Vascular Supply of the Basal Ganglia
The lenticulostriate arteries (LSAs), which originate from the middle cerebral artery (MCA), are the primary vessels that supply the basal ganglia. 1, 2
Anatomical Characteristics of Lenticulostriate Arteries
- LSAs range from 2 to 12 in number and from 0.10 mm to 1.28 mm in diameter, originating primarily from the initial segment of the MCA 1
- They often arise as individual branches (61.76%) with their own common stems, and occasionally from MCA leptomeningeal branches (38.24%) or rarely from the insular segment (2.94%) 1
- LSAs can be categorized into medial, intermediate, and lateral branches, each supplying different portions of the basal ganglia 3
Specific Areas Supplied by Lenticulostriate Arteries
- LSAs supply the lateral half of the caudate nucleus head, the entire putamen, anterior limb, genu, and superior part of the internal capsule, as well as part of the corona radiata 3
- The medial branches perfuse the lateral segment of the globus pallidus, caudate nucleus head, and anterior limb of the internal capsule 3
- The intermediate branches supply the anterior half of the LSA territory, while the lateral branches supply the posterior half 3
Additional Vascular Supply to Basal Ganglia
- Heubner's artery (recurrent artery), a perforator from the anterior cerebral artery (ACA), supplies the inferomedial part of the caudate head, anteromedial putamen, anterior part of the lateral segment of the globus pallidus, and anterior limb of the internal capsule 3
- The anterior choroidal artery (AChA) contributes to basal ganglia blood supply through its superior branches, which supply portions of the internal capsule, globus pallidus, and lateral thalamic nuclei 3
Clinical Significance
- Occlusion of all LSAs can result in a massive central hemispheric infarct, while occlusion of individual LSAs often causes large ganglionic-capsular infarcts 2
- Lacunar infarcts typically result from occlusion of terminal or side branches of the LSAs 2
- In moyamoya disease, the characteristic "puff of smoke" appearance represents abnormal vascular networks in the basal ganglia region due to stenosis of the terminal portion of the internal carotid artery 4
- Proximal MCA stenosis is associated with fewer LSA branches compared to distal stenosis (8.08 ± 1.80 vs. 10.64 ± 2.21), which may increase stroke risk 5
Anatomical Variations
- Common-stem origin of LSAs (CS-LSAs) is an anatomical variation that supplies a moderate to large section of the basal ganglia, observed in approximately 48.5% of patients with deep watershed infarction and MCA occlusion 6
- Extreme variations in the supplying region of LSAs were noted in approximately 14.6% of anatomic specimens 2
Understanding the vascular supply of the basal ganglia is crucial for accurate neurological diagnosis, precise neuroimaging evaluation, and safer neurosurgical approaches to this region.