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The recurrent branch of the anterior cerebral artery.

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The Recurrent Branch of the Anterior Cerebral Artery
D. S. AHMED AND R. H. AHMED
Department of Anatomy, University of Liverpool and
Royal Southern Hospital, Liverpool, England
ABSTRACT
The recurrent branch of the anterior cerebral artery is of considerable
applied importance. The extracerebral course of the vessel has been studied in dissection of 12 brains. Numerous variations in the course of the vessel were found and
these have been presented.
From the proximal part of the anterior
cerebral artery numerous perforating
branches arise, enter the fenestrations of
the anterior perforated substance and contribute to the blood supply of the basal
ganglia. Most of these vessels arise at
right angles to the anterior cerebral trunk
and pursue a somewhat tortuous but short
course to the anterior perforated substance.
They are usually fine vessels. An excep
tion is the recurrent branch of the anterior cerebral artery. This arises from the
anterior cerebral artery at the level of the
anterior communicating artery. First described by Heubner (1874), it is unique
among arteries in that after it doubles
back on its parent anterior cerebral and
follows this vessel and the middle cerebral
artery for a variable distance before entering the brain. According to Critchley
('30) it branches into three main stems
within the brain and supplies the anterior
part of the caudate nucleus, the anterior
third of the putamen, the tip of the outer
segment of the globus pallidus and the
anterior limb of the internal capsule.
Critchley gave clinical and pathological
evidence that occlusion of the recurrent
artery results in hemiplcgia with brachial
dominance. His work has been supported
by other workers notably Webster et al.
('60). The course and relations of the
vessel is thus of considerable importance
to surgeons operating on aneurysms situated on the anterior half of the circle of
Willis. Rather surprisingly, however, although the intracerebral distribution of the
vessel has been studied in considerable detail, relatively little work has been done on
its extracerebral course. This relative lack
of knowledge prompted the present study.
A N A T . REC!.,
157: 699-700.
The clinical implications have been reviewed by Ahmed ('65).
MATERIAL AND METHOD
Twelve human brains were dissected
using simple instruments and the unaided
eye. The recurrent arteries were dissected
on both sides of the circle of Willis in
each brain.
RESULTS
Variations in the course of the artery
were found to be common. The most
usual course (fig. 1 ) is as follows: The
vessel arises from the anterior cerebral
artery at the level of the anterior communicating artery and then passes backwards and laterally, closely bound by
arachnoid strands to the superolateral
aspect of the anterior cerebral trunk. After
about 1 cm it is less closely applied to the
Recurrentartery
Posterior
r
Posterior
artery
Fig. 1 Diagram indicating the most usud
course of the recurrent artery. The vessel has
been shown on the right side only.
699
700
D. S. AHMED AND R. H. AHMED
anterior cerebral artery, but still continues
to run immediately above the vessel and
then above the internal carotid bifurcation
and the proximal part of the middle cerebral artery. It then enters the brain
through the lateral end of the anterior
perforated substance in a single stem or
as two branches immediately above the
middle cerebral bifurcation. The vessel is
largely hidden until the anterior cerebral
artery is displaced medially and supporting
arachnoid strands between them are divided. The artery, especially in its distal
part, tends to become slightly tortuous.
The following variations in the course
of the recurrent artery were found:
1. The origin of the vessel in one case,
was formed by the union of two trunks
arising in front of, and behind the anterior communicating artery respectively.
2. In one brain the artery arose from
the mid-point of the proximal part of the
anterior cerebral artery.
3. In three brains the vessel was represented by twin trunks running parallel and
close to each other on one side of the circle
of Willis whereas on the opposite side
there was only one trunk.
4. In two cases, the vessel on one side
of the circle of Willis was absent.
5. In six cases, the vessel on one side
formed single or multiple loops and passed
well lateral to the anterior cerebral artery
between its point of origin and its point of
entry into the brain.
LITERATURE CITED
Ahmed, R. H. 1965 C1I.M. Thesis: Anterior
cerebral aneurysms. Liverpool.
Critchley, M. 1930 The anterior cerebral artery and its syndromes. Brain, 53: 120-165.
Heubner, 0. 1874 Die leutische Erkrankung
der Hirnarterien. Leipzig: F. C. W. Vogel.
Webster, J. E., E. S. Gurdjian, D. W. Lindner
and W. G. Hardy 1960 Proximal occlusion
of the anterior cerebral artery. Arch. Neurol.,
Chicago, 2: 19-26.
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artery, recurrent, branch, anterior, cerebral
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