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 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 4  |  Issue : 1  |  Page : 5-11

Gross anatomical study of recurrent artery of Huebner


Assistant Professor of Anatomy, Academy of Medical Sciences, Pariyaram, Kannur, Kerala, India

Date of Web Publication29-Nov-2019

Correspondence Address:
Sunitha Narayanan
Assistant Professor of Anatomy, Academy of Medical Sciences, Pariyaram, Kannur District, Kerala
India
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Source of Support: None, Conflict of Interest: None


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  Abstract 


Background: Cerebral aneurysms frequently occur in the arterial complex composed of Anterior Cerebral Artery, Anterior Communicating Artery and Recurrent Artery of Huebner. Due to the anatomical variations in the origin and course of the Recurrent Artery of Huebner, surgical interventions in the anterior portion of circle of Willis can be complicated by obstruction or vascular damage to Recurrent Artery of Huebner, caused by improper clip placement. Objectives: To study the variations in the origin, number, course & termination of Recurrent artery of Huebner. Also the distance of origin of the Recurrent artery from the junction of Pre and Postcommunicating segment of Anterior Cerebral Artery was noted. Materials and methods: The study was conducted in 60 randomly selected brain specimens fixed in 10% formalin for 10 days in the Department of Anatomy. The Recurrent Artery was then carefully dissected and observations were made. Photographs were taken to document the observations. Results: The Recurrent artery of Huebner arose most frequently from the junction of Pre and Postcommunicating segment of Anterior Cerebral Artery (59.2%) and next frequently from the Postcommunicating segment of Anterior Cerebral Artery within 1mm from the junction of Pre and Postcommunicating segment of Anterior Cerebral Artery. It coursed more commonly anterior to the Precommunicating segment of Anterior Cerebral Artery in 80% cases. The artery terminated in the lateral part of anterior perforated substance in 96.7% of the specimens. Conclusions: The Recurrent artery should be routinely identified during clipping of the aneurysm of the Anterior Communicating Artery to prevent postoperative neurological deficit.

Keywords: cerebral aneurysm, variation, clip placement, precommunicating, anterior perforated substance


How to cite this article:
Narayanan S. Gross anatomical study of recurrent artery of Huebner. Natl J Clin Anat 2015;4:5-11

How to cite this URL:
Narayanan S. Gross anatomical study of recurrent artery of Huebner. Natl J Clin Anat [serial online] 2015 [cited 2022 Jan 23];4:5-11. Available from: http://www.njca.info/text.asp?2015/4/1/5/297276




  Introduction Top


Neurologists associate the name of Heubner, who was a German pediatrician, with the artery that supplies the anteromedial part of the caudate nucleus and the anteroinferior part of internal capsule. Johann Otto Heubner was the first to describe the Recurrent artery of Huebner in 1872. He had injected individual arteries of 30 human brains using the dye ‘Berlin blue’. The detailed vascular anatomy was demonstrated including Recurrent branch of Anterior Cerebral Artery[1].

Heubner’s anatomical legacy is important for surgery, particularly for anterior cerebral complex aneurysms. Surgical interventions in the anterior part of the circle of Willis can be complicated by obstruction of or vascular damage to Recurrent artery due to the structures located in the immediate vicinity of the Anterior Cerebral Artery trunk, or insufficient knowledge about its anatomical variations[2]. A decrease or total obstruction of blood flow through Recurrent artery can lead to complications such as hemiparesis of the facial and upper limb muscles on the opposite side, aphasia and cognitive disorders[2]. Since then many others have also described it, calling it the centralis longa artery or the medial striate artery[2],[3]. Anatomists describe Heubner’s artery as largest perforating branch arising from the Postcommunicating segment of ACA (ACA2) 2-5mm distal to the Anterior Communicating Artery. Then it turns backwards along the posterior part of gyrus rectus and orbitofrontal cortex and runs anterior to the proximal part of the anterior cerebral artery to pierce the brain parenchyma at lateral part of anterior perforated substance[4].

The Recurrent artery supplies the medial portion of the orbitofrontal cortex, the anterior crus of the internal capsule, the anterior portion of the caudate nucleus and putamen, the external segment of the globus pallidus, the olfactory region, the anterior hypothalamus, the nucleus accumbens, parts of the uncinate fasciculus, the diagonal band of Broca, and the basal nucleus of Meynert[5],[6],[7].

In the literature, variations of the origin, course and termination of Recurrent Artery have been reported. Recurrent artery may arise from precommunicating segment of Anterior Cerebral Artery, from the junction of Anterior cerebral with Anterior Communicating Artery or from Postcommunicating segment of Anterior Cerebral Artery.

