ANTERIOR CEREBRAL CIRCULATION: A LITERATURE REVIEW

Abstract

Anterior cerebral circulation consists of the anterior cerebral artery and middle cerebral artery of the circle of Willis. The anterior cerebral artery’s course is clas- sified into two main segment classifications constructed by Fischer and Osburn et al. The perfusion area of the anterior cerebral artery extends medially over the entire frontal and parietal lobes, the septum, and the basal forebrain structures such as the hypothalamus, hypophysis, and optic chiasm. The anterior cerebral artery also provides blood to the rostrum, genu, and body of the corpus callosum. The anterior cerebral artery shows some anatomical variations throughout its course. Aplasia or hypoplasia are the common variants in the A1 segment, whereas fenestration occurs in rare cases. Azygos artery formation is a rare variant of the A2 segment, and recurrent artery of Heubner is an important branch arising from A1 and A2 segments, which is one of the main perforators of structures such as but not limited to the anterior parts of the internal capsule and the lentiform nucleus. Common variations of the middle cerebral artery comprise ac- cessory artery formation or duplication, early branching, and also fenestration. Although cerebral circulation is complex with many collaterals and variations, pathological disturbances in the blood supply can still occur. Anatomical variations, cardiac problems, ethnicity, age, and physical exercise are some of the many risk factors that account for pathological cases such as aneurysms, occlusions, dissections, infarctions, and stroke. Disturbances in the blood supply of such a crucial region may lead to severe disabilities, if not death. Middle cerebral artery syndrome is one of the most important pathologies of the brain, where the outcome is stroke. Whether the underlying etiology is stenosis or obstruction, two main mechanisms can be categorized as atherosclerotic and non-atheroscle- rotic. Atherosclerotic causes can be thrombus or emboli origin, and non-atherosclerotic causes can be due to hemodynamic compromise, vasculitis, arterial wall dissections, and moyamoya disease. Keywords: Anterior cerebral artery, middle cerebral artery, aneurysm, infarction

Keywords

• Anterior cerebral artery
• middle cerebral artery
• aneurysm
• infarction

References

1. 1. Fehm HL, Kern W, Peters A. The selfish brain: competition for energy resources. Prog Brain Res 2006;153:129-40.
2. 2. Komutrattananont P, Mahakkanukrauh P, Das S. Morphology of the human aorta and age-related changes: anatomical facts. Anat Cell Biol 2019;52(2):109-14.
3. 3. Cipolla MJ. Integrated Systems physiology: from molecule to function. The cere- bral circulation. San Rafael (CA): Morgan & Claypool Life Sciences; 2009.
4. 4. Sañudo J, Vázquez R, Puerta J. Meaning and clinical interest of the anatomical variations in the 21st century. Eur J Anat 2003;7(1):1-3.
5. 5. Given CA 2nd, Morris PP. Recognition and importance of an infraoptic anterior cerebral artery: case report. AJNR Am J Neuroradiol 2002;23(3):452-4.
6. 6. Fischer E. Die lageabweichungen der vorderen hirnarterie im gefassbild. zbl. Neu- rochir 1938;3:300-12.
7. 7. Rhoton AL. Rhoton's Cranial anatomy and surgical approaches. Philadelphia, PA.
8. 8. Osborn AG, Jacobs JM. Diagnostic cerebral angiography: Lippincott Williams & Wilkins; 1999.

