Microsurgical anatomy of the anterior cerebral-anterior communicating-recurrent artery complex

TLDR

The recurrent artery of Heubner is frequently exposed before the A‑1 segment and its occlusion, along with perforators from the ACoA and A‑1 segments, can have significant clinical consequences. The study mapped microvascular relationships in the anterior communicating region using 50 cadaveric brains. The recurrent artery of Heubner arose from the A‑2 segment in 78 % of cases and usually terminated in the anterior perforated substance, while the ACoA frequently gave rise to perforating branches that supply the optic chiasm and hypothalamus; the proximal A‑1 segment was a richer source of perforators than the distal half, and numerous variants such as double or triple ACoA’s, triple A‑2 segments, and duplicated A‑1 segments were observed.

Abstract

The microvascular relationships important to surgery of aneurysms in the anterior communicating region were defined in 50 cadaver brains. The recurrent artery of Heubner was frequently exposed before the A-1 segment in defining the neck on anterior cerebral aneurysms because it commonly courses anterior to A-1. It arose from the A-2 segment of the anterior cerebral artery (ACA) in 78% and most commonly terminated in the area of the anterior perforated substance, and lateral to it in the Sylvian fissure. The anterior communicating artery (ACoA) frequently gave rise to perforating arteries which terminated in the superior surface of the optic chiasm and above the chiasm in the anterior hypothalamus. This finding contrasts with previous reports that no perforating branches arise from the communicating artery. The proximal half of the A=1 segment was a richer source of perforating arteries than the distal half. The A-1 branches most commonly terminated in the anterior perforated substance, the optic chiasm, and the region of the optic tract. The ACoA increased in size as the difference in the diameter between the right and left A-1 segments increased. Frequent variants such as double or triple ACoA's, triple A-2 segments, and duplication of the A-1 segments were encountered. The clinical consequences of occlusion of the recurrent artery and of the perforators from the ACoA and medial and lateral segment of A-1 are reviewed.