SUNY Health Science Center: Department of Neurosurgery

Here is a review of basic arterial angiography of the central nervous system. You will see
these images, or images like these, frequently. Impress them on your 10-billion neurons,
at least for these two weeks.

Annotated arterial angiograms include:

aortic arch

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carotid bifurcation

in the neck

●

AP view

of internal carotid in the head

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lateral view

of internal carotid in the head

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AP view of vertebrobasilar

artery system

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lateral view of vertebrobasilar

artery system

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what is

A1, A2, M1, M2

anyway?

●

Had enough? No? On, then, to a

lagniappe

carotid artery after subarachnoid hemorrhage but prior to delayed ischemic deficit

●

carotid artery after (fatal) delayed ischemic deficit develops

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Aortic arch

SUNY Health Science Center: Department of Neurosurgery

http://www.neuro.upstate.edu/neuro/teachfile/angio/index.shtml (1 of 7) [26/12/2000 07:47:43 a.m.]

Note the three vessels taking off from the top of the arch from right to left:

the brachiocephalic (AKA "innominate") artery

●

the left common carotid artery

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the left subclavian artery

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Carotid bifurcation in the neck

Note that the internal carotid artery has no branches in the neck, a trick for identifying it
when the anatomy is complicated. Also note that the normal initial segment of the
internal carotid artery has a diameter about that of the common carotid artery. Use this to
compare with stenosis of the internal carotid artery (which typically occurs here).

SUNY Health Science Center: Department of Neurosurgery

http://www.neuro.upstate.edu/neuro/teachfile/angio/index.shtml (2 of 7) [26/12/2000 07:47:43 a.m.]

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AP view of internal carotid A in the head

OK, if both L and R anterior cerebral arteries are filling from the L internal carotid artery,
which communicating artery must be patent? What is the circle of Willys? These
questions are left as an exercise (to quote the old math books).

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Lateral view of internal carotid A in the head

SUNY Health Science Center: Department of Neurosurgery

http://www.neuro.upstate.edu/neuro/teachfile/angio/index.shtml (3 of 7) [26/12/2000 07:47:43 a.m.]

The red line shows the top of the "middle cerebral A candelabra," an important landmark
in these angiograms. What does the posterior communicating artery connect to? Where
does the ophthalmic artery leave the carotid A ?

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AP view of vertebrobasilar artery system

SUNY Health Science Center: Department of Neurosurgery

http://www.neuro.upstate.edu/neuro/teachfile/angio/index.shtml (4 of 7) [26/12/2000 07:47:43 a.m.]

OK, of the three main arteries of the posterior fossa, which two branch off the basilar
artery? What artery does the other one branch off of? Which one typically causes
trigeminal neuralgia? Hemifacial spasm? Obstruction of which artery causes the lateral
medullary (Wallenberg) syndrome? Why do neurosurgeons sweat when they get near
the basilar tip perforators during aneurysm surgery? Just asking.

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lateral view of vertebrobasilar artery system

SUNY Health Science Center: Department of Neurosurgery

http://www.neuro.upstate.edu/neuro/teachfile/angio/index.shtml (5 of 7) [26/12/2000 07:47:43 a.m.]

OK, what nerve runs between the posterior cerebral and superior cerebellar A's? What
dural structure? What are the two top differential diagnoses for a painful third nerve
palsy? What is a Chiari malformation? What angiographic abnormality is common in
Chiari malformations?

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A1, A2, M1, M2, etc.

SUNY Health Science Center: Department of Neurosurgery

http://www.neuro.upstate.edu/neuro/teachfile/angio/index.shtml (6 of 7) [26/12/2000 07:47:43 a.m.]

So the middle cerebral artery is divided into M1 and M2 segments by its trifurcation in
the Sylvian fissure. Similarly, anterior cerebral artery proximal to the anterior
communicating artery is the A1, and distal to the Acom is the A2. Simple, huh?

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