Minim Invasive Neurosurg 2005; 48(4): 218-223
DOI: 10.1055/s-2005-870963
Original Article
© Georg Thieme Verlag Stuttgart · New York

Posterior Communicating Artery: From Microsurgical, Endoscopic and Radiological Perspective

E.  Avcı1 , G.  Bademci2 , A.  Öztürk3
  • 1Department of Neurosurgery, Harran University School of Medicine, Şanliurfa, Turkey
  • 2Department of Neurosurgery, Kirikkale University School of Medicine, Ankara, Turkey
  • 3Department of Radiology, Harran University School of Medicine, Şanliurfa, Turkey
Further Information

Publication History

Publication Date:
20 September 2005 (online)

Abstract

Objective: The main objective of this study was to display the morphological characteristics of the posterior communicating artery and its perforating branches in various configurations of the circle of Willis and their relationship with neighbouring anatomic structures by microscopic examination of the brain hemispheres and endoscopic examination of cadaver specimens. A secondary aim was to investigate the possibility of detecting the posterior communicating artery and its variations in cerebral MR angiographies performed for various reasons. Methods: The posterior communicating artery was examined under the microscope in 24 cerebral hemisphere specimens, by endoscopy in 5 cadavers and by 3D TOF MRI in 62 patients. Results: The posterior communicating artery had a hypoplastic configuration in 28 %, whereas it was transitional in 14 %, fetal in 28 % and adult in 30 % of cerebral hemisphere specimens. While no posterior communicating artery and transitional configuration could be detected in 11 % of the MR angiography examinations, 34 % had a hypoplastic configuration, 10 % a fetal configuration and 45 % an adult configuration. The percentage of infundibular dilatation was 22 % and the premamillary artery was the thickest perforating branch. The diameter of the posterior communicating artery varied between 0.5 and 3.03 mm. Discussion: A detailed knowledge on the variations of the posterior communicating artery and the morphological characteristics of the perforators arising from this artery in various configurations of the circle of Willis is an important factor affecting the results of surgical interventions.

