Recurrent Artery Of Heubner Research Articles

Exploring arterial anatomy of the internal capsule: an analysis of the deep vascular structures and related white matter pathways.

The internal capsule is supplied by perforators originating from the internal carotid artery, middle cerebral artery, anterior choroidal artery and anterior cerebral artery. The aim of this study is to examine the vascular anatomy of the internal capsule, along with its related white matter anatomy, in order to prevent potential risks and complications during surgical interventions. Twenty injected hemispheres prepared according to the Klingler method were dissected. Dissections were photographed at each stage. The findings obtained from the dissections were illustrated to make them more understandable. Additionally, the origins of the arteries involved in the vascularization of the internal capsule, their distances to bifurcations, and variations in supplying territories have been thoroughly examined. The insular cortex and the branches of the middle cerebral artery on the insula and operculum were observed. Following decortication of the insular cortex, the extreme capsule, claustrum, external capsule, putamen and globus pallidus structures were exposed. The internal capsule is shown together with the lenticulostriate arteries running on the anterior, genu and posterior limbs. Perforators supplying the internal capsule originated from the middle cerebral artery, anterior cerebral artery, internal carotid artery and anterior choroidal artery. The internal capsule's vascular supply varied, with the medial lenticulostriate arteries (MLA) and lateral lenticulostriate arteries (LLA) being the primary arteries. The anterior limb was most often supplied by the MLA, while the LLA and anterior choroidal artery dominated the genu and posterior limb. The recurrent artery of Heubner originated mostly from the A2 segment. The distance from the ICA bifurcation to the origin of the first LLA on M1 is 9.55 ± 2.32mm, and to the first MLA on A1 is 5.35 ± 1.84mm. MLA branching from A1 and proximal A2 ranged from 5 to 9, while LLA originating from the MCA ranged from 7 to 12. This study provides comprehensive understanding of the arterial supply to the internal capsule by combining white matter dissection. The insights gained from this study can help surgeons plan and execute procedures including oncological, psychosurgical, and vascular more accurately and safely. The illustrations derived from the dissections serve as valuable educational material for young neurosurgeons and other medical professionals.

Anatomical Variations and Anomalies of the Anterior Communicating Artery Complex

INTRODUCTIONIntracranial arteries have a high rate of variation, but a clear schematic overview is lacking. In this pictorial review we classify and depict all variations and anomalies within the anterior communicating artery complex. MATERIAL AND METHODS: PubMed was searched with the terms “Anterior Communicating Artery” AND “Variations” OR “Anomalies.” Articles were selected based on their description of variants. Cross referencing was used to broaden the range of variations. The variations were then schematically drawn. The surgical view during pterional craniotomy and transsylvian approach was used as a baseline. RESULTS: A total of 42 variants were identified and schematically drawn and classified into A1 / A2 segment, anterior communicating artery and the recurrent artery of Heubner. CONCLUSION: In this review we classify and depict all variations and anomalies within the Anterior Communicating Artery Complex. Anatomical knowledge of this region is of utmost importance during microsurgical clipping to prevent complications. This overview could prove useful in both microsurgical and endovascular management of patients with aneurysms of the anterior communicating artery.

Twig-like Middle Cerebral Artery: Case Series in a European Population

Twig-like middle cerebral artery (MCA) is a rare anomaly where the M1 MCA is partially or completely replaced by a plexiform network. It has been described in angiographic series from Asian and South-American cohorts, but has not yet been reported in a European population. The digital subtraction angiograms (DSAs) of adult patients referred to a single neurovascular center for a diagnostic hypothesis of moyamoya arteriopathy (MMA) from 2018 to 2023 were prospectively and retrospectively checked by experienced neuroradiologists for identifying patients with twig-like MCA. The angioarchitecture of twig-like MCA was systematically evaluated and described. Five of 30 (16.7%) male patients (mean age 55.8+ 14.7 years) of European ancestry were identified as having twig-like MCA. The clinical presentations were ischemic stroke (2 of 5), hemorrhagic stroke (1 of 5), and headache (2 of 5). All patients showed a unilateral involvement on DSA and in 1 of 5 (20%) an intracranial aneurysm was found. DSA was used to confirm the diagnosis of twig-like MCA and define the angioarchitecture and associated anomalies. An accessory MCA and recurrent artery of Heubner were found in 3 of 5 (60%) cases, feeding the network together with the anterior choroidal artery (4 of 5, 80%). Twig-like MCA is a rare vascular anomaly, but it seems to be less rare than expected among adult European patients with suspected MMA on noninvasive neuroimaging studies. DSA is fundamental for a reliable differential diagnosis and should not be omitted in these patients.