9. 9. Tahir RA, Haider S, Kole M et al. Anterior cerebral artery: variant anatomy and pathology. J Vasc Interv Neurol 2019;10(3):16-22.
10. 10. van der Zwan A, Hillen B, Tulleken CA et al. Variability of the territories of the major cerebral arteries. J Neurosurg 1992;77(6):927-40.
11. 11. Trepel M, Dalkowski K. Neuroanatomie: struktur und funktion: Elsevier Health Sciences Germany; 2015.
12. 12. Perlmutter D, Rhoton AL Jr. Microsurgical anatomy of the anterior cerebral-anterior communicating-recurrent artery complex. J Neurosurg 1976;45(3):259-72.
13. 13. Dimmick SJ, Faulder KC. Normal variants of the cerebral circulation at multidetector CT angiography. Radiographics 2009;29(4):1027-43.
14. 14. Uchino A, Nomiyama K, Takase Y et al. Anterior cerebral artery variations detect- ed by MR angiography. Neuroradiology 2006;48(9):647-52.
15. 15. Shatri J, Cerkezi S, Ademi V et al. Anatomical variations and dimensions of arteries in the anterior part of the circle of Willis. Folia Morphol (Warsz) 2019;78(2):259-66.
16. 16. Şahin H, Pekçevik Y. Anatomical variations of the circle of Willis: evaluation with CT angiography. Anatomy 2018;12(1):20-6.
17. 17. Ito J, Washiyama K, Kim CH et al. Fenestration of the anterior cerebral artery. Neuroradiology 1981;21(5):277-80.
18. 18. Auguste KI, Ware ML, Lawton MT. Nonsaccular aneurysms of the azygos anterior cerebral artery. Neurosurg Focus 2004;17(5):E12.
19. 19. Huh JS, Park SK, Shin JJ et al. Saccular aneurysm of the azygos anterior cerebral artery: three case reports. J Korean Neurosurg Soc 2007;42(4):342-5.
20. 20. Uchino A, Saito N, Uehara T et al. True fenestration of the anterior communi- cating artery diagnosed by magnetic resonance angiography. Surg Radiol Anat 2016;38(9):1095-8.
21. 21. Karatas A, Yilmaz H, Coban G et al. The anatomy of circulus arteriosus cerebri (circle of Willis): a study in Turkish population. Turk Neurosurg 2016;26(1):54-61.
22. 22. Shatri J, Bexheti D, Bexheti S et al. Influence of gender and age on average dimen- sions of arteries forming the circle of Willis study by magnetic resonance angiog- raphy on Kosovo's population. Open Access Maced J Med Sci 2017;5(6):714-9.
23. 23. Yeniceri IO, Cullu N, Deveer M et al. Circle of Willis variations and artery di- ameter measurements in the Turkish population. Folia Morphol (Warsz) 2017;76(3):420-5.
24. 24. Maga P, Tomaszewski KA, Skrzat J et al. Microanatomical study of the recurrent artery of Heubner. Ann Anat 2013;195(4):342-50.
25. 25. Loukas M, Louis RG Jr, Childs RS. Anatomical examination of the recurrent ar- tery of Heubner. Clin Anat 2006;19(1):25-31.
26. 26. Gomes F, Dujovny M, Umansky F et al. Microsurgical anatomy of the recurrent artery of Heubner. J Neurosurg 1984;60(1):130-9.
27. 27. Avci E, Fossett D, Aslan M et al. Branches of the anterior cerebral artery near the anterior communicating artery complex: an anatomic study and surgical perspec- tive. Neurol Med Chir 2003;43(7):329-33.
28. 28. Uzun I, Gurdal E, Cakmak YO et al. A reminder of the anatomy of the recurrent artery of heubner. Cent Eur Neurosurg 2009;70(1):36-8.
29. 29. Zunon-Kipre Y, Peltier J, Haidara A et al. Microsurgical anatomy of distal medial striate artery (recurrent artery of Heubner). Surg Radiol Anat 2012;34(1):15-20.
30. 30. Najera E, Truong HQ, Belo JTA et al. Proximal branches of the anterior cerebral artery: anatomic study and applications to endoscopic endonasal surgery. Oper Neurosurg (Hagerstown) 2019;16(6):734-42.
31. 31. Katoh M, Kamiyama H, Makino K et al. Infra-optic course of the anterior cerebral artery. J Clin Neurosci 1999;6(3):252-5.
32. 32. Sato Y, Kashimura H, Takeda M et al. Aneurysm of the A1 segment of the anteri- or cerebral artery associated with the persistent primitive olfactory artery. World Neurosurg 2015;84(6):2079.e7-9.
33. 33. Teal JS, Rumbaugh CL, Bergeron RT et al. Anomalies of the middle cerebral ar- tery: accessory artery, duplication, and early bifurcation. Am J Roentgenol Radi- um Ther Nucl Med 1973;118(3):567-75.
34. 34. Jain KK. Some observations on the anatomy of the middle cerebral artery Can J Surg 1964;7:134-9.
