Cerebral vascular territories

An understanding of cerebral vascular territories is important in understanding stroke and complications from surgery and endovascular procedures. 

Although one could be excused for thinking that within the brain, such a carefully organised organ, blood supply would be constant, the truth is that a great deal of variety exists. Two main factors contribute to vascular territories:

  1. circle of Willis anatomy and normal variants
  2. intrinsic variability in the extent of tissue each main branch supplies

As a result, different sources will have surprisingly different diagrams and descriptions. What is presented here is a general ball-park scheme, with a brief description of main branches and anatomy. 

It is beyond the scope of this single article to describe each vessel/branch in detail: refer to the relevant subarticle if required.

The intracranial circulation can be conveniently divided into anterior and posterior circulation, on the basis of internal carotid artery and vertebral artery supply respectively. 

The anterior cerebral artery (depicted in yellow on the diagrams) is a terminal branch of the internal carotid artery. It may be divided into 2 or 3 segments, depending on the author.  

Branches of the A1-segment of the anterior cerebral artery. They supply the anterior inferior parts of the basal nuclei and the anterior limb of the internal capsule. Heubner's artery is the largest of the medial lenticulostriate arteries and supplies the anteromedial part of the head of the caudate and anterior inferior internal capsule.

The cortical branches of the MCA (depicted in red in the diagrams) supply the lateral surface of the hemisphere, except for the medial part of the frontal and the parietal lobe, which is supplied by the ACA, and the inferior part of the temporal lobe, which is supplied by the PCA. 

The deep penetrating branches are called the lateral lenticulostriate arteries. The territory of the lateral lenticulostriate perforating arteries of the MCA is indicated with a different colour (purple) from the rest of the territory of the MCA because it is a well-defined area supplied by penetrating branches, which may be involved or spared in infarcts separately from the main cortical territory of the MCA.

The vascular territory of the PCA is depicted in blue. The P1 segment extends from the PCA origin to the posterior communicating artery, contributing to the circle of Willis. Posterior thalamoperforating arteries branch off the P1 segment to supply blood to the midbrain and thalamus. Cortical branches of the PCA supply the inferomedial part of the temporal lobe, occipital pole, visual cortex, and splenium of the corpus callosum. In addition, the arterial supply of hippocampus usually arises from PCA, including:

The territory of the AChA is part of the hippocampus, the posterior limb of the internal capsule and extends upwards to an area lateral to the posterior part of the cella media.

Watershed infarcts occur at the border zones between major cerebral arterial territories as a result of hypoperfusion. There are two patterns of border zone infarcts:

  1. cortical border zone infarctions
    Infarctions of the cortex and adjacent subcortical white matter located at the border zone of ACA/MCA and MCA/PCA
  2. internal border zone infarctions
    Infarctions of the deep white matter of the centrum semiovale and corona radiata at the border zone between lenticulostriate perforators and the deep penetrating cortical branches of the MCA or at the border zone of deep white matter branches of the MCA and the ACA

The corpus callosum has a rich blood supply, relatively constant and is uncommonly involved by infarcts. The majority of the corpus callosum (CC) is supplied by the pericallosal arteries and the posterior pericallosal arteries, branches from the anterior and posterior cerebral respectively. In 80% of patients additional supply comes from the anterior communicating artery, via either subcallosal artery or median callosal artery.

  • the subcallosal artery (50% of patients) is essentially a large version of a hypothalamic branch, which in addition to supplying part of the hypothalamus also supplies the medial portions of the rostrum and genu.
  • the median callosal artery (30% of patients) can be thought of as a more extended version of the subcallosal artery, in that it travels along the same course, supplies the same structures but additionally reaches the body of the corpus callosum.
  • the posterior pericallosal artery (also known as splenial artery) supplies a variable portion of the splenium. Its origin is inconstant, arising from P3 or branches thereof.
  • content pending

The brainstem is supplied by the vertebrobasilar circulation and their branches, small branches of the posterior cerebral artery (PCA), and the anterior spinal artery.

Midbrain

Small penetrating branches from:

Pons

Medulla

The cerebellum is essentially supplied by three vessels:

  1. superior cerebellar artery (SCA) (branch of the distal basilar artery)
  2. anterior inferior cerebellar artery (AICA) (branch of the proximal basilar artery)
  3. posterior inferior cerebellar artery (PICA) (branch of the distal vertebral artery)

This vessel supplies:

  • whole superior surface of the cerebellar hemispheres down to the great horizontal fissure
  • the superior vermis
  • dentate nucleus
  • most of the cerebellar white matter

The amount of tissue supplied by the AICA is variable (PICA-AICA dominance) but usually includes:

  • middle cerebellar peduncle
  • inferolateral portion of the pons
  • flocculus
  • anteroinferior surface of the cerebellum

Has a variable territory depending on the size of the AICA, but usually supplies:

  • posteroinferior cerebellar hemispheres (up to the great horizontal fissure)
  • inferior portion of the vermis
  • 18% arise extracranially, inferior to the foramen magnum
  • 10% arise from the basilar rather than vertebral artery
  • 2% bilaterally absent
  • occasionally loops around the cerebellar tonsil

It divides into lateral and medial branches that supply the inferior portion of the vermis and cerebellar hemispheres respectively. 

These branches supply the medulla oblongata and the pons.

NOTE: occasionally a small vertebral artery will terminate into a common PICA/AICA trunk.

Neuroanatomy
Share article

Article information

rID: 1085
Section: Anatomy
Synonyms or Alternate Spellings:
  • Cerebral vessel territories

Support Radiopaedia and see fewer ads

Cases and figures

  • Drag
    Figure 1: lateral sagittal
    Drag here to reorder.
  • Drag
    Figure 2: midline sagittal
    Drag here to reorder.
  • Drag
    Cerebral vascular territories
    Drag here to reorder.
  • Drag
    Figure 4: at level of inferior cerebellum
    Drag here to reorder.
  • Drag
    Figure 5: at level of cerebellopontine angle
    Drag here to reorder.
  • Drag
    Figure 6: at level of inferior temporal lobes
    Drag here to reorder.
  • Drag
    Figure 7: at level of brainstem
    Drag here to reorder.
  • Drag
    Figure 3: cerebral vascular territories
    Drag here to reorder.
  • Drag
    Figure 9: at level of superior basal ganglia
    Drag here to reorder.
  • Drag
    Figure 10: at level of superior lateral ventricles
    Drag here to reorder.
  • Drag
    Figure 11: at level of centrum semiovalear territories
    Drag here to reorder.
  • Drag
    Figure 12: at level of extreme vertex
    Drag here to reorder.
  • Updating… Please wait.
    Loadinganimation

    Alert accept

    Error Unable to process the form. Check for errors and try again.

    Alert accept Thank you for updating your details.