Anatomical variations of the recurrent artery of Heubner: number, origin, and course

Abstract

The clinical anatomy of the recurrent artery of Heubner (RAH) was examined, focusing on its number, origin, and course, in a large number of brain specimens. We studied 724 RAH in total from 357 brain specimens (714 hemispheres). In 98.74 % of 714 cases there were one or more RAHs, while it was absent in 1.26 % of cases. There was a single RAH in 96.22 % of cases, double in 2.38 % of cases, and triple in 0.14 % of cases. In this study, three origin types of the RAH were defined. We defined A1 and A2 segment of the anterior cerebral artery (ACA) as the artery from the origin of the ACA to the junction of the anterior communicating artery (AComA) and the artery from the junction of the AComA to the anterior border of the corpus callosum, respectively. In 76.2 % of 724 arteries, the RAH originated from the junction of the A1 and A2 segment of the ACA. In 16.3 %, the RAH originated from the A2 segment of the ACA. In 7.5 %, the RAH originated from the A1 segment of the ACA. The course of the RAH was superior to the A1 segment of the ACA in 30.1 % of 724 arteries, anterior in 62.2 %, and posterior in 7.7 %. It is of great importance for neurosurgeons to understand the detailed anatomical variations of the RAH before operating to prevent operative complications resulting in neurological deficits.

Utility of evoked potentials during anterior cerebral artery and anterior communicating artery aneurysm clipping

“…Perforators that arise from the proximal ACA supply the genu of the internal capsule that contain the pyramidal tract corresponding to the upper extremity and face ( Dunker and Harris, 1976 ). The largest of the perforators, the RAH typically arises from the ACA at the junction between the ACA and ACoA in approximately 40% to 76% of cases according to cadaveric studies ( Maga et al, 2013 , Matsuda et al, 2018 ). The RAH may rarely originate from other Circle of Willis vessels, be duplicate, or not exist ( Matsuda et al, 2018 ).…”

“…The largest of the perforators, the RAH typically arises from the ACA at the junction between the ACA and ACoA in approximately 40% to 76% of cases according to cadaveric studies ( Maga et al, 2013 , Matsuda et al, 2018 ). The RAH may rarely originate from other Circle of Willis vessels, be duplicate, or not exist ( Matsuda et al, 2018 ). Identification of the RAH and more proximal ACA-derived perforators during surgical manipulation may be challenging because of distorted anatomy and an unusual rate of anatomical variations, particularly in patients with SAH ( Perlmutter and Rhoton, 1976 ).…”