Post-traumatic ischaemic stroke in a teenager after head trauma: A case report

Lacunar strokes in the pediatric population are very uncommon, as well as trauma-induced strokes. It is extremely rare for a head trauma induced ischaemic stroke to occur in children and young adults.We describe a case of a 13-year-old boy who reported acute ischaemic lesions, and in particular a right basal ganglia ischaemic stroke after falling from a height of 10 m, presumably secondary to the stretching-induced occlusion of the recurrent artery of Heubner, with a favorable outcome.Ischaemic strokes can rarely be subsequent to head trauma in young adults, in relationship with the degree of maturity of the perforating vessels. Although very rare, it is important to avoid the lack of recognition of this condition, thus awareness is necessary.

Arterial Supply of the Basal Ganglia: A Fiber Dissection Study.

The basal ganglia, a group of subcortical nuclei located deep in the insular cortex, are responsible for many functions such as motor learning, emotion, and behavior control. Nowadays, because it has been shown that deep brain stimulation and insular tumor surgery can be performed by endovascular treatment, the importance of the vascular anatomy of the basal ganglia is being increasingly recognized. To explain the arterial blood supply of the basal ganglia using white matter dissection. The Klingler protocol was used to prepare 12 silicone-injected human hemispheres. The dissections were performed from lateral to medial with the fiber dissection technique to preserve arteries. The globus pallidus blood supply came from the medial lenticulostriate, lateral lenticulostriate, and anterior choroidal arteries; the substantia nigra and subthalamic nucleus were supplied by the branches of posterior cerebral artery; the putamen was supplied by the lateral and medial lenticulostriate arteries; and the caudate nucleus was supplied by the lateral lenticulostriate and medial lenticulostriate arteries and the recurrent artery of Heubner. Knowledge of the detailed anatomy of the basal ganglia and its vascular supply is essential for avoiding postoperative ischemic complications in surgeries related to the insula. In addition, knowledge of this anatomy and vascular relationship opens the doors to endovascular deep brain stimulation treatment. This study provides a 3-dimensional understanding of the blood supply to the basal ganglia by examining it using the fiber dissection technique. Further studies could use advanced imaging modalities to explore the vascular relationships with critical structures in the brain.

Comparative anatomy of the middle cerebral artery, rhinal and endorhinal sulci, piriform lobe, entorhinal cortex, olfactory tubercule, anterior perforate substance, and hippocampus: A dissection study.

The literature describing the complex anatomy of the middle cerebral artery (MCA), lenticulostriate arteries, and recurrent artery of Heubner, does not discuss the comparative anatomy of the cerebrum, MCA, the recurrent artery of Heubner, and the relationship of the MCA with the rhinal sulci. The entorhinal literature does not detail the comparative anatomic modification of the rhinal and endorhinal sulci, piriform lobe and the hippocampus's compressed positional change in the temporal lobe. This investigation's objectives were to analyze the comparative anatomic modifications of the cerebrum, the MCA, lenticulostriate arteries, recurrent artery of Heubner, olfactory tubercule, anterior perforate substance, rhinal sulcus, endorhinal sulcus, piriform lobe, entorhinal cortex, and hippocampus. Brain dissections of adult iguana, rabbit, sheep, cat, dog, macaque, human and human fetal specimens were analyzed. The MCA branches enter the striate nuclei via the endorhinal sulcus, with few branches present in the rhinal sulcus. Modifications of the cerebrum, with the development of gyri and sulci and opercula covering the insula, changes the linear surface configuration of the MCA into a tridimensional one. Similar changes are present in human fetal specimens. The cerebral neocortical expansion changes the position of the rhinal and endorhinal sulci, their relationship with the MCA, the size of the olfactory tubercule, the position and size of the piriform lobe, and the diagonal course of the lenticulostriates and recurrent artery of Heubner. The hippocampus becomes compressed in the inferomedial region of the human temporal lobe. The lenticulostriate arteries are likely the first developed component of the MCA.

