Normal and abnormal embryology and development of the intracranial vascular system

The brain vascular system develops in such a way that it continuously adapts the supply of oxygen and other nutrients to the needs of the parenchyma. To accompany the developing brain vesicles, it evolves in several steps: superficial meningeal network first; intraventricular choroid plexuses which determine the arterial pattern; penetrating capillaries from the surface to the ventricular germinal matrix forming simple transcerebral arteriovenous loops; cortical capillaries last, mainly in the last trimester. The venous return becomes connected to both the surface and to the choroidal veins, so forming distinct meningeal and subependymal venous drainage systems, while the arteries are on the surface only. While the arterial system was determined early (week 8), the venous system is continuously remodeled by the morphological changes of the base of the skull and the expansion of the brain vesicles. Until late in gestation, the vascular system is made of simple endothelial channels in which the arterial or venous fate is determined primarily by the direction of flow.