Microsurgical anatomy of the anterior cerebral artery – anterior communicating artery complex: An Indian study

Objective: The microsurgical anatomy of the anterior cerebral artery (ACA), anterior communicating artery (ACoA), distal anterior cerebral artery (DACA) and its branches is complex and is known for its frequent variations. The purpose of this study was to document the microsurgical anatomy of this region in Indian population. Methods: Ten anterior cerebral artery complexes from cadaveric brain specimens were microscopically dissected and studied using the operating microscope under 5x to 20x magnification. The outer diameters and length of the proximal segment of the ACA (A1), ACoA and DACA (A2), branches of A1, ACoA and A2 segment and their origin and the various anomalies were documented. Results: The mean outer diameter of the A1 was 2.8 mm on the right side and 2.9 mm of the left side. The mean length of the A1 was 14.6 mm on either side. The mean outer diameter and length of the ACoA was 2.1 mm and 2.45 mm respectively. The DACA rarely gave rise to perforators. The origin of the recurrent artery of Heubner was at the A2-ACoA junction and proximal portion of A2 in most cases. Conclusions: The variations in our study were found to be more in the ACoA and DACA segments rather than the A1 segments. The microsurgical anatomical knowledge of the ACA ACoA complex is essential for a cerebrovascular surgeon. cerebral artery (DACA). Microscopic dissection was done using the Serwell operating microscope under 5x to 20x magnification. Particular attention was paid to the perforators in this area and the recurrent arteries. The DACA was dissected up to the formation of the pericallosal arteries. Measurements of the outer diameters of the A1, ACoA and the DACA were taken. Lengths of the A1 and ACoA were noted. In the case of the ACoA the average of the anterior and posterior lengths was taken. The divisions of the DACA up to the pericallosal arteries were studied. The cortical branches were not dissected as it was beyond the purview of the study. As the cadaveric specimens were not injected with intra-arterial dye meticulous dissection was done to distinguish the small perforators from arachnoid strands. The arterial system was then painted with watercolor and photographic documentation done using a digital camera.