Embryology and variations of the recurrent artery of Heubner

Neuroimaging of middle cerebral artery anomalies: a report of three cases

PURPOSE

This is a description of the main middle cerebral artery (MCA) anomalies from the neuroradiological and embryological point of view, discussing the practical implications and the association with other vascular diseases.

METHODS

Among the patients who underwent digital subtraction angiography (DSA) at our institution in a short time period (from 1 January 2021 to 31 December 2023), we selected three cases with high-quality images, representative for the main MCA anomalies, i.e., accessory, duplicated, and twig-like MCA.

RESULTS

We describe a series of three cases, illustrating the three main embryological anomalies of MCA, including accessory MCA, duplicated MCA, and twig-like MCA. All patients underwent neuroradiological investigations at our institution because of the acute occurrence of neurological symptoms and the findings are presented using computed tomography angiography (CTA), magnetic resonance angiography (MRA), and DSA with a detailed description. These three variants have a very low prevalence and they were reported and described more systematically in the Asian population than in the European population. Both noninvasive and invasive neuroimaging techniques were used for investigating these patients, and catheter angiography still provides the more informative content for precisely imaging the angioarchitecture of these variants and the association with aneurysms on other cerebral arteries. The knowledge of the embryology of these variants is of paramount importance in order to make easier their identification and reporting and to enhance their understanding.

CONCLUSIONS

MCA anomalies should be known and carefully checked in order to avoid misdiagnosis with disease and may affect the treatment of acute stroke.

The prevalence and anatomy of recurrent artery of Heubner: a meta analysis with neurosurgical considerations

BACKGROUND

The recurrent artery of Heubner (RAH) is typically the largest medial lenticulostriate branch of the anterior cerebral artery (ACA). Neurosurgical procedures such as aneurysm treatment on the anterior part of the circle of Willis can result in damage of the RAH leading to neurological deficits. The aim of this study was to identify the gaps and provide comprehensive data on the prevalence and anatomical characteristics of the RAH with neurosurgical considerations.

METHODS

The major electronic databases were thoroughly searched to identify the eligible studies. The information concerning study type, geographical origin, prevalence of the RAH, course and origin of the RAH, symmetry of origin and number of RAHs in each hemisphere, and morphometric data were extracted. The PRISMA guidelines were rigorously followed throughout the study. The AQUA tool was used to evaluate the reliability of included studies.

RESULTS

A total of 34 studies (n = 3645 hemispheres) were included in the meta-analysis. The analysis revealed that the RAH was present in 97.5% (95%CI: 95.5-98.6) of the hemispheres, originating most frequently from the A2 segment (42.2%, 95%CI: 35.0-49.7) or the ACoA-ACA junction (41.6%, 95%CI: 34.0-49.6), and coursing anteriorly (47.6%, 95%CI: 38.7-56.6) or superiorly (43.9%, 95%CI: 34.4-53.8) in relation to ACA. Almost a quarter of patients had more than one RAH, which was on average 22.82 mm (SD: 1.35, 95%CI: 20.16-25.47; I2 = 99.1%, p < 0.01) long and reached 0.76 mm (SD: 0.05, 95%CI: 0.66-0.85; I2 = 99.4%, p < 0.01) in diameter.

CONCLUSIONS

As the RAH is present in the majority of the population, it is important to be aware of the wide variations in its anatomy. This will help to prevent postoperative neurological deficits by avoiding undesirable complications during surgeries that are performed in close proximity to the anterior segment of the circle of Willis.

Anatomical Variations and Anomalies of the Anterior Communicating Artery Complex

BACKGROUND

Intracranial arteries have a high rate of variation, but a clear schematic overview is lacking. In this pictorial review we classify and depict all variations and anomalies within the anterior communicating artery complex.

METHODS

PubMed was searched with the terms "Anterior Communicating Artery" AND "Variations" OR "Anomalies." Articles were selected based on their description of variants. Cross-referencing was used to broaden the range of variations. Surgical view during pterional craniotomy and transsylvian approach was used as a baseline for schematic drawings of the variations.

RESULTS

A total of 42 variants were identified, schematically drawn and classified into A1-A2 segment, anterior communicating artery, and the recurrent artery of Heubner.

CONCLUSIONS

The anterior communicating artery complex consists of the anterior cerebral artery, anterior communicating artery and the recurrent artery of Heubner. An overview of these variations may be helpful in distinguishing pathology from anatomical variations, assist neurosurgeons during clipping of cerebral aneurysms, and support interventional radiologists during endovascular treatments. This article summarizes the current knowledge of anatomical variations within the anterior communicating artery complex, their prevalence and clinical relevance. A total of 42 variants were identified and schematically depicted. We encourage all who diagnose, treat, and study the anterior communicating artery complex to use this overview for a uniform and better understanding of its anatomy.

A Ruptured Anterior Communicating Artery Aneurysm with Infra-optic Course of the Anterior Cerebral Artery: A Case Report and a Short Review

Infra-optic course of the anterior cerebral artery (IOA) is rare and approximately 55 cases of this anomaly have been described. We present a case of a ruptured anterior communicating artery (ACoA) aneurysm arising at the junction between the left IOA and the bilateral A2 segments, at which the right A1 segment was absent. One of the recurrent arteries of Heubner branched off directly from the aneurysmal dome, and was obstructed at aneurysmal neck clipping via an anterior interhemispheric (AIH) approach. In this report, accompanied anatomical variations and surgical approaches for ACoA aneurysms with IOA are reviewed. An IOA is frequently associated with other vascular anomalies, and the origin of functionally important recurrent arteries of Heubner is also variable. Preoperative accurate evaluation of vessel structures and the maximal exposure at surgery are very important. Pterional approach from the ipsilesional side is reportedly to be safe, but interhemispheric approach is also suggested to be effective as to full exposure to recognize the perianeurysmal anatomical structures including potential vessel anomalies.

Embryological Lateral Striate Artery Variants : Revised Concept of Recurrent Artery of Heubner, the Perforators to the Anterior Perforated Substance and Middle Cerebral Artery Variants

PURPOSE

The anterior perforating arteries are a group of arteries that enter the brain through the anterior perforated substance (APS). Because the lenticulostriate artery, the recurrent artery of Heubner (RAH) and the perforators from A1 of anterior cerebral artery (ACA) penetrate the APS and supply the basal ganglia, these arteries can be considered as having a common embryological origin.

RESULTS

During development, the lateral striate arteries are divided from the lateral olfactory artery and divided into the RAH and middle cerebral artery (MCA). The RAH is a fascinating artery for its early development and variations of origin and course. The MCA has also several variations, such as the duplicated MCA, accessory MCA, and fenestration.

CONCLUSION

We provide a review of embryologic development and anatomical variations of the RAH, the perforators to the APS and MCA as a group of the lateral striate artery.