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Neurol India. 2019 May-Jun;67(3):823-828. doi: 10.4103/0028-3886.263174.

Intraoperative microsurgical anatomy of the anterior communicating artery complex harbouring an anterior cerebral territory aneurysm.

Author information

1
Department of Neurosurgery, Govind Ballav Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India.

Abstract

Background:

The vascular anatomy of the anterior communicating artery complex (ACAC), the most frequent site of occurrence of aneurysms, is complex and associated with many anatomical and morphological variations.

Aims:

The aim of this study was to determine the anatomical variations of ACAC in the Indian population.

Setting and Design:

This was an observational study.

Materials and Methods:

Sixty-two patients of ACAC aneurysms were subjected to clipping, and intraoperative microsurgical details were analyzed.

Results:

Twenty-two (35.48%) patients had anatomical and morphological variations that were more common on the right side. Right A1 was hypoplastic in 5 (8.06%), aplastic in 2 (3.22%), and tortuous in 1 (1.61%) patient. Left A1 was aplastic in 3 (4.83%), hypoplastic in 1 (1.61%) and prominent in 2 (3.22%) patients. One patient (1.61%) had a prominent left A2 segment and 2 (3.22%) had a prominent right A1 and A2 segment. Two patients (3.22%) had fenestration of the ACAC and 3 (4.83%) had the median artery of corpus callosum. The recurrent artery of Heubner was identified in only 44 (70.96%) patients, and in these patients, distinct anatomical variations were noted. Eleven patients were found to present with a parent vessel anomaly, having a total of 23 (mean, 2.09) perforators arising from ACAC, whereas those without a parent vessel anomaly had a total of 57 (mean, 1.11) perforators. This difference was statistically significant.

Conclusion:

The ACAC region is the area of highest anatomical and morphological variability. This variability is even more exhaustive when associated with aneurysmal formation. A sound anatomical knowledge of the perforators and their preservation during the surgical management of the ACAC is of paramount importance for ensuring a good clinical outcome of patients.

KEYWORDS:

Anterior communicating arterial complex; aplasia; fenestration; hypoplasia; perforators; recurrent artery of Heubner

PMID:
31347561
DOI:
10.4103/0028-3886.263174
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