Microsurgical anatomy of the distal anterior cerebral artery

1978 ◽  
Vol 49 (2) ◽  
pp. 204-228 ◽  
Author(s):  
David Perlmutter ◽  
Albert L. Rhoton
Keyword(s):  
Corpus Callosum ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Internal Capsule ◽  
Optic Chiasm ◽  
Anterior Communicating Artery ◽  
Microsurgical Anatomy ◽  
Content Type ◽  
Cm Points ◽  
Distal Anterior Cerebral Artery

✓ 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.

Occlusion of an “accessory” distal anterior cerebral artery during treatment of anterior communicating artery aneurysms

1991 ◽  
Vol 74 (1) ◽  
pp. 133-135 ◽  
Author(s):  
Kevin Gibbons ◽  
Leo N. Hopkins ◽  
Roberto C. Heros
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Anterior Communicating Artery ◽  
Case Histories ◽  
Content Type ◽  
Anterior Communicating Artery Aneurysms ◽  
Artery Segment ◽  
Distal Anterior Cerebral Artery ◽  
Clip Occlusion ◽  
Fine Print

✓ Two cases are presented in which clip occlusion of a third distal anterior cerebral artery segment occurred during treatment of anterior communicating artery aneurysms. Case histories, angiograms, operative descriptions, and postmortem findings are presented. The incidence of this anomalous vessel is reviewed. Preoperative and intraoperative vigilance in determining the presence of this anomaly prior to clip placement is emphasized.

Carotid-anterior cerebral artery anastomosis

1976 ◽  
Vol 44 (3) ◽  
pp. 378-382 ◽  
Author(s):  
Stephen Nutik ◽  
Domenico Dilenge
Keyword(s):  
Optic Nerve ◽  
Cerebral Artery ◽  
Ophthalmic Artery ◽  
Internal Carotid ◽  
Anterior Cerebral Artery ◽  
Optic Chiasm ◽  
Anterior Communicating Artery ◽  
Content Type ◽  
Anatomical Features ◽  
Fine Print

✓ The angiographic and anatomical features of an anomalous communication between the intradural internal carotid artery and the anterior cerebral artery are described. Essential features of the anastomosis include an origin at, or close to, the origin of the ophthalmic artery, a course ventral to the ipsilateral optic nerve and anterior to the optic chiasm, and a termination near the anterior communicating artery. Although rare, the condition should be considered as an entity. The incidence of associated berry aneurysm and other congenital vascular anomalies is high.

Microanatomy of the pericallosal arterial complex

2000 ◽  
Vol 93 (4) ◽  
pp. 667-675 ◽  
Author(s):  
Médard Kakou ◽  
Christophe Destrieux ◽  
Stéphane Velut
Keyword(s):  
Corpus Callosum ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Anterior Communicating Artery ◽  
Human Cadaver ◽  
Embryological Development ◽  
Content Type ◽  
Pericallosal Artery ◽  
Fine Print

Object. The pericallosal arterial complex supplies the callosal and pericallosal regions, as well as the anterior two thirds of the medial and superomedial aspects of both hemispheres. It is composed of the pericallosal artery (that is, the segment of the anterior cerebral artery located distal to the anterior communicating artery [ACoA]) and the median callosal artery (or third pericallosal artery), which originates from the ACoA. This system was studied in 46 specimens (23 human cadaver heads) injected with colored latex.Methods. After being injected with colored latex, embalmed, and bleached, the specimens were studied with the aid of optic magnification.The pericallosal artery was found to be divided into four segments (A2–A5 in the proximodistal direction). After giving rise to central, callosal, and cortical branches, it terminated near the splenium of the corpus callosum as the posterior pericallosal artery, or on the precuneus as the inferomedial parietal artery.Conclusions. The authors propose a logical classification of the different variations in the pericallosal arterial complex based on embryological development. This complex can be considered a hemodynamic solution to an abnormal regression of one of its parts, which is balanced by the development of supplemental channels from other parts.

