SYLVIUS ARTERY AND VEIN

The superficial middle cerebral vein (also known as the Sylvian vein) is one of the superficial cerebral veins. It usually passes along the Sylvian fissure posteroanteriorly, it collects numerous small tubutaries which drain the opercular areas around the lateral sulcus.

The middle cerebral artery is the largest branch of the internal carotid. It is divided into a proximal (M1) segment and a distal (M2) segment by the middle cerebral artery bifurcation. The bifurcation of the middle cerebral artery is located at the base of the insula and it forms the M2 segment which consists of the superior and inferior trunks. These trunks travel deep in the lateral (Sylvian) fissure along the insula.

Franciscus Sylvius (1614-1672) (Figure 1) was a physician and scientist (chemist, physiologist and anatomist). He was born in Hanau, Germany, but worked in Netherlands, where he died. He founded the Iatrochemical School of Medicine in which all life and disease processes are based on chemical actions.  He researched the brain structure and discovered the fissure, the artery and vein that take his name (Figures 2 and 3) [1].

Fig. 1: Franciscus Sylvius (1614-1672).
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Fig. 2: Schematic drawing demonstrates the Sylvian branch (M2) of the middle cerebral artery.
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Fig. 3: Arteriography shows the same branch (M2) (green arrow).
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RECURRENT ARTERY OF HEUBNER

The recurrent artery of Heubner is the largest vessel of the medial lenticulostriate arteries. It supplies many deep structures, mainly the corpus striatum, the globus pallidus, and the anterior crus of the internal capsule.

Johann Otto Leonhardt Heubner (1843-1926) (Figure 4) described the recurrent artery (A2), the second branch after the anterior communicant artery, in 1872 (Figures 5 and 6). He was known as the father of the German pediatricians. He also described the syphilitic endarteritis, disease that received his name (Heubner disease) [2].

Fig. 4: Johann O. L. Heubner (1843-1926).
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Fig. 5: Schematic drawing shows the recurrent branch (A2) of the anterior cerebral artery (artery of Heubner).
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Fig. 6: Digital subtraction angiography (DSA) demonstrates the artery of Heubner (yellow arrows).
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ARTERY OF PERCHERON 

The artery of Percheron is an uncommon anatomic variant, in which a single dominant thalamoperforating artery supplies the bilateral medial thalami with variable contribution to the rostral midbrain. 

The artery of Percheron was first described in 1973 by the French medical scientist, Gerard Percheron (Figure 7). He was born in Pavilly, France in1930 and died in 2011. Gerard Percheron was a practicing neurologist and prolific researcher at the Institute Nationale de la Sante et de la Recherche Medicale (INSERM). He made significant and valuable contributions to medicine, in particular, to the vascular anatomy of the basal ganglia. His particular interest in the thalamus eventually led to the identification of an anatomic variation in its vascular supply. This newly identified artery was subsequently named the artery of Percheron (Figures 8) [3]. Occlusion of this artery results in a characteristic pattern of ischemia: bilateral paramedian thalamic infarcts with or without midbrain involvement (Figures 9 and 10).

Fig. 7: Gerard Percheron (1930-2011).
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Fig. 8: Schematic drawing shows the artery of Percheron irrigating both sides of thalamus and midbrain.
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Fig. 9: Diffusion weighted image at the level of the midbrain demonstrates hypersignal (arrow). Infarction of the artery of Percheron.
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Fig. 10: ADC map shows restricted diffusion (red arrow) at the level of the midbrain (infarction).
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ARTERY OF BERNASCONI-CASSINARI

The artery of Bernasconi and Cassinari is an important infraclinoid branch of the internal cerebral artery. It is of neuroendovascular relevance in view of its supply to complex lesions such as meningiomas and arteriovenous malformations in the tentorial and falcotentorial regions. 

Vittorio Bernasconi and Valentino Cassinari were the first ones to notice an enlargement of tentory arteries in patients with meningioma. This finding was published in 1976 in the Italian magazine named Chirurgia. This pathologic branch is visualized in other pathologies (Figure 11 ) and even in some healthy patients (Figure 12) and is known as the artery of Bernasconi-Cassinari (Figure 13) [4].