References

  • 1 Pikus H J, Heros R C. Surgical treatment of internal carotid and posterior communicating artery aneurysms.  Neurosurg Clin N Am. 1998;  9 785-795
  • 2 Padget D H. The circle of Willis: Its embryology and anatomy. In: Dandy (ed). Intracranial Arteriel Aneurysms. Ithaca, NY, Comstock 1944: 67-90
  • 3 Lazorthes G, Gouaze A, Salamon G. Vascularisation et circulation de l'encephale. Paris: Masson et Cie 1976: 8-12 and 164 - 165
  • 4 Saeki N, Rhoton A L. Microsurgical anatomy of the upper basilary artery and the posterior circle of Willis.  J Neurosurg. 1977;  46 563-578
  • 5 Bisaria K K. Anomalies of the posterior communicating artery and their potential clinical significance.  J Neurosurg. 1984;  60 572-576
  • 6 Yasargil M G. Microneurosurgery. Stuttgart, New York: Thieme Vol. 1 1984: 60-66
  • 7 Vincentelli F, Caruso G, Grisoli F, Rabehanta P. et al . Microsurgical ana-tomy of the cisternal course of the perforating branches of the posterior communicating artery.  Neurosurgery. 1990;  26 824-831
  • 8 Overbeeke V JJ, Hilen B, Tulleken C AF. A comparative study of the circle of Willis in fetal and adult life. The configuration of the posterior bifurcation of the posterior communicating artery.  J Anat. 1991;  176 45-54
  • 9 Chason J L, Hindman W M. Berry aneurysms of the circle of Willis. Results of a planned autopsy study.  Neurology (Minneap). 1958;  8 41-44
  • 10 Alpers B J, Berry R G. Circle of Willis in cerebral vascular disorders.  Arch Neurol. 1963;  8 398-402
  • 11 Mattle H, Edelman R R, Wentz K U, Reis M A, Atkinson D J, Ellert T. Middle cerebral artery: Determination of flow velocities with MR angiography.  Radiology. 1991;  181 527-530
  • 12 Warach S, Li W, Ronthal M, Edelmann R R. Acute cerebral ischemia: Evaluation with dynamic contrast enhanced MR imaging and MR angiography.  Radiology. 1992;  182 41-47
  • 13 Parker D L, Goodrich K C, Alexander A L, Buswell H R, Blatter D D, Tsuruda J S. Optimized visualization of vessels in contrast enhanced intracranial MR angiography.  Magn Reson Med. 1998;  40 873-882
  • 14 Schomer D F, Marks M P, Steinberg G K. The anatomy of the posterior communicating artery as a risk factor for ischemic cerebral infarction.  N Engl J Med. 1994;  330 1565-1570
  • 15 Patrux B, Laissy J P, Jouini S, Kawiecki W, Coty P, Thiebot J. Magnetic resonance angiography (MRA) of the circle of Willis: A prospective comparison with conventional angiography in 54 subjects.  Neuroradiology. 1994;  36 193-197
  • 16 Miralles M, Dolz J L, Cotillas J. The role of the circle of Willis in carotid occlusion: Assessment with PC-MRA and transcranial duplex US.  Eur J Vasc Endovasc Surg. 1995;  10 424-430
  • 17 Uehara T, Tabuchi M, Hayashi T, Kurogane H, Yamadori A. Asymptomatic occlusive lesions of carotid and intracranial arteries in Japanese patients with ischemic heart disease: Evaluation with MRA.  Stroke. 1996;  27 393-397
  • 18 Edelmann R R, Mattle H P, O'Reilly G V, Wentz K U, Liu C, Zhao B. Magnetic resonance imaging of flow dynamics in the circle of Willis.  Stroke. 1990;  21 56-65
  • 19 Marks M, Pelc N J, Ross M R, Enzmann D R. Determination of cerebral blood flow with a phase-contrast cine MR imaging technique: Evaluation of normal subjects and patients with arteriovenous malformations.  Radiology. 1992;  182 467-476
  • 20 Fürst G, Steinmetz H, Fischer H. Selective MRA and intracranial collateral blood flow.  J Comput Assist Tomogr. 1993;  17 178-183
  • 21 Parker D I, Blatter D D, Du Y P, Goorich K J. The effect of image resolution in MRA.  JMRI. 1996;  6 632-641
  • 22 Endo S, Furuichi S, Tabak M. et al . Clinical study of enlarged infundibular dilatation of the origin of the posterior communicating artery.  J Neurosurg. 1995;  83 421-425
  • 23 Hassler O, Saltzman G F. Histologic changes in infundibular widening of the posterior communicating artery. A preliminary report.  Acta Pathol Microbiol Scand. 1959;  46 305-312
  • 24 Patrick D, Appleby A. Infundibular widening of the posterior communicating artery progressing to true aneurysm.  Br J Radiol. 1983;  56 59-60
  • 25 Stehbens W E. Histopathology of cerebral aneurysms.  Arch Neurol. 1963;  8 272-285
  • 26 Stuntz J T, Ojemann G A, Alvord Jr E C. Radiographic and histologic demonstration of an aneurysm developing on the infundibulum of the posterior communicating artery. Case report.  J Neurosurg. 1970;  33 591-595
  • 27 Hassler O, Saltzman G F. Angiographic and histologic changes in infundibular widening of the posterior communicating artery.  Acta Radiol Diagn. 1963;  1 321-327
  • 28 Regli L, Tribolet N de. Tuberothalamic infarct after division of a hypoplastic posterior communicating artery for clipping of a basilar tip aneurysm: Case report.  Neurosurgery. 1991;  28 456-459
  • 29 Pedroza A, Dujovny M, Cabezudo Artero J. et al . Microanatomy of the premamillary artery.  Acta Neurochir (Wien). 1987;  86 50-55
  • 30 Marinkovic S, Gibo H, Milisavljevic M. The surgical anatomy of the relationships between the perforating and the leptomeningeal arteries.  Neurosurgery. 1996;  39 72-83
  • 31 Marinkovic S, Milisavljevic M, Marinkovic Z. Branches of the anterior communicating artery.  Acta Neurochir (Wien). 1990;  106 78-85
  • 32 Serizawa T, Saeki N, Yamaura A. Microsurgical anatomy and clinical significance of the anterior communicating artery and its perforating branches.  Neurosurgery. 1997;  40 1211-1218
  • 33 Ture U, Yasargil M G, Krisht A F. The arteries of the corpus callosum. A microsurgical anatomic study.  Neurosurgery. 1996;  39 1075-1085
  • 34 Avci E, Fossett D, Erdogan A, Egemen N. et al . Perforating branches of anomalous anterior communicating artery.  Clin Neurol Neurosurg. 2001;  103 19-22

Dr. Emel Avcı

Harran Üniversitesi · Tip Fakültesi Arastirma Hastanesi · Beyin Cerrahisi Klinigi

63100 Şanliurfa

Turkey

Phone: +90-414-314-1170-1281

Fax: +90-414-315-180 ·

Email: avciemel@hotmail.com

    >