Perlmutter D, Rhoton A L
J Neurosurg. 1976 Sep;45(3):259-72. doi: 10.3171/jns.1976.45.3.0259.
The microvascular relationships important to surgery of aneurysms in the anterior communicating region were defined in 50 cadaver brains. The recurrent artery of Heubner was frequently exposed before the A-1 segment in defining the neck on anterior cerebral aneurysms because it commonly courses anterior to A-1. It arose from the A-2 segment of the anterior cerebral artery (ACA) in 78% and most commonly terminated in the area of the anterior perforated substance, and lateral to it in the Sylvian fissure. The anterior communicating artery (ACoA) frequently gave rise to perforating arteries which terminated in the superior surface of the optic chiasm and above the chiasm in the anterior hypothalamus. This finding contrasts with previous reports that no perforating branches arise from the communicating artery. The proximal half of the A=1 segment was a richer source of perforating arteries than the distal half. The A-1 branches most commonly terminated in the anterior perforated substance, the optic chiasm, and the region of the optic tract. The ACoA increased in size as the difference in the diameter between the right and left A-1 segments increased. Frequent variants such as double or triple ACoA's, triple A-2 segments, and duplication of the A-1 segments were encountered. The clinical consequences of occlusion of the recurrent artery and of the perforators from the ACoA and medial and lateral segment of A-1 are reviewed.
在50个尸体大脑中确定了与前交通区域动脉瘤手术相关的微血管关系。在确定大脑前动脉瘤的瘤颈时，Heubner回返动脉常在A1段之前暴露，因为它通常走行于A1段前方。它在78%的情况下起自大脑前动脉（ACA）的A2段，最常见的终止部位是前穿质区域，以及在外侧裂中位于其外侧。前交通动脉（ACoA）常发出穿动脉，这些穿动脉终止于视交叉上表面以及视交叉上方的下丘脑前部。这一发现与之前关于交通动脉不发出穿支的报道形成对比。A1段的近端发出穿动脉的数量比远端更多。A1段分支最常终止于前穿质、视交叉和视束区域。随着左右A1段直径差异增大，ACoA的尺寸也增大。还发现了一些常见变异，如双或三ACoA、三A2段以及A1段重复等情况。本文还回顾了Heubner回返动脉以及ACoA和A1段内侧及外侧段穿支闭塞的临床后果。
