A study of the anatomy of the anterior communicating artery with the aid of the operating microscope

doi:10.1016/S0303-8467(78)80038-9

Clinical Neurology and Neurosurgery

Volume 80, Issue 3, 1978, Pages 169-173

https://doi.org/10.1016/S0303-8467(78)80038-9 Get rights and content

Summary

The anatomy of the Anterior Communicating Artery complex is studied with the aid of the Zeiss operating microscope in 75 human brains removed at autopsy. The variations in the structure of the Anterior Communicating Artery and the A₁ and A₂ segments of the Anterior Cerebral Artery are reported.

Special attention is given to the site of origin and number of branches from the Anterior Communicating Artery and the site of origin of Heubner's arteries.

The necessity of using the operating microscope during surgical treatment of aneurysms of the Anterior Communicating Artery complex is stressed.

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Cited by (27)

Detailed description of the anterior cerebral artery anomalies observed in a cadaver population
2016, Annals of Anatomy
Citation Excerpt :
This is in accordance with the range indicated in the literature (Table 1, 0.9–33.3%). In six of the seven cases, the MedACA originated from the AcoA which is consistent with reports by previous authors (Fawcett and Blachford, 1905; Critchley, 1930; Tulleken, 1978; Okahara et al., 2002; Rhoton, 2002; Hussain et al., 2005; Kahilogullari et al., 2008; Kapoor et al., 2008; Pekcevik et al., 2012; Makowicz et al., 2013). Few studies comment on the regions that are supplied by the MedACA, although comments have been made on whether one or both hemispheres are supplied (Baptista, 1963).
Anomalies of the anterior cerebral artery (ACA) include the median ACA (MedACA), bihemispheric ACA (BihemACA) and the azygos ACA. Knowledge of these anomalies can be crucial to clinicians and neurosurgeons, especially during surgeries involving the interhemispheric region and in the interpretation of the clinical signs of a stroke. Since few reports exist on the origin, area supplied, diameter and length of the ACA anomalies, the aim of this study is to give a detailed description on the anatomy of the ACA anomalies.
The ACAs of 60 brains were injected with a colored silicone. When an anomaly was observed, a detailed illustration of the course and pattern of the ACA and cortical branches were made. The origins and the areas supplied by the anomalous arteries were noted. The external diameter was measured using a digital micrometer and the length was measured using string and a ruler.
There were seven cases (11.7%) of a MedACA and 12 cases (20.0%) of a BihemACA. The MedACA originated mostly from the anterior communicating artery, and from the A2 segment in one case. The MedACA was bilateral in four cases and unilateral in three cases. Excluding Cases 5 and 9, the BihemACA cases can be divided into two groups; one branch to the left hemisphere (n = 3), and one branch to the right hemisphere (n = 7). The average diameter of both the BihemACA and MedACA was 1.8 mm.
Studies rarely provide additional information on these anomalies. Therefore, the present study elaborated on the origin, diameter, length and the area supplied by these anomalies. The definitions are described in the literature, although additional criteria were still lacking and this was provided in the present study. Since information on these aspects of the ACA anomalies is scarce, future research should give detailed descriptions on the ACA anomalies.
Clinical significance of blood supply to the internal capsule and basal ganglia
2016, Journal of Clinical Neuroscience
Citation Excerpt :
The premamillary branch of the PComA does not participate in the perfusion of the basal ganglia [50–52], but some authors claim that it may supply the genu of the internal capsule, or the most proximal part of the posterior limb of the capsule [6,16]. The AComA perforators do not contribute to the vascularization of the capsule and the basal ganglia [57–60]. All the other perforating branches, that is those of the ICA, ACA, MCA and AChA (Fig. 2), perfuse most of the internal capsule and basal ganglia [30–49].