Fig. 11: DSA demonstrates the Bernasconi-Cassinari artery (green arrow), in a patient with a vascular tumor in the tentorium region.
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Fig. 12: DSA shows a healthy individual with the tentorial artery (yellow arrow).
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Fig. 13: Schematic drawing shows the Bernasconi-Cassinari branch (black arrow).
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VIDIAN ARTERY AND VEIN

The pterygoid canal, also known as the Vidian canal, is a foramen in the base of skull, located in the sphenoid bone, inferomedial to the foramen rotundum. It transmits the Vidian artery and vein and and Vidian nerve from the middle cranial fossa to the pterygopalatine fossa. 

Vidius Vidius [Guido Guidi] (1509-1569) (Figure 14) was an italian anatomist and surgeon. He was invited by Francisco I, from France, to be his personal physician and professor at the Collège de France. He described the vessels (Figure 15) and nerves that pass through the pterygoid canal (Figure 16) [5]. Figure 17 illustrates the vidian artery (angiography).

Fig. 14: Vidius Vidius (1509-1569).
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Fig. 15: Schematic drawing of the the Vidian artery in the Vidian canal.
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Fig. 16: Axial CT (bone window) shows the pterygoid canal (green arrow).
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Fig. 17: DSA demonstrates the Vidian artery (yellow arrow).
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CIRCLE OF WILLIS

The circle of Willis is a ring of interconnecting arteries located at the base of the brain. It is a vascular network formed by the interconnection of the middle cerebral, anterior cerebral, posterior cerebral, basilar, anterior communicating, and posterior communicating arteries. This arterial circle is more accurately referred to as “the polygon of Willis” by the French.

Thomas Willis (1621-1675) (Figure 18) was a British physician, anatomist and physiologist. He studied the central nervous system anatomy and circulation and described the arterial anastomosis at the base of the brain, named as circle of Willis (Figures 19 and 20) [3].

Fig. 18: Thomas Willis (1621-1675).
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Fig. 19: Schematic drawing shows the arteries that form the polygon of Willis. MCA: middle cerebral artery; ICA: internal carotid artery; ACA: anterior cerebral artery; AcomA: anterior communicating artery; PcomA: posterior communicating artery; PCA:posterior cerebral artery
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Fig. 20: MR angiography (MRA). 3D reconstruction shows the arteries of the circle of Willis.
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ARTERY OF ADAMKIEWICZ

The artery of Adamkiewicz, also known as the great anterior radiculomedullary artery or arteria radicularis anterior magna, is the name given to the dominant thoracolumbar segmental artery that supplies the spinal cord.

Albert Wojciech Adamkiewicz (1850-1921) was a Polish pathologist (Figure 21) He was born in Zerkow. In 1873 he earned his medical doctorate from the University of Breslau. Adamkiewicz is remembered for his pathological examinations of the central nervous system. His research of the variable vascularity of the spinal cord was an important factor in regards to modern clinical vascular surgery. He is credited with describing the major anterior segmental medullary artery which is now known as the artery of Adamkiewicz (Figures 22 and 23) [1].

Fig. 21: Albert W. Adamkiewicz (1850-1921).
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Fig. 22: Illustration demonstrates two different levels of the origin of Adamkiewicz artery.
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Fig. 23: DSA demonstrates the artery of Adamkiewicz (green arrow).
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BASAL VEIN OF ROSENTHAL

The basal vein of Rosenthal begins at the anterior perforated substance by the union of anterior cerebral vein, middle cerebral vein and the striate vein. The basal vein on each side passes around the midbrain to join the great cerebral vein. The vein of Rosenthal courses from the premesencephalic cistern, through the ambient cistern, and terminates in the quadrigeminal cistern.

Friedrich Christian Rosenthal (1780-1829) (Figure 24) was a prominent German anatomist and surgeon. He was born in the city of Griefswald. He died prematurely in 1829, leaving his anatomical paper of the brain and cranial nerves unfinished. After an itinerant academic, military, and professional career, he died of tuberculosis in Greifswald in 1829, working to the end on an unfinished treatise on the anatomy of the brain and cranial nerves. His name is associated with the spiral canal of the inner ear and the basal cerebral vein, which drains into the vein of Galen (Figures 25, 26 and 27)  [3,6].

Fig. 24: Friedrich C. Rosenthal (1780-1829).
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Fig. 25: Schematic representation of the venous circulation of the brain. The basal vein of Rosenthal (red arrow).
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Fig. 26: MRA (3D reconstruction) shows the venous circulation of the brain. Basal vein of Rosenthal (arrow).
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Fig. 27: DSA (venous phase) demonstrates the basal vein of Rosenthal.
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VEIN OF GALEN 

The great cerebral vein of Galen is a short (1-2 cm long), thick vein that passes posterosuperiorly behind the splenium of corpus callosum in the quadrigeminal cistern. It receives the basal veins and the posterior fossa veins and drains to the anterior end of the straight sinus where this unites with the inferior sagittal sinus. 

