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Oper Neurosurg (Hagerstown). 2019 Jun 1;16(6):734-742. doi: 10.1093/ons/opy308.

Proximal Branches of the Anterior Cerebral Artery: Anatomic Study and Applications to Endoscopic Endonasal Surgery.

Author information

1
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
2
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California.

Abstract

BACKGROUND:

The endoscopic endonasal approach is a surgical alternative for midline anterior skull base tumors. A detailed understanding of the proximal anterior cerebral artery (ACA) branches' anatomy from an endonasal perspective is essential for avoiding vascular complications.

OBJECTIVE:

To evaluate, from an endonasal perspective, the anatomic variations of the ACA and its proximal branches, specifically the recurrent artery of Heubner (RAH), and the fronto-orbital (FOA) and frontopolar (FPA) arteries.

METHODS:

We study the origin, course, branching pattern, diameter, and relationship between the proximal ACA branches and the optic apparatus and olfactory tract in 25 head specimens.

RESULTS:

The RAH was present in all hemispheres and originated within 3 ± 1.5 mm of the AcomA, with a 0.4 ± 0.1 mm diameter. Based on its relationship with the A1 segment, we observed three RAH courses: anterior (40%), superior (22%), and posterior (38%). The FOA was present in all cases, a mean of 6 ± 4 mm from the AcomA, with a 0.7 ± 0.4 mm diameter. The FOA arose mainly from the A2 (70%), with three courses in relation to the olfactory tract: crossing its proximal third (54%), crossing its middle third (31%), and running parallel to it along the gyrus rectus (15%). The FPA was present in 92% of the hemispheres, a mean of 10 ± 5 mm from the AcomA, always arising from the A2 and coursing anteriorly within the interhemispheric fissure towards the frontal pole.

CONCLUSION:

The RAH, FOA, and FPA can be differentiated by origin, course, and destination using the A1 segment, olfactory tract, and interhemispheric fissure, respectively, as surgical landmarks.

KEYWORDS:

Anterior cerebral artery; Anterior communicating artery; Endoscopic endonasal surgery; Fronto-orbital artery; Frontopolar artery; Recurrent artery of Heubner; Suprasellar suprachiasmatic region

PMID:
30649510
DOI:
10.1093/ons/opy308

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