The present study aims to find the variations in the origin, number, course and termination of the Recurrent Artery of Huebner to provide data for the neurosurgeon to construct a better and safer micro-dissection plan, to save time and so prevent postoperative neurological deficits.


  Materials and Methods Top


The study was conducted in 60 randomly selected brain specimens (120 hemispheres;33 male and 27 female brain specimens). Of these, 40 specimens were obtained from the department of Forensic Medicine, Govt. Medical College, Calicut during routine autopsies and 20 specimens were obtained from the cadavers used for dissection by the undergraduate medical students in the department of Anatomy, Medical College, Calicut over a period of two years. Specimens of traumatized brain following head injuries and those with gross pathological lesions like tumours were excluded. Brain specimens were numbered, sex of the respective cadavers were noted and fixed in 10% formalin for 10 days. The arachnoid mater was carefully removed. The Recurrent artery of Heubner was carefully dissected. The specimens were then dried and the vessels were painted using water dipped eosin pencils. The variation in number, presence, origin, course and termination of Recurrent artery of Huebner was observed. The distance of origin of the Recurrent artery from the junction of Pre and Postcommunicating segment of Anterior Cerebral Artery was measured in ‘mm’ using a graduated scale.


  Results Top


Variations in the origin

The Recurrent artery of Huebner was present in all the 60 specimens examined. In the present study, it arose most commonly from the junction of Pre and Post communicating segment of Anterior Cerebral Artery (ACA1-ACA2junction). There were differences noted in origin of Recurrent artery bilaterally in the same specimen. [Figure 1], [Figure 2] [Table 1], [Table 2].
Figure 1: Showing the origin of Recurrent Artery of Huebner (RAH) from precommunicating segment of Anterior Cerebral Artery (ACA1) on the right side

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Figure 2: Showing the origin of Recurrent artery of Huebner (RAH) from the junction of Anterior Cerebral Artery and Anterior Communicating Artery on the right side and from the post communicating segment of Anterior Cerebral Artery (ACA2) on the left side

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Table 1: Incidence of variation in the origin of Recurrent artery of Huebner in relation to 120 cerebral hemispheres

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Table 2: Incidence of origin of U/L & B/L Recurrent artery of Huebner

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Abbreviations : ACA1-Precommunicating segment of Anterior Cerebral Artery;ACA2 -Postcommunicating segment of Anterior Cerebral Artery;U/L - Unilateral; B/L- Bilateral.

Variations in the number

The artery was found to be double in five specimens on one side only (8.3% - Figure 3). It arose from a single point. Absence or triplication of the artery was not noted in the present study.
Figure 3: Showing double Recurrent artery of Huebner (RAH 1 and RAH 2) on left side

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The distance of origin of Recurrent artery from the junction of Pre and Postcommunicating segment was also noted. It was found to be at a distance of less than 1mm in 30.8% [Figure 6]; between 1-2mm in 8.3% [Figure 7]; between 6 - 7mm in 1.7% [Figure 8] of the hemispheres. However a distance between 3 - 6 mm was not observed in the present study.
Figure 4: Showing posterior course of Recurrent artery of Huebner on right side and anterior course of Recurrent artery of Huebner on the left side

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Figure 5: Superior course of Recurrent artery of Huebner(RAH)

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Figure 6: Origin of Recurrent artery of Huebner (RAH) 1mm from the ACA-ACoA Jt

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Figure 7: Origin of Recurrent artery of Huebner 2mm from ACA-ACoAJt

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Figure 8: Origin of Recurrent artery of Huebner 7mm from ACA- ACoA Jt

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Variations in the course

The artery coursed either anterior to, posterior to or superior to the Precommunicating segment of Anterior Cerebral Artery. In the present study, the artery had an anterior course in 80% of hemispheres. In 12.8% of hemispheres, the artery had a superior course. There were differences in the course of artery bilaterally in a specimen. [Figure 4], [Figure 5] [Table 3], [Table 4].
Table 3: Incidence of course of Recurrent artery of Huebner in relation to 120 cerebral hemispheres

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Table 4: Incidence of variation in course of Recurrent artery of Huebner

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Variations in the mode of termination

In the present study, the artery terminated most commonly in the lateral part of anterior perforated substance. There were differences in the termination of the artery bilaterally. [Figure 9] [Table 5], [Table 6].
Figure 9: Termination of Recurrent artery at lateral part of Anterior perforated substance and medial part of perforated substance on right and left side respectively
Abbreviations : RAH-Recurrent artery of Huebner; ACoA- Anterior Communicating Artery; PoCA- Posterior Communicating Artery; ACA1- Precommunicating segment of Anterior Cerebral Artery; ACA2-Postcommunicating segment of Anterior Cerebral Artery; ICAInternal Carotid Artery.


