We examined anastomoses among the hypothalamic arteries in 14 human brains using an injection technique, microdissection, and a stereoscopic microscope. Five to 22 anastomoses (mean 10.1) were found in all 14 brains on each side, varying from 20 to 280 (mean 71) /*m in diameter and from 0.1 to 5.3 (mean 1.52) mm long. A single hypothalamic artery may be connected to other vessels by one to 10 anastomoses. The anastomoses were channel-like or plexiform; both types may be ipsilateral or right-left. They connected the hypothalamic arteries "end-to-end," "end-to-side," and "side-to-side." The interconnected arteries ranged from 30 to 1,900 (mean 148) /xm in diameter. Anastomoses were most frequent among the commissural arteries and in the distribution of the superior hypophyseal arteries and the tuberoinfundibular branches of the posterior communicating artery. The largest anastomoses were found among the tuberoinfundibular branches of the posterior communicating and internal carotid arteries, as well as among the premamillary arteries and the mamillary branches. We discuss the neurologic, neuroendocrinologic, and neurosurgical significance of the described anastomoses. {Stroke 1989;20:1341-1352) M ost previous studies dealing with the anatomic examination of the hypothalamic arteries 1 -8 have only mentioned the presence of a "circuminfundibular plexus" without giving any information about the frequency, number, or size of the anastomoses within the plexus. Others 9 -12 drew special attention only to capillary connections and not to arterial anastomoses in the hypothalamopituitary region. Hence, there is an obvious lack of data concerning anastomoses among the hypothalamic arteries. These anastomoses could be of great neurologic, neuroendocrinologic, and neurosurgical significance for several reasons. Neurologists need information about the vascular pattern in the hypothalamic region to predict the risk of ischemic damage in that region following thromboembolic events and other pathologic processes that may compromise local blood flow; neurosurgeons, who perform delicate operations in the perichiasmatic, tuberal, and interpeduncular regions, must have detailed information on the hypothalamic microvasculature; and, finally, ongoing presence of Received October 17, 1988; accepted May 17, 1989. these anastomoses could be a way of locally regulating neurosecretory activity.Subjects and Methods We examined 28 sets of hypothalamic arteries in 14 brains of individuals aged 28-67 years. Each brain was carefully removed from the skull after cutting the internal carotid arteries (ICAs), optic nerves, and pituitary stalk as low as possible. Plastic catheters were placed in the basilar artery and in both ICAs. In most instances, the main stems of the middle cerebral and anterior choroidal arteries were ligated, as were the distal segments of the anterior cerebral arteries (ACAs) and the posterior cerebral arteries (PCAs). Thereafter, the components of the circle of Willis were irrigated with isotonic saline and injected wit...