Microsurgical anatomy of distal medial striate artery (recurrent artery of Heubner).

INTRODUCTION: In literature, many controversies exist about courses and terminology of the distal medial striate artery (DMSA) or recurrent artery first described by Heubner near 1872. The purpose of this study was to define the accurate anatomy of this artery, to help the practitioners during surgery of the anterior cerebral-anterior communicating arteries (ACA-ACoA) complex.

MATERIALS AND METHODS: 20 cranial bases were examined using magnification of the surgical microscope. One half for which the internal carotid arteries and internal jugular veins were dissected, cannulated and perfused with colored silicon on fresh cadavers; the other half only with arterial injection of formalin-fixed normal adult human brains.

RESULTS: The artery arose principally from A2 segment (58%), always less than 5 mm up to downstream from ACA to ACoA junction. In 59.5% it had a recurrent course anterior to A1 segment. It terminated in one to three stems which entered the medial part of the anterior perforated substance. The DMSA was present as a single vessel in 95% of cases. Its main outer diameter was 0.7 mm and the length had an average of 24 mm.

CONCLUSION: Iatrogenic damage or occlusion leads to a mediobasal striatum infarction with important neurological deficits such as brachiofacial hemiparesis and aphasia. This artery should be routinely identified during clipping of ACoA aneurysm. Special attention in this study was given to atypical posterior course or anatomic variations such as double DMSA on a same side.