Microsurgical anatomy of the distal anterior cerebral artery

David Perlmutter Department of Neurological Surgery, University of Florida Health Center, Gainesville, Florida

Search for other papers by David Perlmutter in
Current site
Google Scholar
PubMed
Close
and
Albert L. Rhoton Jr. Department of Neurological Surgery, University of Florida Health Center, Gainesville, Florida

Search for other papers by Albert L. Rhoton Jr. in
Current site
Google Scholar
PubMed
Close
 M.D.
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $525.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $624.00
USD  $45.00
USD  $525.00
USD  $624.00
Print or Print + Online Sign in

✓ The microsurgical anatomy of the distal anterior cerebral artery (ACA) has been defined in 50 cerebral hemispheres. The distal ACA, the portion beginning at the anterior communicating artery (ACoA), was divided into four segments (A2 through A5) according to Fischer. The distal ACA gave origin to central and cerebral branches. The central branches passed to the optic chiasm, suprachiasmatic area, and anterior forebrain below the corpus callosum. The cerebral branches were divided into cortical, subcortical, and callosal branches. The most frequent site of origin of the cortical branches was as follows: orbitofrontal and frontopolar arteries, A2; the anterior and middle internal frontal and callosomarginal arteries, A3; the paracentral artery, A4; and the superior and inferior parietal arteries, A5. The posterior internal frontal artery arose with approximately equal frequency from A3 and A4 and the callosomarginal artery. All the cortical branches arose more frequently from the pericallosal than the callosomarginal artery. Of the major cortical branches, the internal frontal and paracentral arteries arose most frequently from the callosomarginal artery. The distal ACA of one hemisphere sent branches to the contralateral hemisphere in 64% of brains. The anterior portions of the hemisphere between the 5-cm and 15-cm points on the circumferential line showed the most promise of revealing a recipient artery of sufficient size for an extracranial-intracranial artery anastomosis. The distal ACA was the principal artery supplying the corpus callosum. The recurrent artery, which arose from the A2 segment in 78% of hemispheres, sent branches into the subcortical area around the anterior limb of the internal capsule.

  • Collapse
  • Expand
  • 1.

    Alpers BJ, & Berry RG: Circle of Willis in cerebral vascular disorders. Arch Neurol 8:398402, 1963 Alpers BJ, Berry RG: Circle of Willis in cerebral vascular disorders. Arch Neurol 8:398–402, 1963

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Baptista AG: Studies on the arteries of the brain. II. The anterior cerebral artery: some anatomic features and their clinical implications. Neurology 13:825835, 1963 Baptista AG: Studies on the arteries of the brain. II. The anterior cerebral artery: some anatomic features and their clinical implications. Neurology 13:825–835, 1963

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Beevor CE: On the distribution of different arteries supplying the human brain. Philos Trans R Soc Lond [Biol Sci] 200:156, 1909 Beevor CE: On the distribution of different arteries supplying the human brain. Philos Trans R Soc Lond [Biol Sci] 200:1–56, 1909

    • Search Google Scholar
    • Export Citation
  • 4.

    Blackburn IV: Anomalies of the encephalic arteries among the insane. J Comp Neurol 17:493517, 1907 Blackburn IV: Anomalies of the encephalic arteries among the insane. J Comp Neurol 17:493–517, 1907

    • Search Google Scholar
    • Export Citation
  • 5.

    Critchley M: The anterior cerebral artery, and its syndromes. Brain 53:120165, 1930 Critchley M: The anterior cerebral artery, and its syndromes. Brain 53:120–165, 1930

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Dandy WE: Intracranial Arterial Aneurysms. New York: Comstock Publishing, 1944, p viii Dandy WE: Intracranial Arterial Aneurysms. New York: Comstock Publishing, 1944, p viii

    • Search Google Scholar
    • Export Citation
  • 7.

    Ferguson GG: Physical factors in the initiation, growth, and rupture of human intracranial saccular aneurysms. J Neurosurg 37:666677, 1972 Ferguson GG: Physical factors in the initiation, growth, and rupture of human intracranial saccular aneurysms. J Neurosurg 37:666–677, 1972

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Fischer E: Die Lageabweichungen der vorderen Hirnarterie im Gefässbild. Zentralbl Neurochir 3:300312, 1938 Fischer E: Die Lageabweichungen der vorderen Hirnarterie im Gefässbild. Zentralbl Neurochir 3:300–312, 1938

    • Search Google Scholar
    • Export Citation
  • 9.