35. 35. Komiyama M, Nakajima H, Nishikawa M et al. Middle cerebral artery variations: duplicated and accessory arteries. AJNR Am J Neuroradiol 1998;19(1):45-9.
36. 36. Abanou A, Lasjaunias P, Manelfe C et al. The accessory middle cerebral artery (AMCA). Diagnostic and therapeutic consequences. Anat Clin 1984;6(4):305-9.
37. 37. Kim JS, Caplan LR. Clinical stroke syndromes. Front Neurol Neurosci 2016;40:72-92.
38. 38.Sato S, Toyoda K, Matsuoka H et al. Isolated anterior cerebral artery territory infarc- tion: dissection as an etiological mechanism. Cerebrovasc Dis 2010;29(2):170-7.
39. 39. Toyoda K. Anterior cerebral artery and Heubner's artery territory infarction. Front Neurol Neurosci 2012;30:120-2.
40. 40. Kim YJ, Lee JK, Ahn SH et al. Nonatherosclerotic isolated middle cere- bral artery disease may be early manifestation of moyamoya disease. Stroke 2016;47(9):2229-35.
41. 41. Lin J, Xian W, Lai R et al. Bilateral cerebral infarction associated with severe ar- teriosclerosis in the A1 segment: a case report. J Int Med Res 2019;47(3):1373-7.
42. 42. Arboix A, Garcia-Eroles L, Sellares N et al. Infarction in the territory of the anteri- or cerebral artery: clinical study of 51 patients. BMC Neurol 2009;9:30.
43. 43. Bogousslavsky J, Regli F. Anterior cerebral artery territory infarction in the Lausanne Stroke Registry. Clinical and etiologic patterns. Arch Neurol 1990;47(2):144-50.
44. 44. Hong SK. Ruptured proximal anterior cerebral artery (A1) aneurysm located at an anomalous branching of the fronto-orbital artery--a case report. J Korean Med Sci 1997;12(6):576-80.
45. 45. Kim MK, Lim YC. Aneurysms of the proximal (A1) segment of the anterior ce- rebral artery: a clinical analysis of 31 cases. World Neurosurg 2019;127:e488-e96.
46. 46. Lehecka M, Lehto H, Niemela M et al. Distal anterior cerebral artery aneurysms: treatment and outcome analysis of 501 patients. Neurosurgery 2008;62(3):590-601.
47. 47.Lehecka M, Dashti R, Lehto H et al. Distal anterior cerebral artery aneurysms. Acta Neurochir Suppl 2010;107:15-26.
48. 48. Cianfoni A, Pravata E, De Blasi R et al. Clinical presentation of cerebral aneu- rysms. Eur J Radiol 2013;82(10):1618-22.
49. 49. Chuang YM, Liu CY, Pan PJ et al. Anterior cerebral artery A1 segment hypoplasia may contribute to A1 hypoplasia syndrome. Eur Neurol 2007;57(4):208-11.
50. 50. El-Koussy M, Schroth G, Brekenfeld C et al. Imaging of acute ischemic stroke. Eur Neurol 2014;72(5-6):309-16.
51. 51. Bogousslavsky J, Barnett HJ, Fox AJ et al. Atherosclerotic disease of the middle cerebral artery. Stroke 1986;17(6):1112-20.
52. 52. Wong KS, Gao S, Chan YL et al. Mechanisms of acute cerebral infarctions in patients with middle cerebral artery stenosis: a diffusion-weighted imaging and microemboli monitoring study. Ann Neurol 2002;52(1):74-81.
53. 53. Ahn SH, Lee J, Kim YJ et al. Isolated MCA disease in patients without significant atherosclerotic risk factors: a high-resolution magnetic resonance imaging study. Stroke 2015;46(3):697-703.
54. 54. Lhermitte F, Gautier JC, Derouesne C et al. Ischemic accidents in the mid- dle cerebral artery territory. A study of the causes in 122 cases. Arch Neurol 1968;19(3):248-56.
55. 55. Moulin DE, Lo R, Chiang J et al. Prognosis in middle cerebral artery occlusion. Stroke 1985;16(2):282-4.
56. 56. Lee PH, Oh SH, Bang OY et al. Isolated middle cerebral artery disease: clinical and neuroradiological features depending on the pathogenesis. J Neurol Neuro- surg Psychiatry 2004;75(5):727-32.
57. 57. Torvik A. The pathogenesis of watershed infarcts in the brain. Stroke 1984;15(2):221-3.
58. 58. Beal MF, Williams RS, Richardson EP et al. Cholesterol embolism as a cause of transient ischemic attacks and cerebral infarction. Neurology 1981;31(7):860-5.
59. 59. Caplan LR. Lacunar infarction and small vessel disease: pathology and patho- physiology. J Stroke 2015;17(1):2-6.
60. 60. Kim JE, Kim KM, Kim JG et al. Clinical features of adult moyamoya disease with special reference to the diagnosis. Neurol Med Chir 2012;52(5):311-7. 61. Scott RM, Smith ER. Moyamoya disease and moyamoya syndrome. N Engl J Med 2009;360(12):1226-37.