Arteries Of Brain: Frontal View and Section

The proximal interhemispheric portions of the anterior cerebral arteries have medial orbitofrontal branches that travel anteriorly along the gyrus rectus to supply the medial part of the orbital gyri and the olfactory bulbs and tracts, and frontopolar artery branches to the superior frontal gyri. The anterior cerebral artery then passes around the genu of the corpus callosum and, in that general location, divides into callosomarginal and pericallosal branches. The callosomarginal artery passes over the cingulate gyrus to course posteriorly within the cingulate sulcus. It supplies anterior, middle, and posterior branches to the medial frontal lobes. The pericallosal artery courses posteriorly, below and parallel to the callosomarginal artery, in a sulcus between the corpus callosum and the cingulate gyrus. It supplies branches to the precuneus and medial superior parietal lobes. The pericallosal artery anastomoses with the pericallosal branch of the posterior cerebral artery variably, usually near the splenium of the corpus callosum.

Middle Cerebral Arteries

The middle cerebral arteries arise from the internal carotid artery bifurcation just lateral to the optic chiasm. The “mainstem” (M1) portion of the arteries courses horizontally in a lateral direction to enter the sylvian fissure. Three to six medial and lateral lenticulostriate arteries arise from the mainstem middle cerebral artery and penetrate the anterior perforated substance to supply the basal ganglia and deep portions of the cerebral hemispheres. The medial lenticulostriate arteries supply the outer portion of the globus pallidus and the medial parts of the caudate nucleus and putamen. The lateral lenticulostriate arteries supply the lateral portion of the caudate nucleus, the putamen, the anterior portion and genu of the internal capsule, and the adjacent corona radiata. Anterior temporal and frontopolar branches arise from the mainstem middle cerebral artery after the lenticulostriate origins.

As they near the sylvian fissures, the middle cerebral arteries divide into large superior and inferior divisions (referred to as M2 portions). The superior division supplies the lateral portions of the cerebral hemispheres above the sylvian fissures, and the inferior division supplies the temporal and inferior parietal lobes below the sylvian fissures. These main divisions turn upward around the inferior portion of the insula of Reil to continue upward and backward in the deepest part of the sylvian fissure between the outer surface of the insula and the medial surface of the temporal lobe. The superior division of the middle cerebral artery has lateral orbitofrontal, ascending frontal, rolandic, and anterior and posterior parietal branches. When the mainstem of the middle cerebral artery is short, the lenticulostriate branches may arise from the proximal portion of the superior division. The inferior division provides posterior temporal and angular branches to supply the lateral portions of the cerebral hemispheres below the sylvian fissures.

Meningeal Arteries

The meningeal arteries and veins are located along the outer portion of the dura, grooving the inner table of the skull. They supply the dura, the adjacent bony structures, and form anastomoses across both sides of the skull and with cerebral arteries. Their major clinical importance is (1) injuries to the skull, especially fractures, can cut across meningeal arteries, leading to epidural hemorrhages that require urgent drainage, and (2) meningiomas are often fed by meningeal arteries. Contrast opacification of meningeal arteries is often diagnostic in confirming that lesions are meningiomas, and interventional blockage of these feeding arteries can lead to shrinkage of a meningioma.

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