What is the anatomy and supply of the recurrent artery of Heubner?

Anatomy and Supply of the Recurrent Artery of Heubner

The recurrent artery of Heubner (RAH) is the largest vessel of the medial lenticulostriate arteries that supplies critical deep brain structures including the corpus striatum, globus pallidus, and anterior crus of the internal capsule. 1

Origin and Anatomical Variations

• The RAH most commonly originates from three locations:

  • Postcommunicating part (A2 segment) of the anterior cerebral artery (ACA) in 16-47% of cases 1, 2
  • At the junction of the anterior communicating artery (AComA) and ACA in 43-76% of cases 1, 2
  • Precommunicating part (A1 segment) of the ACA in 3-14% of cases 1, 2

• The artery is typically present in 95-99% of hemispheres, with absence reported in 1-6% of cases 1, 2, 3

• Multiple RAHs can occur in the same hemisphere:

  • Single RAH is most common (77-96% of cases) 2, 3
  • Double RAH occurs in 2-17% of cases 2, 3
  • Triple RAH is rare, occurring in approximately 0.14% of cases 2

Morphometric Characteristics

• Mean outer diameter: 0.6-0.8 mm 1, 3
• Range of diameter: 0.19-1.34 mm 1, 3
• Average length: 2.4 cm (range 0.9-3.8 cm) 3

Course and Trajectory

• The RAH typically follows one of three courses relative to the A1 segment of the ACA:

  • Superior course in 30% of cases 2
  • Anterior course in 62% of cases 2
  • Posterior course in 8% of cases 2

• The artery may demonstrate various patterns in angiography:

  • Horizontal segment only (visible in some cases) 4
  • Horizontal followed by vertical segment 4
  • Horizontal and vertical segments with visible intraparenchymal branching 4
  • In some cases, the artery forms a half-loop or full loop before its vertical segment 4

Vascular Territory and Supply

• The RAH supplies critical deep structures including:
  • Corpus striatum 1
  • Globus pallidus 1
  • Anterior crus of the internal capsule 1
  • Parts of the basal ganglia 3

Clinical Significance

• Damage to the RAH during neurosurgical procedures, particularly during aneurysm clipping near the anterior communicating artery, can lead to significant neurological deficits 3

• RAH aneurysms, though rare, can impact cognitive and motor functions when they occur 5

• The RAH is visible in approximately 12% of hemispheres during routine selective cerebral angiography (DSA) 4

• Understanding the variable anatomy of the RAH is essential for planning neurosurgical procedures to avoid unexpected neurological complications 1, 3