Although the general vascular supply of the basal ganglia and internal capsule is well known, precise data are lacking regarding the variations of the vascular territories in the two regions. Twelve hemispheres were studied following an injection of coloured ink into the main cerebral arteries, namely the anterior cerebral (ACA), middle cerebral (MCA), anterior choroidal (AChA) and posterior cerebral artery (PCA). Serial sections of the injected hemispheres were taken in the axial or coronal plane. In 75% of the hemispheres, ACA perforators were seen to supply the inferomedial part of the head of the caudate nucleus and the anterior limb of the internal capsule, as well as the anterior and inferior portions of the putamen and globus pallidus. The MCA vessels perfused the superolateral part of the head and body of the caudate nucleus, the superior part of the entire internal capsule, most of the putamen and part of the globus pallidus. The AChA perforators perfused the medial segment of the globus pallidus, the inferior part of the posterior limb, the retrolenticular and sublenticular portions of the internal capsule, and occasionally its genu. The same segment of the globus pallidus and the inferior part of the genu of the internal capsule were most likely supplied by the perforators of the internal carotid artery. A predominance of ACA territory was noticed in one specimen (8.33%) and a predominance of MCA territory in two specimens (16.67%). The obtained anatomical data may help radiologic determination of perforators involved in ischemic events, as well as a better understanding of the neurological deficits in the same events.
Microsurgical anatomy of perforating branches of anterior communicating artery
2015, Morphologie
L’artère communicante antérieure (ACoA) est à l’origine des branches perforantes destinées au chiasma optique, à l’hypothalamus et au corps calleux. Les branches perforantes peuvent être variables et leur connaissance est indispensable au bon déroulement des interventions chirurgicales de cette région. Leur sacrifice débouche sur des complications post-opératoires ischémiques.
L’objectif était d’actualiser la connaissance anatomique à propos des branches perforantes de l’ACoA.
L’étude était menée sur une série de sept cerveaux prélevés sur des cadavres humains frais. Une injection de néoprène était réalisée pour chaque cas et, après prélèvement du cerveau, la région d’intérêt était examinée sous microscope opératoire. Étaient examinés : la longueur de l’ACoA, son calibre, son orientation, sa configuration, ainsi que ses branches perforantes (nombre et territoire vasculaire).
Trois cas sur cinq présentaient une variation anatomique au niveau de l’ACoA. La longueur moyenne de l’ACoA était de 2,1 millimètres (min : 2, max : 2,2), le calibre moyen de l’ACoA était de 1,67 mm (min : 1,1, max : 2,1). Le nombre moyen de branches perforantes était de 4,2 (min : 2, max : 6). La présence d’une artère médiane du corps calleux semblait être en relation avec un faible nombre de branches perforantes. Les branches à destination du chiasma optique étaient les plus nombreuses.
The anterior communicating artery (ACoA) gives perforating branches to the optic chiasma, the hypothalamus and the corpus callosum. Perforating branches are variable (number, direction). Nevertheless, their knowledge is crucial during surgery of this area to spare injuries leading to ischemic post-operative complications.
The objective was to update the anatomical knowledge about perforating branches of the ACoA.
The study was led on a series of seven brains taken from human cadavers. An injection of latex neoprene was performed for every case. The region of interest was observed under operating microscope. Were examined: the length of the ACoA, its diameter, its orientation, its configuration and perforating branches (number and areas).
Three cases on five presented with an anatomical variation at the level of the ACoA. The average length of AcoA was 2.1 millimeters (min: 2, max: 2.2). The average diameter of the ACoA was 1.67 mm (min: 1.1, max: 2.1). The average number of perforating branches was 4.2 (min: 2, max: 6). The presence of a median artery of the corpus callosum seemed to correlated with a low number of perforating branches. Branches supplying the optic chiasma seemed to be more numerous.
Microanatomical study of the recurrent artery of Heubner
2013, Annals of Anatomy
The purpose of this study has been to describe the microanatomy of the recurrent artery of Heubner (RAH) in detail, to deepen anatomical knowledge and aid neurosurgeons in their work.
The material was obtained from cadavers (ages 31–75 years) at routine autopsy. A total of 70 human brains (39 male and 31 female) were examined. People who died due to neurological disorders were not included in the study. Right after dissection, the arteries were perfused with acrylic paint emulsion, through the Circle of Willis or electively through the RAH. Brains were fixed in a 10% solution of formaldehyde, sectioned and placed in methyl salicylate for tissue transparency. To obtain corrosion-casts, the vessels were perfused with polyvinyl chloride or Mercox CL-2R resin and corroded using concentrated potassium chloride. The obtained material was analyzed using a stereoscopic light microscope.