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Table 5: Incidence of mode of termination of Recurrent artery of Huebner in relation to 120 cerebral hemispheres

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Table 6: Incidence of mode of termination of Recurrent artery of Huebner

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  Discussion Top


In the present study, the Recurrent artery was present in all the specimens. In the literature, occurrence of Recurrent artery of Huebner was found to be between 94% and 100%.

Origin:

In the present study, ACA1-ACA2 Junction was the most common location of origin of Recurrent artery of Huebner [Table 1]. It is consistent with the findings of previous studies by Aydin et al[2], Loukas et al[6], Gonzalez et al[9] and Uzun et al[11]. Variations in the origin of the Recurrent artery as observed by previous workers are given in the [Table 8].
Table 7: Incidence of variation in the distance of origin of Recurrent artery of Huebner from the junction of Pre and Postcommunicating segment

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Table 8: Variations in the origin of Recurrent artery of Huebner as observed by other workers

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Number :

The presence of double and triple Recurrent arteries has been reported by many workers in the previous studies [Table 9]. Double Recurrent artery was observed in 4.2% of cases in the present study [Figure 9].
Table 9: Duplication of Recurrent artery of Huebner as observed by other workers

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Triplication of the Recurrent artery was not observed in the present study. Triple Recurrent artery has been reported by Boongird et al (2009)[3] and Vosovic et al (2008)[12] in 2% and 3.3% respectively. Vosovic et al (2008)[12] concluded that the knowledge of anatomical variations in the number and origin of the Recurrent artery may assist neuroradiologists in the interpretation of diagnostic test results, and neurosurgeons in performing procedures in the anterior cerebral circulation.

Course:

Three types of courses of Recurrent artery of Huebner have been described in the previous studies [Table 10]. They are the ‘Anterior’, ‘Superior’ and ‘Posterior’ courses, in relation to the Precommunicating segment of Anterior Cerebral Artery. In the present study, 80% of the artery coursed ‘Anterior’, 12.8% ‘Superior’ and 7.2% ‘Posterior’ to the Precommunicating segment of Anterior Cerebral Artery [Table 3]. This is more or less consistent with the previous studies.
Table 10: Variations in the course of Recurrent artery of Huebner as observed by other workers

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Termination:

Most studies have confirmed that the Recurrent artery terminates by penetrating the brain parenchyma at the level of the medial or lateral part of the anterior perforated substance [Table 11]. In the present study, the artery terminated in the lateral part of the anterior perforated substance in 96.7% of cases and in its medial part in 3.3% of cases [Table 5].
Table 11: Variations in the termination of Recurrent artery of Huebner as observed by other workers
(*APS- Anterior Perforated Substance )


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The distance of origin of Recurrent artery from the junction of Pre and Postcommunicating segments of Anterior Cerebral Artery was found to be less than or equal to 1mm in 30.8% cases; between 1 - 2mm in 8.3% cases; between 6 - 7mm in 1.7% cases [Table 7]. Boongird et al (2009)[3] reported 92% of the origin of the Recurrent artery within 2mm from the ACA1-ACA2 junction. Perlmutter et al (1976)[10] reported that in 52% of cases, it arose within 2mm, in 80% cases within 3mm and in 95% cases within 4mm from ACA1-ACA2 junction. In one case they observed the origin of the Recurrent artery 9.8mm proximal to ACA1-ACA2 junction. As the Recurrent artery has its origin most frequently within 2mm from the ACA1-ACA2 junction, they expressed their opinion that it can be damaged with an improper clip placement during repair of aneurysms near the Anterior Communicating Artery.

The anterior part of circle of Willis is the most common site of aneurysm formation. Surgical procedures like applying temporary clips in the anterior part of circle of Willis or excision of gyrus rectus can damage or occlude the Reccurent artery. This may result in hemiparesis with brachial predominance and aphasia if the occluded artery is on the dominant side[14].The Recurrent artery arises from Anterior Cerebral Artery in and around the Anterior Communicating Artery. Embryologically Recurrent artery arises from the different organizations of anastamotic channels that were present between the anterior and middle cerebral artery[15].

Variations in the origin, number and course of the artery may be the result of this different organizations.

The existence of multiple Recurrent artery was found to be associated with other cereberovascular anomalies or malformations which can cause complications in these patients[16].