Surgical strategy for distal anterior cerebral artery aneurysms: microsurgical anatomy

2003 ◽  
Vol 99 (3) ◽  
pp. 517-525 ◽  
Author(s):  
Masatou Kawashima ◽  
Toshio Matsushima ◽  
Tomio Sasaki
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Parallel Line ◽  
Lower Half ◽  
Surgical Strategy ◽  
Surgical Approaches ◽  
Microsurgical Anatomy ◽  
Content Type ◽  
Distal Anterior Cerebral Artery ◽  
Fine Print

Object. Most distal anterior cerebral artery (ACA) aneurysms arise at the pericallosal—callosomarginal artery (PerA—CMA) junction, which is usually located in the A3 segment of the ACA around the genu of the corpus callosum. Aneurysms in the PerA—CMA junction are divided into two types according to their location: supracallosal and infracallosal. Infracallosal distal ACA aneurysms are defined as those located in the lower half of the A3 segment, which makes it more difficult to gain proximal control. In this study, the authors examined the microsurgical anatomy of the distal ACA region, focusing especially on the relationship between the PerA and CMA located in the lower half of the A3 (infracallosal) segment, and present a surgical strategy for dealing with distal ACA aneurysms. Methods. The microsurgical anatomy of the distal ACA region was examined in 22 adult cadaveric cerebral hemispheres after perfusion of the arteries and veins with colored silicone. The relationships of the infracallosal segment of the PerA to the CMA and the A2 segment of the PerA to the frontopolar artery were examined. The distance between the nasion and the site at which a parallel line directed along the long axis of the infracallosal PerA just proximal to the origin of the CMA artery crosses the forehead (which we have named the PC point) was also measured. Surgical approaches to distal ACA aneurysms were examined in stepwise dissections. Conclusions. The PerA—CMA junctions were located in the supracallosal and infracallosal segments of A3 in 36 and 55% of cases, respectively. In the infracallosal region, it was difficult to identify the proximal PerA and to establish proximal control of the vessel. The infracallosal part of the proximal PerA coursed almost parallel to the frontal cranial base, and the PC point was 42.2 ± 15.9 mm (mean ± standard deviation) from the nasion. These findings indicate that there is only a limited space in which to access an infracallosal distal ACA aneurysm below the PC point and establish proximal control by the anterior interhemispheric approach. When the approach is made above the PC point, an anterior callosotomy may be necessary to establish proximal control before final aneurysm dissection and clip placement are completed. The PC point is an important surgical landmark in planning the surgical strategy for infracallosal distal ACA aneurysms.

Surgical anatomy of the proximal anterior cerebral artery

1976 ◽  
Vol 44 (3) ◽  
pp. 359-367 ◽  
Author(s):  
Ralph O. Dunker ◽  
A. Basil Harris
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Anterior Commissure ◽  
Cerebral Arteries ◽  
Internal Capsule ◽  
Carotid Bifurcation ◽  
Surgical Anatomy ◽  
Anterior Communicating Artery ◽  
Content Type ◽  
Posterior Limb

✓ The authors present this study of proximal anterior cerebral arteries in the normal human to provide a clearer basis for strategy in aneurysm surgery. They describe patterns of origin of branches, their subarachnoid course, and parenchymal distribution. Branches that originate from the anterior cerebral artery at the internal carotid bifurcation perfuse the genu and contiguous posterior limb of the internal capsule and the rostral thalamus. Proximal 4-mm branches supply the anterior limb of the internal capsule, the neighboring hypothalamus, anteroventral putamen, and pallidum. The remaining anterior cerebral artery proximal to the communicating artery sends branches to the optic chiasm, the adjacent hypothalamus, and the anterior commissure. Heubner's artery arises directly opposite the anterior communicating artery to supply much of the striatum and internal capsule rostral to the anterior commissure. The anterior communicating artery branches supply the fornix, corpus callosum, septal region, and anterior cingulum. The parenchymal distribution of these end arteries may be surmised from the site of origin of named vessels. With this anatomical information one can avoid interruption of blood supply to vital structures when dealing with the anterior cerebral artery and its branches.

