Microsurgical Anatomy of the Anterior Cerebral Artery

Lee, Je Hyuk

Abstract

The microsurgical anatomical characteristics of the anterior cerebral artery(ACA) are described. Inequality of horizontal segment of ACA has been reported. The majority of anterior communicating artery (ACoA) aneurysms occur in association with dominance of one A1 and hypoplasia of the other. ACoA has variation such as dimple, fenestration duplication, string, median artery of the corpus callosum and azygos anterior cerebral artery. ACoA gives rise to the perforating branches which feed subcallosal, hypothalamic area and optic chiasm. The recurrent artery of Heubner arises at A1-A2 junction, proximal A2 or distal A1. The distal ACA gives origin to many cortical branches, but there is the large variety of their origin. The aneurysm arising from A1 could be clipped through the pterional route, and those of distal ACA throuph the interhemispheric approach. ACo aneurysm could be approached through pterional or interhemspheric route. Essential points in ACo aneurysm surgery through any approach are to confirm H complex and to clip aneurysmal neck precisely without compromising feeding arteries or perforating branches.