Neurovascular Anatomy in Interventional Neuroradiology A Case-Based Approach Timo Krings, MD, PhD, FRCPC Professor of Radiology and Surgery Director, Neuroradiology Program University of Toronto, Toronto Western Hospital Toronto, Ontario, Canada Sasikhan Geibprasert, MD Staff Neurointerventionalist and Lecturer Department of Radiology Ramathibodi Hospital, Mahidol University Bangkok, Thailand Juan Pablo Cruz, MD Staff Neuroradiologist and Assistant Professor Department of Radiology Hospital Clínico de la Pontifica Universidad Católica de Chile Santiago, Chile Karel G. terBrugge, MD, FRCPC The David Braley and Nancy Gordon Chair in Interventional Neuroradiology Professor of Radiology and Surgery Head, Division of Neuroradiology University of Toronto, Toronto Western Hospital Toronto, Ontario, Canada Thieme New York • Stuttgart • Delhi • Rio de Janeiro ThiemeMedicalPublishers,Inc. 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Toour students Contents ForewordbyInSupChoi.................................................................................ix Preface.................................................................................................. x Contributors............................................................................................xi SectionI: AorticArch................................................................................ 1 Case1: TheCommonOriginoftheBrachiocephalicandLeftCommonCarotidArtery.................................. 2 Case2: TheAberrantSubclavianArtery........................................................................ 6 SectionII: InternalCarotidArtery................................................................... 11 Case3: TheCarotidSegments,theAberrantICA,andthePersistentStapedialArtery................................. 12 Case4: PersistentCarotid-VertebrobasilarAnastomoses......................................................... 17 Case5: TheInferolateralandtheMeningohypophysealTrunk..................................................... 23 Case6: TheDuralRingandtheCarotidCave................................................................... 27 Case7: TheDorsalandVentralOphthalmicArteries............................................................. 31 Case8: TheBranchesoftheOphthalmicArtery ................................................................ 35 Case9: TheAnteriorChoroidalArtery ........................................................................ 38 SectionIII: AnteriorCirculation...................................................................... 45 Case10: TheInfraopticCourseoftheAnteriorCerebralArtery.................................................... 46 Case11: TheAnteriorCommunicatingArteryComplex.......................................................... 49 Case12: TheAzygosAnteriorCerebralArtery.................................................................. 54 Case13: TheCorticalBranchesoftheAnteriorCerebralArtery.................................................... 58 Case14: TheMiddleCerebralArteryTrunk .................................................................... 62 Case15: TheRecurrentArteryofHeubner..................................................................... 67 Case16: TheCorticalBranchesoftheMiddleCerebralArtery..................................................... 76 Case17: TheLeptomeningealAnastomoses ................................................................... 83 SectionIV: PosteriorCirculation..................................................................... 89 Case18: VariationsoftheOriginofthePICA................................................................... 90 Case19: TheCerebellarArteries............................................................................. 94 Case20: TheBasilarArteryTrunk........................................................................... 100 Case21: TheBrainstemPerforators ......................................................................... 106 Case22: TheBasilarTip ................................................................................... 111 Case23: TheThalamoperforatingArteries.................................................................... 115 Case24: TheCorticalBranchesofthePosteriorCerebralArtery.................................................. 121 SectionV: ExternalCarotidArtery ................................................................. 127 Case25: The“Dangerous”AnastomosesI:OphthalmicAnastomoses ............................................. 128 Case26: The“Dangerous”AnastomosesII:PetrousandCavernousAnastomoses ................................... 132 Case27: The“Dangerous”AnastomosesIII:UpperCervicalAnastomoses.......................................... 137 Case28: TheCranialNerveSupply .......................................................................... 140 Case29: TheVascularAnatomyoftheNose .................................................................. 146 Case30: TheAscendingPharyngealArtery ................................................................... 150 Case31: TheMeningealSupply............................................................................. 154 vii Contents SectionVI: CerebralVeins........................................................................... 161 Case32: TheSuperiorSagittalandTransverseSinuses.......................................................... 162 Case33: TheCavernousSinus.............................................................................. 168 Case34: TheSuperficialCorticalVeins....................................................................... 175 Case35: TheTransmedullaryVeins.......................................................................... 179 Case36: TheDeepVenousSystemI:InternalCerebralVeins,Tributaries,andDrainage............................... 184 Case37: TheDeepVenousSystemII:TheBasalVeinofRosenthalandtheVenousCircle.............................. 188 Case38: TheInfratentorialVeins............................................................................ 193 SectionVII: Spine .................................................................................... 199 Case39: TheSegmentalSpinalArteries...................................................................... 200 Case40: TheRadiculopialandRadiculomedullaryArteries ...................................................... 205 Case41: TheIntrinsicArteriesoftheCord.................................................................... 211 Case42: TheArteryoftheFilumTerminale................................................................... 216 Case43: TheSpinalCordVeins ............................................................................. 220 Index.................................................................................................. 228 viii
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