326 Neuroanatomy: Draw It to Know It
Deep Cerebral Arteries ( Advanced )
Here, we will draw the deep, perforating cerebral arterial
territories. Label the right-hand side of the page as the
deep cerebral structures and the left -hand side as the
perforating arterial territories. Note that an attempt to
draw the exact vascular supply of each deep structure
would be impractical due to the number of structures
we would have to account for and the multiplicity of
their arterialization. Instead, here, we will label only the
vascularization of certain landmark structures. As we go
through our vertically compressed axial diagram we
must think in terms of three diff erent axes. Draw the
anterior– posterior and medial–lateral axes, now, and we
will denote the superior–inferior variations in arterial-
ization where appropriate in our diagram, itself.
First, draw the key anatomic landmarks. Indicate the
hypothalamus, which lies in the anterior midline; it bor-
ders the third ventricle. Next, label the thalamus, which
lies above the hypothalamus in midline. Th en, anterior
to the hypothalamus, draw the head of the caudate and
then draw the lentiform nucleus, which is the globus pal-
lidus and putamen combination. Sandwiched in between
the aforementioned structures, draw the internal capsule
and divide it into its central-lying genu and its anterior
and posterior limbs.
Now, sketch this same arrangement on the arterial
side of the page. Show that the perforating branches of
the MCA, which are known as the lenticulostriate arter-
ies, supply the anterior-superior-lateral basal ganglia
region: they supply the putamen and lateral globus pal-
lidus, superior internal capsule, the body of the caudate,
and the superior caudate head. Th en, show that the ACA
perforating branches (including the recurrent artery of
Heubner) supply the anterior-inferior-medial basal gan-
glia region: the anterior-inferior head of the caudate,
anterior-inferior portion of the anterior limb of the inter-
nal capsule, and the medial lentiform nucleus. As we can
see, there is substantial overlap in the lenticulostriate and
anterior cerebral artery vascularization of the basal gan-
glia. To distinguish the arterial supply of these vessels,
denote that the lenticulostriate arteries supply the supe-
rior portion of the overlapping structures, whereas the
ACAs supply the inferior portion.
Next, show that the perforating branches of the inter-
nal carotid artery supply the genu of the internal capsule
and the areas that immediately surround it. Th en, show
that the anterior choroidal artery supplies the posterior-
inferior-medial basal ganglia region: the lower posterior
internal capsule, medial geniculate nucleus and related
acoustic radiations, medial globus pallidus, and tail of
the caudate. Now, show that the anterior communicat-
ing artery supplies the anterior hypothalamus and neigh-
boring diencephalic structures. Th en, show that the
posterior communicating artery supplies the posterior
hypothalamus, optic chiasm and mammillary bodies,
and also the anterior thalamus via the thalamotuberal
artery. Finally, show that many diff erent thalamic arter-
ies supply the remainder of the thalamus (see Drawing
19-8 ).
Next, let’s consolidate this information into a single
perforating artery–single structure/region list so we
can simplify the aforementioned material. On the left -
hand side, label the deep, perforating arteries, and on the
right-hand side, label the single structure or region.
Indicate that the lenticulostriate arteries supply the
antero-supero-lateral basal ganglia; the ACA supplies
the antero-infero-medial basal ganglia; the internal
carotid artery supplies the genu of the internal capsule;
the anterior communicating artery supplies the anterior
hypothalamus; the posterior communicating artery sup-
plies the posterior hypothalamus; the anterior choroidal
artery supplies the posterior limb of the internal capsule;
and the thalamic arteries supply the thalamus.^1 , 2 , 4 – 6