    Hamilton JG, & Falconer MA: Immediate and late results of surgery in cases of saccular intracranial aneurysms. J Neurosurg 16:514541, 1959 Hamilton JG, Falconer MA: Immediate and late results of surgery in cases of saccular intracranial aneurysms. J Neurosurg 16:514–541, 1959

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Kempe LG: Personal communication, 1977 Kempe LG: Personal communication, 1977

  • 11.

    Krayenbühl HA, & Yaşargil MG: Cerebral Angiography, ed 2. Philadelphia: JB Lippincott, 1968 Krayenbühl HA, Yaşargil MG: Cerebral Angiography, ed 2. Philadelphia: JB Lippincott, 1968

    • Search Google Scholar
    • Export Citation
  • 12.

    Laitinen L, & Snellman A: Aneurysms of the pericallosal artery. A study of 14 cases verified angiographically and treated mainly by direct surgical attack. J Neurosurg 17:447458, 1960 Laitinen L, Snellman A: Aneurysms of the pericallosal artery. A study of 14 cases verified angiographically and treated mainly by direct surgical attack. J Neurosurg 17:447–458, 1960

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Lazorthes G, , Bastide G, & Gomes FA: Les variations du trajet de la carotide interne d'après une étude artériographique. Arch Anat Pathol 9:129133, 1961 Lazorthes G, Bastide G, Gomes FA: Les variations du trajet de la carotide interne d'après une étude artériographique. Arch Anat Pathol 9:129–133, 1961

    • Search Google Scholar
    • Export Citation
  • 14.

    Lin J, & Kircheff I: Normal anterior cerebral artery complex, in Newton TH, & Potts DG (eds): Radiology of the Skull and Brain, Volume II, Book 2. St. Louis: CV Mosby, 1974, pp 13191410 Lin J, Kircheff I: Normal anterior cerebral artery complex, in Newton TH, Potts DG (eds): Radiology of the Skull and Brain, Volume II, Book 2. St. Louis: CV Mosby, 1974, pp 1319–1410

    • Search Google Scholar
    • Export Citation
  • 15.

    Marino R Jr: The anterior cerebral artery. I. Anatomo-radiological study of its cortical territories. Surg Neurol 5:8187, 1976 Marino R Jr: The anterior cerebral artery. I. Anatomo-radiological study of its cortical territories. Surg Neurol 5:81–87, 1976

    • Search Google Scholar
    • Export Citation
  • 16.

    McKissock W, , Paine K, & Walsh L: Further observations on subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 21:239248, 1958 McKissock W, Paine K, Walsh L: Further observations on subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 21:239–248, 1958

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Moniz E: Die Cerebral Arteriographie und Phlebographie. Berlin: Springer-Verlag, 1940, 413 pp Moniz E: Die Cerebral Arteriographie und Phlebographie. Berlin: Springer-Verlag, 1940, 413 pp

    • Search Google Scholar
    • Export Citation
  • 18.

    Morris AA, & Peck CM: Roentgenographic study of the variations in the normal anterior cerebral artery. One hundred cases studied in the lateral plane. Am J Roentgenol Radium Ther Nucl Med 74:818826, 1955 Morris AA, Peck CM: Roentgenographic study of the variations in the normal anterior cerebral artery. One hundred cases studied in the lateral plane. Am J Roentgenol Radium Ther Nucl Med 74:818–826, 1955

    • Search Google Scholar
    • Export Citation
  • 19.

    Moscow N, , Michotey P, & Salamon G: Anatomy of the cortical branches of the anterior cerebral artery, in Newton TH, & Potts DG (eds): Radiology of the Skull and Brain, Volume II, Book 2. St. Louis: CV Mosby, 1974, pp 14111420 Moscow N, Michotey P, Salamon G: Anatomy of the cortical branches of the anterior cerebral artery, in Newton TH, Potts DG (eds): Radiology of the Skull and Brain, Volume II, Book 2. St. Louis: CV Mosby, 1974, pp 1411–1420

    • Search Google Scholar
    • Export Citation
  • 20.

    Perlmutter D, & Rhoton AL Jr: Microsurgical anatomy of the anterior cerebral-anterior communicating-recurrent artery complex. J Neurosurg 45:259272, 1976 Perlmutter D, Rhoton AL Jr: Microsurgical anatomy of the anterior cerebral-anterior communicating-recurrent artery complex. J Neurosurg 45:259–272, 1976

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    Pertuiset B, , Lepoire J, & Bondin G, et al: Les anévrysmes de l'artère péricalleuse. (Étude anatomo-clinique et thérapeutique à propos de 5 observations). Neurochirurgie 7:321338, 1961 Pertuiset B, Lepoire J, Bondin G, et al: Les anévrysmes de l'artère péricalleuse. (Étude anatomo-clinique et thérapeutique à propos de 5 observations). Neurochirurgie 7:321–338, 1961

    • Search Google Scholar
    • Export Citation
  • 22.