Global Frequency and Clinical Features of Stroke in Patients With Tuberculous Meningitis

Stroke in tuberculous meningitis (TBM) is associated with significant morbidity and mortality. To determine the country-specific, regional, and overall prevalence of stroke among patients with TBM, including their clinical manifestations, stroke locations, and outcomes. This systematic review searched records in MEDLINE by PubMed, Scopus, and EMBASE until July 2020 for relevant articles on the occurrence and characteristics of stroke in TBM. Randomized clinical trials and cohort studies that included a population of patients with TBM were analyzed for clinical manifestations, type of stroke, area of stroke, vascular territory, and outcomes. Studies that did not report the occurrence of stroke, reported as abstract only with no full-texts available, and articles not in English were excluded. The country-specific, regional, and overall frequencies of stroke among patients with TBM were determined; secondary analysis enumerated the summary estimates of the clinical presentations, common locations of stroke, and outcomes. The Murad tool was used to assess methodological quality. From 852 articles identified, 71 studies involving 2194 patients with stroke in TBM were included. The sample size for each study ranged from 17 to 806 patients. The frequency of stroke in TBM showed an estimate of 0.30 (95% CI, 0.26-0.33). The most common clinical manifestations were fever and headache. The lateral striate, middle cerebral, and medial striate arteries were typically affected. The basal ganglia, cortex and lobar, and internal capsule were the frequently involved areas of the brain. The pooled proportions of mortality and poor outcomes were 0.22 (95% CI, 0.16-0.29) and 0.51 (95% CI, 0.37-0.66), respectively. The results of this systematic review suggest that stroke is considerably frequent among patients with TBM. The reported frequencies of stroke in TBM and its clinical features vary across the studies and populations.

Recurrent Ischemic Strokes in the Territory of Recurrent Artery of Heubner Presenting in Relation to Facial Swelling and Weakness

Strokes involving the Recurrent Artery of Huebner are quite rare and are often asymptomatic. Here, we describe a rare case of recurrent infarctions involving the right Recurrent Artery of Heubner, likely due to small vessel disease. Our 32-year-old patient presented to the emergency department with sudden onset right-sided facial weakness, numbness, and difficulty with eye closure. A non-contrast head computed tomography scan and magnetic resonance imaging revealed an incidental subacute infarct in the territory of the right Recurrent Artery of Heubner. He was discharged on valacyclovir and prednisone for suspected Bell’s palsy, as well as aspirin, atorvastatin, metformin, and antihypertensives for secondary stroke prevention. Unfortunately, he was noncompliant with medications and lost to follow-up until he presented again more than one year later with a complaint of isolated right facial swelling and ipsilateral weakness. Imaging revealed an incidental new subacute infarct in the territory of the right Recurrent Artery of Heubner. Close follow-up of the patient and guidelines for appropriate management of secondary risk factors are discussed.

Endoscopic endonasal surgical anatomy through the prechiasmatic sulcus: the key window to suprachiasmatic and infrachiasmatic corridors

