Variations of the Anterior Cerebral Artery in human cadavers: A

dissection study.
Paul S and Mishra S.
Maulana Azad Medical College, New Delhi.

Abastract:
50 specimens of brain were studied in the dissection hall of Maulana Azad Medical College, New Delhi over a period of five years.
The brains were removed from the cranial cavity and the branching pattern and course of the anterior cerebral arteries were observed.
Out of the 50 specimens dissected 9 of them showed an aberrant course and anastomosis between the anterior cerebral arteries of
both the hemispheres. Most of the anastomoses were seen on the orbital surface of the frontal lobe. Arteries on both sides showed
differences in their size also. The knowledge of this anatomical variation may be of consderable help to the neurosurgeons.

Key words: Circle of willis, anterior communication, anastomosis, orbital surface.

Introduction:
In 1962, Thomas Willis was the first scientist
to describe the circuls arteriosus, the major blood
supply to the brain. Since then many anatomical
variations have been reported on different
branches forming the circle of Willis by various
authors pertaining to the formation, developemt
and size of the principal arteries (Orlando et al,
1986; Pchadus-orts et al, 1975; Kamath, 1981 and
Van overbreek et al, 1991)The circulus arteriosus
has an important role in maintaining a stable and
constant blood flow to the cerebral hemisphere
(Puchabus-orts et al 1975). The majority of vessels
contributing to the formation of the circulus
arteriosus are the anterior cerebral, middle
cerebral and posterior cerebral. Most of the
anatomical variations have been reported on the
posterior cerebral and posterior communication
arteries. however there are very few case reports
regarding the variations encountered in the anterior
cerebral arteries and their communications (Wisoff
& Flamm, 1997, Kayambe et al, 1984 & Koyoma,
2000) Hence the present study was undertaken,
to study the origin, course and termination of the
anterior cerebral arteries, to observe the anterior
communicating artery and to observe other
variations between the two sides.
Observations:
Out of 50 brains dissected 9 of them showed
aberrant course of the anterior cerebral arteries,
the branching pattern and the anterior
communicating artery showed a number of
anomalies. The 9 cases, which showed anomalies,
are described as follows.
Case 1.
The anterior cerebral artery of left side crossed
over to the right side and the main stem curved to
the orbital surface to supply both sides by small
anastomotic channels. The left branch was thinner
than the right side.
Case 2.
A common stem was seen arising from the
anterior part of circle of Wilis. It divided into two
branches and again joined further to divide into
two branches after a brief course of about 1.5 cm.
The left branch had a curved course before going
to the orbital surface of the same side. The right
branch deviated towards the right side and coursed
alog the longitudinal fissure to supply the orbital
surface of the same side. Both branches also had
a number of anastomotic channels.

Materials and Methods: Case 3.

50 Brains were taken out from cadavers from
the dissection hall of Maulana Azad Medical
College. Circulus arteriosus was observed in the
interpeduncular cistern. The arachnoid mater was
carefully removed. The anterior cerebral artery
was traced from its origin to its termination, anterior
communicating artery was also observed. All
variations encountered were noted. From each
specimen detailed drawings and photographs
were made.
The two anterior cerebral arteries were joined
by the anterior communicating artery as seen in
normal cases. Immediately after communication
the right anterior cerebral artery separated from
the left and took a curved course to join the left
branch and then traversed forwards along the
medial border of the orbital surface. They also
showed communications in addition to the anterior
communicating artery between the two sides
(fig 1.)

J.Anat.Soc.India 53 (1)15-16 (2004) 15

Variations of the Anterior Cerebral Artery: Paul S et al
Case 4.
The two anterior cerebral arteries arose from
a single point. The left branch coursed for a short
distance near the median plane and then curved
to the orbital surface of the same side, whereas
the right branch took a turn and curved to the
opposite side.
Case 5.
The two anterior cerebral arteries seemed to
be arising from a common stem showing a
number of anastomotic branches between the two
sides. The right branch is deviated from the midline
and shows one communication immediately above
the common stem (fig 2).
Case 6.
This specimen also showed a common stem
with the anterior cerebral artery arising from it and
took a tortuous course on to the left side before
going to their respective sides.
Case 7.
Anterior cerebral arteries of both sides were
of different calibers and they were joined by the
anterior communicating artery. Right artery was
distinctly larger than the left and crossed over to
the left side. Before crossing it gave a major branch
to the right side (fig 3).
Case 8.
The distances between anterior cerebral
arteries were much more than normally seen.
Case 9.
The anterior cerebral and anterior
communicating arteries were distinctly visible. The
right artery deviated more to the left and both the
branches showed communications in the midline.
Thereafter they were running parallel to each other
(fig 2).
Discussion:
Anastomoses between the two anterior
cerebral arteries in addition to the anterior
communicating artery have been observed.
Narrowing of the anterior cerebral artery of one
side was observed while the artery of the opposite
side crossed over to compensate for the vascular
J.Anat.Soc.India 53 (1)15-16 (2004)
insufficiency.
There are reports on agenesis and hypoplasia
of the initial segment of the anterior cerebral artery
and anterior communicating arteries resulting in
a defective circulation. The circulus arteriosus
offers a potential shunt in abnormal conditions
such as occlusions and spasms. In normal
circumstances it is not an equalizer and distributor
of blood from differnt sources. In about 1/3 cases
angiographic evidence of defective circulation
have been observed, Puchades-Orts et al, (1975)
Therefore, existence of an effective circulation can
never be assumed on surgical procedures involving
its feeders. There are few case reports indicating
a variation of the anterior cerebral artery and the
communicating artery observed during operation
(Dunker and Harris, 1976; Wisoff & Flamm, 1997;
Kayembe, 1984; Koyoma, 2000 & Hoksberegen
et al, 2000). All surgical interventions of the anterior
cerebral artery should be preceded by
angiography. The present study confirms the high
percentage of variation seen in case of the anterior
cerebral artery.
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Variations of the Anterior Cerebral Artery: Paul S et al

Fig. 1. Anterior cerebral arteries joined by
anterior communicating artery (arrow). Right
branch is seen to separate out from the left
branch and rejoins is showing additional
communication (arrowhead)
Fig. 2. The Two anterior cerebral arteries
arising from a common stem (arrow) and
showing number of anastomotic branches
between the two sides (*).

Fig. 3. Right artery (R) is larger than left (L)

and crosses over to the opposite side. Before
crossing, it gives a major branch (arrow).

J.Anat.Soc.India 53 (1)15-16 (2004)

Restraint Stress and Testosterone level : Rai J et al

Fig. 1. Photomicrograph showing group of leydig cells between three seminiferous tubule.
Masson's Trichrome X 600.

Fig. 2. Photomicrograph of intertubular space showing lipid vacuolations in leydig cells,

extracellular fat cells and increased peritubular firbroblastic activity. H & E X 600.

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