Galen (Figure 28) was born in Pergamum in Minor Asia (Turkey nowadays). He was a physician, writer, and philosopher who exercised a dominant influence on medical theory and practice in Europe from the Middle Ages until the mid-17th century. His authority in the Byzantine world and the Muslim Middle East was similarly long-lived. He studied mathematics, geometry, philosophy and medicine. He was the first one to describe that there was blood within the blood vessels which contrasts with the Pneuma, theory in which the vessels were filled with air. His name is associated with magna cerebral vein or vein of Galen (Figures 25, 29 and 30) [3,7].

Fig. 28: Galen of Pergamum (129-210 B.C).
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Fig. 29: MRA (3D) demonstrates the venous circulation of the brain. Vein of Galen (arrow).
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Fig. 30: DSA (venous phase) shows the great cerebral vein (green arrow).
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INFERIOR ANASTOMOTIC VEIN OF LABBÉ

The vein of Labbé, also known as inferior anastomotic vein, is part of the superficial venous system of the brain. The vein of Labbé is the largest channel that crosses the temporal lobe between the Sylvian fissure and the transverse sinus and connects the superficial middle cerebral vein and the transverse sinus.

Charles Labbé (1851-1889) was born in Merlerault, France. He entered the Medical School of Paris in 1871. He described the various connections of the cerebral veins in his doctoral thesis published in The Journal of Physiologie in Paris in 1879 (Figure 31), including the inferior anastomotic veins that recieved his name (Figures 32 and 33)  [8,9].

Fig. 31: Schematic representation of the Charles Labbé`s doctoral paper in 1879 demonstrating the anastomotic venous systems of brain.
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Fig. 32: DSA (venous phase). Vein of Labbé (white arrow).
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Fig. 33: MRA (3D). Vein of Labbé (arrow).
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SUPERIOR ANASTOMOTIC VEIN OF TROLARD

The superior anastomotic vein of Trolard connects the superior sagittal sinus and the superficial middle cerebral vein (of Sylvius). It is the largest cortical vein that drains into the superior sagittal sinus.

Jean Baptiste Paulin Trolard (1842-1910) (Figure 34) was born in 1842 in the city of Sedan, France. He defended his doctoral thesis "Research in the Brain and Skull Venous System” and described the largest anastomotic veins of the cerebral circulation, which today bears his name (Figure 35) [9,10]. 

Fig. 34: Jean B. P. Trolard (1842-1910).
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Fig. 35: MRA (3D). Vein of Trolard (arrow).
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TORCULA HEROPHILI

The confluence of sinuses, torcular herophili, or torcula is the connecting point of the superior sagittal sinus, straight sinus and occipital sinus.

Herophilus (340-280 B.C) (Figure 36) was born in Bitinia, today Kadikoy in Turkey. He studied medicine at the Praxágoras’s school. He founded the Medical School of Alexandria helped by Erístrato. He is considered by many the first anatomist of antiquity. Studied the brain anatomy and described the dural sinus and their confluence, also known as Torcula herophili (Figures 37 and 38) [2].

Fig. 36: Herophilus (340-280 B.C).
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Fig. 37: DSA (venous phase). Torcula herophili (gree arrow).
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Fig. 38: MRA (MIP). Confluence of venous sinus (Torcula herophili).
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DANDY’S VEIN 

The superior petrosal veins, known collectively as the “petrosal vein,” or “Dandy's vein,” are one of the most constant and largest venous complexes in the posterior fossa. 

Walter Edward Dandy (1886-1946) (Figure 39) was born in Sedalia, Missouri. He graduated from John Hopkins School of Medicine in 1910. He was pioneer in the pneumatic ventriculography, studied the formation of cerebrospinal fluid, and developed many surgical techniques for aneurysms and tumors of the cerebellopontine angle. His name is associated with Dandy-Walker syndrome and superior vena petrosa, Dandy’s vein (Figure 40) [11].

Fig. 39: Walter E. Dandy (1886-1946).
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Fig. 40: DSA (venous phase) shows the vein of Dandy (green arrow).
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