Cerebrovascular morphology: Insights into normal variations, aging effects and disease implications

Abstract Cerebrovascular morphology plays a critical role in brain health, influencing cerebral blood flow (CBF) and contributing to the pathogenesis of various neurological diseases. This review examines the anatomical structure of the cerebrovascular network and its variations in healthy and diseased populations and highlights age-related changes and their implications in various neurological conditions. Normal variations, including the completeness and anatomical anomalies of the Circle of Willis and collateral circulation, are discussed in relation to their impact on CBF and susceptibility to ischemic events. Age-related changes in the cerebrovascular system, such as alterations in vessel geometry and density, are explored for their contributions to age-related neurological disorders, including Alzheimer’s disease and vascular dementia. Advances in medical imaging and computational methods have enabled automatic quantitative assessment of cerebrovascular structures, facilitating the identification of pathological changes in both acute and chronic cerebrovascular disorders. Emerging technologies, including machine learning and computational fluid dynamics, offer new tools for predicting disease risk and patient outcomes based on vascular morphology. This review underscores the importance of understanding cerebrovascular remodeling for early diagnosis and the development of novel therapeutic approaches in brain diseases.