Microsurgical insights: A comprehensive anatomical study of Heubner's recurrent artery.

Background: The recurrent artery of Heubner (RAH) was first described by Johann Heubner in 1872 and later named by H.F. Aitken in 1909. It is the largest medial lenticulostriate artery from the anterior cerebral artery (ACA). Originating from the A1, A2, or ACA-anterior communicating artery junction, it supplies key brain structures like the caudate nucleus and anterior hypothalamus, with variations in origin and course among individuals. Methods: We studied 15 human brains (5 females and 10 males), ensuring no neurological disease or damage to the anterior communicating complexes. Brains were fixed in 10% formalin for a month and then injected with red-colored latex for vascular visualization. Dissections were performed using a Zeiss OPMI surgical microscope, and detailed notes and images were captured for analysis. Results: RAH was identified in 28 of 30 hemispheres, with 11 exhibiting double arteries. RAH origin is located approximately 1-4 mm from the anterior communicating artery (ACOM). The most common origins were the juxtacommunicating, A2, and A1 segments. Trajectories observed included "L," inverted "L," oblique, and sinuous, with oblique being the most common. Variations included the absence of RAH replaced by an accessory middle cerebral artery in some cases. Conclusion: The RAH shows significant anatomical variability, originating from different ACA segments or the frontopolar artery, with four main trajectory types. Understanding these variations is critical for neurosurgical planning, as preserving the RAH can prevent neurological deficits. Gender differences in origin and trajectory were noted, influencing surgical approaches and outcomes.