Classically, the transtuberculum and transplanum approaches have been utilized to reach the suprachiasmatic and infrachiasmatic corridors. The aim of this study was to provide a better understanding of the key endoscopic endonasal anatomy of the suprachiasmatic and infrachiasmatic corridors provided through selective removal of the prechiasmatic sulcus (SRPS). A SRPS was performed in 16 sides of 8 alcohol-fixed head specimens. Twenty anatomical measurements were collected on the suprachiasmatic and infrachiasmatic corridors. The transplanum and transtuberculum approaches were also performed. In the suprachiasmatic corridor, the SRPS exposed the anterior communicating artery (AComm) and the post-communicating segment of the anterior cerebral arteries in all the cases, while the pre-communicating segment of the anterior cerebral arteries, recurrent arteries of Heubner, and fronto-orbital arteries were visualized in 75% (12/16), 31% (5/16), and 69% (11/16) of cases, respectively. In the infrachiasmatic corridor, the ophthalmic segment of the internal carotid artery and superior hypophyseal arteries were always visible through the SRPS. The mean width and height of the prechiasmatic sulcus were 13.2mm and 9.6mm, respectively. The mean distances from the midpoint of the AComm to the anterior margin of the optic chiasm (OCh) was 5.3mm. The mean width of the infrachiasmatic corridor was 12.3mm at the level of the proximal margin of the ophthalmic segment of the internal carotid artery. The mean distances from the posterior superior limit of the pituitary stalk to the basilar tip and oculomotor nerve were 9.7mm and 12.3mm, respectively. The SRPS provides access to the main neurovascular and cisternal surgical landmarks of the suprachiasmatic and infrachiasmatic corridors. This anatomical area constitutes the key part of the approach to the suprasellar area. To afford adequate surgical maneuverability, the transplanum or transtuberculum approaches are usually a necessary extension.

Assessment of Arterial Configurations of the Suprachiasmatic Region from the Endoscopic Endonasal Perspective: A Cadaveric Anatomical Study

Endoscopic endonasal surgery has proved to offer a practical route to treat suprasellar lesions, including tumors and vascular pathologies. Understanding the different configurations of the anterior cerebral communicating artery (ACoA) complex (ACoA-C) is crucial to properly navigate the suprachiasmatic space and decrease any vascular injury while approaching this region through an endonasal approach. An endoscopic endonasal transplanum-transtubercular approach was performed on 36 cadaveric heads (72 sides). The variations of the ACoA-C and feasibility of reaching its different components were analyzed. The surgical area exposure of the lamina terminalis was also quantified before and after mobilization of the ACoA-C. The typical ACoA-C configuration was found in 41.6% of specimens. The following 2 main variations were identified: accessory anterior cerebral artery segment 2 (5, 13.9%) and common trunk of anterior cerebral artery with absence of ACoA (5, 13.9%). Of 101 recurrent arteries of Heubner, 96 (95.0%) were identified within 4 mm proximal or distal to the ACoA. The mean lamina terminalis exposure area was 33.1 ± 16.7 mm2, which increased to 59.9 ± 11.9 mm2 after elevating the ACoA. A considerable amount of variation of the ACoA-C can be found through an endoscopic endonasal transplanum-transtubercular approach. These configurations determine the feasibility of lamina terminalis exposure and the complexity of reaching the ACoA. Assessment of ACoA morphology and its adjacent structures is crucial while approaching the suprachiasmatic through a transnasal corridor.

A comparative analysis of the endoscopic endonasal and pterional approaches for clipping anterior communicating artery aneurysms on three-dimensional printed models.

A comparative analysis of the endoscopic endonasal and pterional approaches for clipping anterior communicating artery aneurysms on three-dimensional printed models.

Morphological evaluation of the distal medial striate artery. A study with cadaveric material.

Objective: To evaluate the morphology of the distal medial striated artery, taking into account biometric variables useful for clinical and surgical management. Methods: A descriptive transversal study was performed with a sample of brains, who underwent autopsy at the Institute of Legal Medicine and Forensic Sciences of Bucaramanga-Colombia, which were evaluated using the perfusion technique of vascular structures with polyester resin.Results: The distal medial striated artery was presented in 1.4% and 4.2% duplicated in the right and left hemispheres respectively. Agenesis was presented in 2.8% in the left hemisphere. Its origin was 44.6% of the anterior cerebral artery junction site with the anterior communicating artery and was observed in 6 cases (4.2%) presented with a common trunk with the orbitofrontal artery. The main qualitative finding was the sinuous trajectory that was observed in 57.7% on the right side and 45.1% in the left hemisphere. Also, an important alteration found at the biometric analysis was hypoplasia that could be related to the decreased blood supply to the basal nuclei. The diameter was 0.5 ± 0.2 mm and its total length was 20.3 ± 4.1 mm.Conclusions: The topographical knowledge of this structure determines the vulnerability of its morphology because it can complicate surgical procedures performed in the anterior segment of the arterial circle of the brain. Besides, the observed collateral circulation contributes to the blood supply and the perfect functionality of the subcortical nervous structures.

