Recurrent artery of Heubner - morphological variations

Recurrent artery of Heubner (RAH) is the largest and most constant perforating branch of anterior cerebral artery. It supplies blood to the medial portion of the orbitofrontal cortex, the anterior portion of the caudate nucleus, the anterior third of the putamen, the external segment of the globus pallidus, and the anterior crus of the internal capsule The anatomical variation of RAH is related to its traject, number, presence, or absence, and the diverse origin from ACA is of considerable clinical impact mainly from the point of view of the surgical procedures involving the anterior portion of the circle of Willis or the topographically related structures. The present study aimed to demonstrate vascular anatomy of this RAH and its variation. The study included 60 human cadaveric brains fixed in the formalin and examined under operating microscope. 22 freshly harvested human cadaveric brains, injected with a polymer (Technovit 7143), a partial coroded and also we have consulted 30 digital subtraction angiograms. We have evaluated the origin, traject and caliber of recurrent artery of Heubner, our results were compared with other anatomical studies published. The most obvious finding was the great variability of its origin but in 91% of the cases it was in the range of 2mm around anterior communicating artery, that could be harmed during aneurismal clipping. The RAH is commonly arising from ACA-ACoA junction. This portion of the circle of Willis is the place of many anatomical variations and malformations. The vessel can be absent, single, or multiple, and its diameter is highly variable. The awareness of these distinct anatomical and morphometric variations of the RAH is essential in planning the neurosurgical procedures in the anterior part of the circle of Willis to avoid the unexpected neurological complications.