Neurosurgery notes/Anatomy/Vascular/Artery/Choroidal arteries

Choroidal arteries

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Artery

Supratentorial choroidal arteries

Anterior choroidal artery (ACh)
  • Origin
    • (1–3 mm distant to the PComA origin) usually arises from the posterior aspect of the ICA
  • Course:
    • Lateral to optic tract, curves medially to be inferomedial to optic tract --> curve laterally to run along the lateral aspect of the optic tract --> circumvents the cerebral peduncles to reach the lateral geniculate body --> traverses in the posterolateral direction above the uncus to enter the choroidal fissure, at the plexal point.
      • Plexal point is always constant
  • Two segments
    • Cisternal segment:
      • Extends from its origin until the choroidal fissure; measures ~2.5 cm
    • Plexal/Intraventricular segment (3-10 perforators)
      • Plexal point: where anterior choroidal artery enter temporal horn
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  • Supplies
    • Visual system: Inferior optic chiasm, Posterior portion of optic tract, Optic radiation, Lateral geniculate body
    • Temporal lobe: Uncus, Parahippocampal gyrus, Amygdala, Choroid plexus, Temporal horn, Atrium
    • Basal ganglia: Globus pallidus medial, Tail of caudate, Internal capsule (genu)
    • Diencephalon: Subthalamus, Thalamus (Lateral ventrolateral nucleus, Lateral ventroanterior nucleus)
    • Midbrain: Middle 1/3 of cerebral peduncle, Upper red nucleus, Substantia nigra
  • Very rare to have perforating branches outside of origin of anterior choroidal artery
  • Anastomoses with lateral posterior choroidal artery
  • Anterior choroidal artery-Clinical
    • Use to be ligated to tx Parkinson's in the past
    • Aneurysm: located superior/superiorlaterally to origin of anterior choroidal artery
    • Stroke → Anterior choroidal artery syndrome: (3H)
      • Hemisensory loss
      • Hemiplegia
      • Homonymous hemianopia
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Difference between PCOM vs Anterior choroidal artery
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Features
Anterior choroidal
PComA
Origin
More distal
More proximal
Size
Smaller
Larger
Direction of travel
Has a superior hump (plexal point) where it passes through the inferior choroidal point to enter the temporal horn.
Goes up and down the straight back up and usually bifurcates
Relation between each
More lateral
More medial
Medial posterior choroidal artery (MPChAs)
  • Origin:
    • They arise most frequently from the posteromedial aspect of the proximal part of the PCA (P1 or P2) in the interpeduncular and crural cisterns.
  • Course
    • Travels inferior and medial to the PCA through the crural → ambient cisterns and turns medially to enter the quadrigeminal cistern.
    • Passes beneath the splenium of the corpus callosum
    • The artery then turns forward to enter the velum interpositum and supplies the choroid plexus in the roof of the third ventricle
  • Destination: Lateral + 3rd ventricle
  • Supplies:
    • Cerebral peduncle
    • Tegmentum
    • Geniculate bodies (medial > lateral)
    • Colliculi
    • Pulvinar
    • Pineal gland
    • Medial thalamus
In this picture the MPCA and LPCA are coming from the same artery, this is not correct. Most pt have these two artery arising from the PCA separately
In this picture the MPCA and LPCA are coming from the same artery, this is not correct. Most pt have these two artery arising from the PCA separately
Lateral posterior choroidal artery (LPChAs)
  • Origin: They arise from the PCA (most commonly the P2P segment) or its cortical branches in the ambient and quadrigeminal cisterns.
  • Course
    • They pass laterally around the pulvinar
    • Course laterally along the upper edge of the parahippocampal gyrus within the ambient cistern
    • Pass through the choroidal fissure to enter the posterior part of the temporal horn and atrium
      • enters the ventricle adjacent to the lateral geniculate nucleus through the choroid fissure
  • Destination: temporal horn of lateral ventricle
  • The number of LPChAs in a hemisphere averages four (ranging from one to nine).
  • Supplies:
    • Cerebral peduncle
    • Posterior commissure
    • Fornix (Part of crura and body)
    • Lateral geniculate body
    • Pulvinar
    • Dorsomedial thalamic nucleus
    • Body of the caudate nucleus
  • Anastomosis with
    • Ant Choroidal Artery
    • Medial Posterior Choroidal Artery
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In this picture the MPCA and LPCA are coming from the same artery, this is not correct. Most pt have these two artery arising from the PCA separately
In this picture the MPCA and LPCA are coming from the same artery, this is not correct. Most pt have these two artery arising from the PCA separately
Images
The top sagittal photo in the current figure illustrates the anatomic relationship of the MPChA to the third ventricle. The middle image demonstrates the more proximal anatomy of the LPChA through the left temporal horn (viewing from inside the temporal horn out), whereas the bottom photo shows the MPChA anatomy relative to the third ventricle from an inferior point of view
The top sagittal photo in the current figure illustrates the anatomic relationship of the MPChA to the third ventricle. The middle image demonstrates the more proximal anatomy of the LPChA through the left temporal horn (viewing from inside the temporal horn out), whereas the bottom photo shows the MPChA anatomy relative to the third ventricle from an inferior point of view
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Infratentorial choroidal arteries

