What areas are supplied by the recurrent artery of Heubner?

Areas Supplied by the Recurrent Artery of Heubner

The recurrent artery of Heubner (RAH) primarily supplies the head of the caudate nucleus, the anterior limb of the internal capsule, and parts of the putamen. 1, 2

Anatomical Origin and Course

• The RAH is the largest vessel of the medial lenticulostriate arteries and demonstrates considerable anatomical variation in its origin 3
• Most commonly originates from:
  • The postcommunicating part (A2 segment) of the anterior cerebral artery in 47.81% of cases 3
  • At the level of the anterior communicating artery in 43.4% of cases 3
  • From the precommunicating part (A1 segment) of the anterior cerebral artery in 3.55% of cases 3
• The RAH may be absent in approximately 5-6% of hemispheres and doubled in about 6-17% of hemispheres 1, 3
• Mean diameter ranges from 0.6-0.8 mm, with measurements varying between 0.19-1.34 mm 1, 3

Extracerebral Course

• The RAH typically follows a tortuous path before entering the brain parenchyma 2
• In 61% of cases, the RAH runs superiorly to the A1 segment of the anterior cerebral artery 2
• In 32% of cases, it runs anteriorly to the A1 segment 2
• In 4% of cases, it runs inferiorly to the A1 segment 2
• In 3% of cases, it runs posteriorly to the A1 segment 2
• The extracerebral course is typically 1-5 times longer than the direct distance between its origin and point of penetration into the anterior perforated substance due to its tortuous nature 2

Areas Supplied (Vascular Territory)

• The RAH primarily supplies 1, 2, 4:
  • The head of the caudate nucleus
  • The anterior limb of the internal capsule
  • Parts of the putamen (corpus striatum)
  • Portions of the globus pallidus
  • The lateral orbital gyrus
  • The gyrus longus of the insula

Clinical Significance

• The RAH can be damaged during neurosurgical procedures, particularly during clip placement for aneurysm repair near the anterior communicating artery 1
• Occlusion or damage to the RAH can result in neurological deficits due to ischemia in its supplied territories 2
• The RAH is visible in approximately 12% of cerebral angiograms performed for neurological patients 5
• Understanding the variable anatomy of the RAH is essential for neurosurgeons operating in this region to avoid unexpected neurological complications 3

Imaging Considerations

• The RAH can be visualized using high-resolution imaging techniques 5
• On angiography, the RAH may demonstrate:
  • Only a horizontal segment (in some cases) 5
  • Both horizontal and vertical segments 5
  • Horizontal and vertical segments with visible intraparenchymal branching patterns 5
• In some cases, the RAH may only be visible after contrast injection in the contralateral internal carotid artery during angiography 5