Microsurgical anatomy of anterior communicating artery complex through pterional keyhole approach

Objective To explore the morphological characteristics of the anterior communicating artery complex(ACoAC)through the pterional keyhole approach,in order to provide the anatomic basis for the treatment of diseases related to the ACoAC.Methods Fifteen adult cadaver heads were dissected through the pterional keyhole approach,and the bilateral ACoAC was exposed and observed under a microscope.The morphological characteristics of the ACoAC and its perforating branches were studied.Results The ACoACs were exposed sufficiently through the pterional keyhole approach.The anterior cerebral artery(ACA)originated from the internal carotid artery and connected by the anterior cerebral communicating artery(ACoA)to contralateral ACA.The recurrent artery of Heubner was the thickest branch of the ACA-A1 segment and the location of its origin was in the range of 3 cm proximally to 3 cm distally.Few perforating arteries were found within 3～5 mm proximally and middle 1/3 of the ACA-A1 segment.Many variations were found in the diameter,length and origin of the ACA,ACoA and their perforating branches.Conclusion It is feasible to treat the diseases related to the ACoAC by the microsurgery via the pterional keyhole approach.The complicated morphological features of the ACoAC should be mastered sufficiently before the operation.The two positions located within 3-5 cm proximal to A1 segment and middle 1/3 portion of A1 segment can be used to transiently block for ACoA aneurysms.