  • Upper: Posterior or suboccipital view.
    • The choroid plexus is composed of
      • 2 medial segments.
        • Each medial segment is divided into a
          • Rostral or nodular part
          • Caudal or tonsillar part
      • 2 lateral segments.
        • Each lateral segment is divided into a
          • Medial or peduncula part
          • Lateral or floccular part
    • The medulla, fourth ventricle, vertebral arteries, and origin of the PICAs are below.
    • The choroidal arteries arise from the
      • PICA
      • SCA
      • AICA.
    • The choroid plexus is attached to the tela choroidea, which is attached to the taenia along the border of the floor of the fourth ventricle.
  • Lower: Anterolateral view.
    • The choroid plexus is seen through the brainstem.
    • The AICA arises from the basilar artery and sends branches that enter the choroid plexus near the flocculus.
    • The SCA may also send choroidal branches to the floccular part of the choroid plexus.
  • Right Center: Diagram showing subdivision of the choroid plexus into medial and lateral segments.
    • The medial segments have nodular and tonsillar parts and the lateral segments have peduncular and floccular parts.
    • The floccular parts protrude through the foramina of Luschka, and the tonsillar parts extend through the foramen of Magendie.
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Abbreviation

Abbreviation
Full Form
Abbreviation
Full Form
Abbreviation
Full Form
A.
Artery
Gen.
Geniculate
Plex.
Plexus
Ac.
Acoustic
He.
Hemispheric
Pon.
Pontine
A.I.C.A.
Anteroinferior cerebellar artery
Hem.
Hemispheric
Post.
Posterior
Ant.
Anterior
Hypogl.
Hypoglossal
Premeat.
Premeatal
Atl.
Atlanto
Inf.
Inferior
Prox.
Proximal
B.A.
Basilar artery
Int.
Intermediate
Quad.
Quadrigeminal
Bas.
Basilar
Intermed.
Intermedius
Rec.
Recurrent
Bivent.
Biventral
labyr.
Labyrinthine
Ro.
Rostral
Bo.
Body
L.
Long
Rost.
Rostral
Br.
Branch
Lat.
Lateral
S.
Short
Bridg.
Bridging
Lig.
Ligament
S.C.A.
Superior cerebellar artery
Ca.
Caudal
Marg.
Marginal
Seg.
Segment
Caud.
Caudal
Meat.
Meatal
Sp.
Spinal
Cer.
Cerebellar
Med.
Medial, median, medullary
Str.
Straight
Cer. Med.
Cerebellomedullary
Men.
Meningeal
Suboccip.
Suboccipital
Cer. Mes.
Cerebellomesencephalic
Mes.
Mesencephalic
Sulc.
Sulcus
Cer. Pon.
Cerebellopontine
Mid.
Middle
Sulcare.
Sulcature
Ch.
Choroid, choroidal
Mod.
Moderate
Sup.
Superior
Chor.
Choroid
N.
Nerve
Tent.
Tentorial
Circ.
Circumflex
No.
Nodular
To.
Tonsillo
Cist.
Cistern
Nerv.
Nervus
Ton.
Tonsillar
CN
Cranial nerve
Nucl.
Nucleus
Tr.
Trunk
Co.
Communicating
O.
Optic
Trans.
Transverse
Cochl.
Cochlear
Occ.
Occipital
Trig.
Trigeminal
Coll.
Colliculus
Paramed.
paramedian
V.A.
Vertebral artery
Cran.
Cranial
P.
Posterior
V.
Vein
Dent.
Dentate
P.C.A.
Posterior cerebral artery
Ve.
Vermian
Dup.
Duplicate
Pe.
Peduncular
Vel.
Velum
F.
Foramen
Ped.
Peduncle
Vent.
Ventral, ventricle
Fiss.
Fissure
Perf.
Perforating
Verm.
Vermian
Fl.
Floccular
Pet.
Petrosal
Vert.
Vertebral
Flocc.
Flocculus
P.I.C.A.
Posteroinferior cerebellar artery
Vest.
Vestibular
For.
Foramen
Pl.
Plexus
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