The RAH was present in 138 hemispheres with a mean of 1.99 RAH per hemisphere (275 RAH in total). The mean RAH length was 25.2 mm and the mean RAH diameter, in its place of origin, was 1 mm. Two to 30 branches (mean = 9.4) originated from the stem of the RAH. The number of RAHs showed a negative correlation to the number of arteries from the medial group of lenticulo-striate arteries (LSA) (R = −0.62; p < 0.0001) which branch off the middle cerebral artery (MCA).
This study further supports the RAH embryologic theory by Abbie. The RAH, in its extra- and intracerebral course, may join with the middle group of the LSA or directly with the MCA.
Mixed perfusion: A combined blood supply to the brain tissue by multiple arteries
2010, Journal of Neuroradiology
From intra-arterial angiography studies and recently developed imaging techniques capable of non-invasively visualizing the flow territories of the cerebral arteries at brain tissue level, it is known that brain regions can be fed by multiple arteries simultaneously. This indicates a mixing of blood from separate supplying arteries before reaching the brain tissue. Herein, we aim to explore the various manners blood from different arteries may mix in both healthy individuals and in patients with steno-occlusive disease. Furthermore, the impact of cerebrovascular interventions on the blood flow patterns and its effect on the mixing of the blood supply is discussed. More accurate knowledge and understanding of the vascular sources of tissue perfusion, and potential mixing, may result in more efficient vascular therapies and interventions targeted specifically to affected brain tissue areas.
Microneurosurgical management of aneurysms at the A2 segment of anterior cerebral artery (proximal pericallosal artery) and its frontobasal branches
2008, Surgical Neurology
Citation Excerpt :
The origin of the RAH and its course in relation to the A1 trunk is highly variable. In most cases, it originates from the first few mm of the A2 segment or the A1-A2 junction and in only about 10% from the distal A1 segment [4,15,19,29,55,81,91,93]. Rare origin from the orbitofrontal branch is known [19].
Aneurysms originating from the A2 segment of ACA and its frontobasal branches are rare, forming less than 1% of all IAs. There are only few reports on management of A2As. In this article, we review the practical anatomy, preoperative planning, and avoidance of complications in the microsurgical dissection and clipping of A2As.
This review, and the whole series on IAs, is mainly based on the personal microneurosurgical experience of the senior author (JH) in two Finnish centers (Helsinki and Kuopio), which serve, without patient selection, the catchment area in Southern and Eastern Finland.
These two centers have treated more than 10000 patients with IAs since 1951. In the Kuopio Cerebral Aneurysm Database of 3005 patients and 4253 IAs, there were 35 patients carrying 35 A2As, forming 1% of all patients with IAs, 0.8% of all IAs, and 3% of all ACA aneurysms. Twenty-one (60%) patients presented with ruptured A2As with ICH in 11 (52%) and IVH in 7 (33%). Nineteen patients (54%) had multiple aneurysms.
A2As are often small, even when ruptured, with relatively wide base, and they are frequently associated with ICHs of IVHs. Our data suggest that A2As rupture at smaller size than IAs in general. The challenge is to select appropriate approach, locate the aneurysm deep inside the interhemispheric fissure, and to clip the neck adequately without obstructing branching arteries at the base. Unruptured A2As also need microneurosurgical clipping even when they are small.

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A study of the anatomy of the anterior communicating artery with the aid of the operating microscope

Summary

The recurrent branch of the anterior cerebral artery

Anatomical Record

Studies on the arteries of the brain

Acta Neurol. Scand.

The cerebral arterial supply

Brain

Anatomy and embryology of cerebral circulation

The anterior cerebral artery and its syndromes

Brain

Surgical anatomy of the proximal anterior cerebral artery

J. of Neurosurg.

Recherches anatomiques sur la circulation de l'Encéphale

Arch. de Phys.

Zur Topographie der Ernährungsgebiete der einzelnen Hirnarterien

Zentralblatt für die med. Wissenschaften