**Part 4**

**Procedures & Neuroscience** 

172 Neuroimaging for Clinicians – Combining Research and Practice

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pp. S15-S21

**10** 

*USA* 

*1Department of Neurosurgery,* 

**Intracranial Arterial Collateralization:** 

Peng R. Chen1, Adnan H. Siddiqui2 and Peng Roc Chen3

*2Department of Neurosurgery, School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, New York, 3Department of Neurosurgery University of Texas Medical School at Houston,* 

*University of Texas Medical School at Houston, Houston, Texas;* 

**Relevance in Neuro-Endovascular Procedures** 

Endovascular strategies for addressing intracranial and extracranial diseases continue to gain momentum. These techniques are limited principally by technology and imagination. As newer devices and implements are introduced to the endovascular surgeon, more diseases previously construed to be the realm of open surgery or untreatable are becoming amenable to endovascular interventions. Because of the nature of endovascular procedures, with liquid agents, flow-directed therapies, and embolic materials, it is critical for a neuro-interventionalist to be aware of the collaterals that exist between the vessels being embolized and other critical collaterally connected vessels, occlusion of which may result in undesirable outcomes. Similarly, for other occasions, such collaterals may provide unique conduits that may afford access in novel ways to the intracranial or extracranial circulation. The understanding of these collaterals is best undertaken with an initial understanding of the development of the cranial vasculature. The rich anastomotic connections and interlinked development shed great light and provide a firm basis for understanding the cranial collaterals. Secondly, the collateral circulation may be divided by collaterals between extracranial and intracranial systems on one hand and collaterals between the internal carotid and vertebrobasilar (VB) systems on the other. In this chapter, we endeavor to provide a brief overview of cranial vascular development, followed by specific clinically relevant examples of extracranial and intracranial anastomoses and the internal carotid artery (ICA) and vertebrobasilar (VB) anastomoses,

The cranial vasculature begins with the development of a vascular supply to the paired pharyngeal arches. This supply develops as vascular arches that emanate from the ventral aortic sac connect with the paired dorsal aortae. Each pharyngeal arch gets its own vascular arch. These vascular arches then develop and regress in rostrocaudal fashion. The pharyngeal arches become apparent at approximately 3 to 4 weeks' gestation. The pharyngeal arches develop plexiform vascular channels that ultimately connect the ventral aortic sac with the paired dorsal aortae, forming the vascular arch. The first arch gives rise to

**1. Introduction** 

intracranial and intracranial anastomoses.

**2. Cranial vascular embryology** 