    Pool JL, & Potts DG: Aneurysms and Arteriovenous Anomalies of the Brain. New York: Harper and Row, 1965 Pool JL, Potts DG: Aneurysms and Arteriovenous Anomalies of the Brain. New York: Harper and Row, 1965

    • Search Google Scholar
    • Export Citation
  • 23.

    Ring BA, & Waddington MM: Roentgenographic anatomy of the pericallosal arteries. Am J Roentgenol Radium Ther Nucl Med 104:109118, 1968 Ring BA, Waddington MM: Roentgenographic anatomy of the pericallosal arteries. Am J Roentgenol Radium Ther Nucl Med 104:109–118, 1968

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    Salamon G, & Huang YP: Radiologic Anatomy of the Brain. Berlin/Heidelberg/New York: Springer-Verlag, 1976, 404 pp Salamon G, Huang YP: Radiologic Anatomy of the Brain. Berlin/Heidelberg/New York: Springer-Verlag, 1976, 404 pp

    • Search Google Scholar
    • Export Citation
  • 25.

    Snyckers FD, & Drake CG: Aneurysms of the distal anterior cerebral artery. A report on 24 verified cases. S Afr Med J 47:17871791, 1973 Snyckers FD, Drake CG: Aneurysms of the distal anterior cerebral artery. A report on 24 verified cases. S Afr Med J 47:1787–1791, 1973

    • Search Google Scholar
    • Export Citation
  • 26.

    Stephens RB, & Stilwell DL: Arteries and Veins of the Human Brain. Springfield, Ill: Charles C Thomas, 1969, 181 pp Stephens RB, Stilwell DL: Arteries and Veins of the Human Brain. Springfield, Ill: Charles C Thomas, 1969, 181 pp

    • Search Google Scholar
    • Export Citation
  • 27.

    Sugar O, & Tinsley M: Aneurysms of terminal portion of anterior cerebral artery. Arch Neurol Psychiatry 60:8185, 1948 Sugar O, Tinsley M: Aneurysms of terminal portion of anterior cerebral artery. Arch Neurol Psychiatry 60:81–85, 1948

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28.

    Van der Eecken HM: Anastomosis Between the Leptomeningeal Arteries of the Brain. Their Morphological, Pathological and Clinical Significance. Springfield, Ill: Charles C Thomas, 1959, 160 pp Van der Eecken HM: Anastomosis Between the Leptomeningeal Arteries of the Brain. Their Morphological, Pathological and Clinical Significance. Springfield, Ill: Charles C Thomas, 1959, 160 pp

    • Search Google Scholar
    • Export Citation
  • 29.

    Waddington MM: Atlas of Cerebral Angiography with Anatomic Correlation. Boston: Little, Brown and Co, 1974, 265 pp Waddington MM: Atlas of Cerebral Angiography with Anatomic Correlation. Boston: Little, Brown and Co, 1974, 265 pp

    • Search Google Scholar
    • Export Citation
  • 30.

    Wilson CB, , Christensen FK, & Subrahmanian MV: Intracranial aneurysms at the pericallosal artery bifurcation. Am Surg 31:386393, 1965 Wilson CB, Christensen FK, Subrahmanian MV: Intracranial aneurysms at the pericallosal artery bifurcation. Am Surg 31:386–393, 1965

    • Search Google Scholar
    • Export Citation
  • 31.

    Windle BCA: On the arteries forming the circle of Willis. J Anat Physiol 22:289293, 1888 Windle BCA: On the arteries forming the circle of Willis. J Anat Physiol 22:289–293, 1888

    • Search Google Scholar
    • Export Citation
  • 32.

    Yaşargil MG, & Carter LP: Saccular aneurysms of the distal anterior cerebral artery. J Neurosurg 40:218223, 1974 Yaşargil MG, Carter LP: Saccular aneurysms of the distal anterior cerebral artery. J Neurosurg 40:218–223, 1974

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33.

    Zeal AA, & Rhoton AL Jr: Microsurgical anatomy of the posterior cerebral artery. J Neurosurg 48:534559, 1978 Zeal AA, Rhoton AL Jr: Microsurgical anatomy of the posterior cerebral artery. J Neurosurg 48:534–559, 1978

    • Crossref
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 4293 782 49
Full Text Views 737 45 0
PDF Downloads 495 66 0
EPUB Downloads 0 0 0