Vertebrobasilar System

The vertebral arteries, basilar trunk and their branches provide the vascular supply to the brainstem and cerebellum. The anatomy of these arteries has been studied by STOPFORD (1917), FOIX and HILLEMAND (1925) and LAZORTHES, POULHES and ESPAGNO (1950).

Aqueduct of Sylvius

The aqueduct of Sylvius represents the communication between the third and fourth ventricles. It is 15 to 18 mm long and 1 to 2 mm in diameter. Its shape is like the neck of a swan. Posteriorly, its relations are, from superiorly to inferiorly, the posterior commissure, the superior and inferior colliculi and the anterior medullary velum. Its floor is the midbrain, and contains the nuclei of the third and fourth cranial nerves (Fig. 153).

Fourth Ventricle and Cisterns of the Posterior Fossa

Knowledge of the radiologic anatomy of the posterior fossa has certainly benefited from recent investigations into the arterial supply and venous drainage of its structures, and from studies of the anatomy of the fourth ventricle and cisterns of the posterior fossa.

Frontal Sections — 60°

These sections are similar to the sagittal/para sagittal and frontal (90°) sections in that they are 1 cm thick and are sectioned from the occiput forward. There are ten slices, all of which were made with reference to the external acoustic meatus. In addition to those structures described in Sect. II. 1. A, the central sulcus, and occasionally pre- and postcentral sulci, may be better visualized in these modified frontal sections. Since the posterior ramus of the lateral sulcus (Sylvian fissure) runs approximately 40° in relation to the orbitomeatal line, the anterior portion of the Sylvian fissure and the superior temporal sulcus will usually be shown in the sections through the sella and planum sphenoidale. As in 90° frontal sections, the orbit, the extraocular muscles, and the optic nerve are usually well demonstrated in these sections. Unlike horizontal (or transaxial) sections, frontal or modified frontal sections are useful in distinguishing supra- from infra-Sylvian lesions. The clearly visualized tentorial leaves make it easy to distinguish supratentorial from infra tentorial lesions.

Horizontal Sections of Skull and Brain: Parallel to the Orbitomeatal Line

In the lowest section (1 cm below the orbitomeatal line) the spinal cord and maxillary sinus are seen. The section through the orbitomeatal line shows the orbits, nasal cavity, medulla oblongata, cerebellar tonsils, and petrous pyramids. One section above the orbitomeatal line delineates the brainstem, cerebellum, cerebellopontine angles, and temporal lobes.

CT Sections of Isolated Formalin-Fixed Brain in Sagittal and Parasagittal Planes

Following careful removal of the arachnoid and pial vessels, the brain was photographed from the superior, inferior, anterior, and posterior aspects. The inferior surface of the cerebral hemispheres and the cerebellum with brainstem were photographed separately. Finally, the midsagittal section of the hemispheres was made and medial views taken.