  Conclusion Top


In this study, the Recurrent artery of Huebner originated most frequently from the junction of Pre and Postcommunicating segment of Anterior Cerebral Artery (59.2%) followed by origin from the Post communicating segment of Anterior Cerebral Artery within 1mm from the junction of Pre and Post communicating segment of Anterior Cerebral Artery. It coursed more commonly anterior to the Pre communicating segment of Anterior Cerebral Artery in 80% of cases. The artery terminated in the lateral part of anterior perforated substance in 96.7% of cases. The awareness of these anatomical variations of Recurrent artery of Huebner helps in planning the neurosurgical procedures in the anterior part of the circle of Willis to avoid unexpected neurological complications.



 
  References Top

1.
Ahmed AH, Ahmed D S. The Recurrent branch of the Anterior Cerebral Artery. Anat Rec. 1967; 157: 699-700.  Back to cited text no. 1
    
2.
Aydin IH, Ondir A, Takci E, Kadioglu HH, Kayaoglu CR, Tuzun Y. Huebner’s artery variations in Anterior Communicating Artery aneurysms. Acta Neurochir (Wien). 1994; 127: 17-20.  Back to cited text no. 2
    
3.
Boongird A, Duangtongphon P. Variation of the Recurrent artery of Huebner in human cadavers. J Med Assoc Thai. 2009; 92(5): 643-647.  Back to cited text no. 3
    
4.
Izci Y, Segkin H, Medow J, Turnquist C, Baskaya MK. Sulcal and gyral anatomy of the orbitofrontal cortex in relation to the recurrent artery of Heubner: an anatomical study. Surgical and Radiologic Anatomy.2009; Vol 31(6): 439-445.  Back to cited text no. 4
    
5.
Mavridis I, Anagnostopoulou S. Comment on the brain areas whose blood supply is provided by the recurrent artery of Heubner. Surgical and Radiologic Anatomy.2010; 32(1): 91.  Back to cited text no. 5
    
6.
Loukas M, Louis RG, Childs RS. Anatomical examination of the Recurrent artery of Huebner. Clin. Anat. 2006; 19: 25-31.  Back to cited text no. 6
    
7.
Feekes JA, Cassell M D. The vascular supply of the functional compartments of the human striatum. Brain.2006;129(8): 2189-2201.  Back to cited text no. 7
    
8.
Gomes F, Dujovny M, Umansky F, Ausman JI, Diaz FG, Ray WJ, Mirchandani HG. Microsurgical anatomy of the Recurrent artery of Huebner. J. Neurosurg.1984; 60: 130-139.  Back to cited text no. 8
    
9.
Gonzalez OOG, Delgado-Reyes L, Cruz JCP. Microsurgical anatomy of the extracereberal segment of Recurrent artery of Huebner in the Mexican population. Cir Cir. 2011; 79: 201-206.  Back to cited text no. 9
    
10.
Perlmutter D, Rhoton AL. Microsurgical anatomy of the Anterior Cerebral- Anterior Communicating- Recurrent artery complex. J. Neurosurg. 1976; 45: 259272.  Back to cited text no. 10
    
11.
Uzun I, Gurdal E, Cakmak YO, Ozdogmus O, Cavdar. A reminder of the anatomy of Recurrent artery of Huebner. Cen Eur Neurosurg. 2009; 70(1): 36-38.  Back to cited text no. 11
    
12.
Vasovic L, Ugrenovic S, Jovanovic I. Human fetal medial striate artery or artery of Huebner. J. Neurosurg. Pediatr. 2008; 3(4): 296-301.  Back to cited text no. 12
    
13.
Musso F, Anderle DV, Coutinho PL, Baleens RF. Morphological aspects of the distal medial striated artery (Artery of Huebner). Braz. J. Morphol. Sci. 2002; 19(2): 63-66.  Back to cited text no. 13
    
14.
Pai SB, Kulkarni RN, Varma RG. Microsurgical anatomy of the anterior cerebral artery-anterior communicating artery complex: an Indian study. Neurology Asia. 2005;10: 21-28.  Back to cited text no. 14
    
15.
Zunon-Kipre Y, Peltier J, Hai’dara A, et al. Microsurgical anatomy of distal medial striate artery (recurrent artery of Heubner). Surgical and Radiologic Anatomy. 2012; 34: 15-20.  Back to cited text no. 15
    
16.
Marinkovic S, Milisavljevic M, Kovacevic M. Anatomical bases for surgical approach to the initial segment of the anterior cerebral artery. Microanatomy of Heubner’s artery and perforating branches of the anterior cerebral artery. Surgical and Radiologic Anatomy. 1986; 8(1): 7-18.  Back to cited text no. 16
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11]



 

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