Surgical treatment of distal anterior cerebral artery aneurysms

1979 ◽  
Vol 50 (1) ◽  
pp. 40-44 ◽  
Author(s):  
Takashi Yoshimoto ◽  
Keita Uchida ◽  
Jiro Suzuki
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Aneurysm Rupture ◽  
Anterior Communicating Artery ◽  
Parent Artery ◽  
Content Type ◽  
Aneurysm Neck ◽  
Horizontal Portion ◽  
Distal Anterior Cerebral Artery ◽  
Fine Print

✓ Between June, 1961, and September, 1975, the authors operated on 60 patients with aneurysms of the anterior cerebral artery distal to the anterior communicating artery (ACoA) by a direct intracranial approach. It is of utmost importance in the treatment of aneurysms to have control of the parent artery of the aneurysm. This makes it easier and safer to approach the aneurysm neck and to handle possible premature aneurysm rupture. The aneurysms were classified into two types, ascending and horizontal. Aneurysms arising from the origin of the ACoA and including the entire portion of the knee of the corpus callosum were designated as aneurysms of the ascending portion, whereas aneurysms beyond the genu were designated as aneurysms of the horizontal portion. For aneurysms of the ascending portion, bifrontal craniotomy was considered the safest approach. For aneurysms of the horizontal portion, a small parasagittal craniotomy was determined to be sufficient.

Interhemispheric approach with callosal resection for distal anterior cerebral artery aneurysms

1992 ◽  
Vol 77 (3) ◽  
pp. 481-483 ◽  
Author(s):  
Vincent C. Traynelis ◽  
Ralph O. Dunker
Keyword(s):  
Corpus Callosum ◽  
Cerebral Artery ◽  
Early Identification ◽  
Anterior Cerebral Artery ◽  
Feeding Artery ◽  
Content Type ◽  
Interhemispheric Approach ◽  
Interhemispheric Fissure ◽  
Distal Anterior Cerebral Artery ◽  
Fine Print

✓ Distal anterior cerebral artery aneurysms are commonly found near the genu of the corpus callosum. While these aneurysms may be surgically obliterated through a variety of approaches, exposure via the interhemispheric fissure is used by many surgeons. Early identification of the afferent artery may be difficult with this approach, however, particularly if the aneurysm lies just beneath the genu of the corpus callosum. The authors have modified the interhemispheric approach to distal anterior cerebral artery aneurysms by electively exposing the feeding artery through a small anterior callosotomy. While this maneuver is not necessary for all distal anterior cerebral artery aneurysms, it can greatly enhance exposure in the region just below the genu of the corpus callosum. Experience with this technique in five patients is reported. In all cases, the limited anterior callosotomy enhanced surgical exposure. No morbidity could be attributed to the callosotomy in any patient. It is concluded that, when the interhemispheric approach is used, anterior callosotomy improves exposure of the region just below the genu of the corpus callosum and may be a useful maneuver when treating distal anterior cerebral artery aneurysms.

Infraoptic course of the anterior cerebral artery associated with anterior communicating artery and distal anterior cerebral artery aneurysms

2015 ◽  
Vol 63 (5) ◽  
pp. 797 ◽  
Author(s):  
NarayanamAnantha Sai Kiran ◽  
ArunSadashiva Rao ◽  
ZarinaAbdul Assis ◽  
AlangarS Hegde
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Anterior Communicating Artery ◽  
Distal Anterior Cerebral Artery

Saccular aneurysms of the distal anterior cerebral artery

1974 ◽  
Vol 40 (2) ◽  
pp. 218-223 ◽  
Author(s):  
M. Gazi Yaşargil ◽  
L. Philip Carter
Keyword(s):  
Cerebral Artery ◽  
Subarachnoid Space ◽  
Operative Mortality ◽  
Anterior Cerebral Artery ◽  
Operative Morbidity ◽  
Content Type ◽  
Interhemispheric Fissure ◽  
Distal Anterior Cerebral Artery ◽  
Fine Print ◽  
Saccular Aneurysms

✓ A series of 13 patients with saccular aneurysms of the distal anterior cerebral artery, operated on by the same surgeon with microtechniques, is reviewed. The incidence of aneurysms in this location was 3.4%, the median age of the patients 44 years, and the median time from most recent hemorrhage to surgery 13 days. There were five cases of multiple aneurysms. No operative mortality occurred; the operative morbidity was 15%. Because of their multiplicity, characteristic broad base, and the small subarachnoid space in the interhemispheric fissure, these aneurysms are judged technically difficult.

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