Enlarged anterior communicating artery masquerading as intracranial aneurysm

Background. The anterior communicating artery (ACoA) complex consists of the ACoA, the pre-and post-communicating segments of the anterior cerebral artery, and the recurrent artery of Heubner. It is the most common site for anatomical variations in the circle of Willis. Such variations can mimic intracranial aneurysms.
 Case description. A 30-year-old female presented with recurrent episodes of extreme headache and bilateral tinnitus. A brain computed tomography (CT) scan showed no significant lesions, while her CT-angiography (CTA) showed an enlarged vascular lesion at the ACoA, raising the suspicion for an ACoA aneurysm. A repeated CTA revealed a rare anatomical variation with a pattern of cross dominance in the ACoA complex; the left A1 and right A2 were dominant-enlarged, resulting in an enlargement of the ACoA. The presence of an ACoA aneurysm was hence excluded and the patient was managed conservatively. At 6-month follow-up, CTA showed no new findings. 
 Conclusion. ACoA enlargement can result from unequal hemodynamics around the ACoA complex, which may be mistaken for an aneurysm. A thorough study of the imaging data is of pivotal importance and may change the management strategy.

Clipping of Complex Internal Cerebral Artery Terminus Aneurysm: 2-Dimensional Operative Video.

Internal carotid artery (ICA) bifurcation, or terminus, aneurysms are uncommon, and although they can be accessed with relative ease, clip occlusion of such aneurysms is often challenging due to the close proximity of basal forebrain perforator vessels. This patient had an incidentally discovered ICA terminus aneurysm and elected for microsurgical clipping. A modified orbitozygomatic approach was used to approach the aneurysm. The clipping was significantly complicated by the adherence and close proximity of the recurrent artery of Heubner to the aneurysm dome. Following successful dissection of the artery from the aneurysm dome and complete visualization of the aneurysm neck to avoid violation of perforator flow, successful clip occlusion of the aneurysm was achieved. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Partial Gyrus Rectus Resection as a Technique to Improve the Exposure to the Anterior Communicating Artery Complex through the Junctional Triangle: A Quantitative Study.

Objective The junctional triangle, formed by the distal A1 anterior cerebral artery (ACA) segment, the proximal A2 ACA segment, and the medial surface of gyrus rectus (GR), is a corridor of access to superiorly and posteriorly projecting anterior communicating artery (AComA) aneurysms that is widened by GR retraction or resection. Exposure of the AComA complex through the junctional triangle after GR resection has not been previously quantitatively evaluated. Design GR resection extent and increase in artery exposure through the junctional triangle were assessed in this study. Setting This study was conducted in the laboratory with a pterional approach, exposing the AComA complex. Participants Ten sides of five cadaveric heads were considered. Main Outcome Measures Exposure extent of ipsilateral and contralateral A1, A2, and AComA and accessibility of branches coming off the AComA complex were measured before and after GR resection. The GR was resected until sufficient bilateral A2 and contralateral A1 exposures were achieved. GR resection span was measured. Results The mean (standard deviation) resected span of GR was 7 ± 3.9 mm. After GR resection, the exposed span of the ipsilateral A2 increased from 2 ± 0.7 mm to 4 ± 1.1 mm ( p = 0.001); contralateral A2 exposure increased from 3 ± 1.5 mm to 4 ± 1.1 mm ( p = 0.03). Contralateral recurrent artery of Heubner (RAH) and orbitofrontal artery were accessible in five and eight specimens, respectively, before GR resection and in all 10 after resection. Conclusion GR resection improves exposure of bilateral A2 segments through the junctional triangle. Exposure improvement is greater for the ipsilateral A2 than contralateral A2. The junctional triangle concept is enhanced by partial GR resection during surgery for superior and posterior AComA aneurysms.

"Reverse Picket Fence" Technique for Clipping of a Large, Anterior Communicating Artery Aneurysm: 2-Dimensional Operative Video.

The "picket fence" technique is a clipping technique used for large, wide-neck complex aneurysms not suitable for conventional clipping.1 With this technique, simple or fenestrated straight clips are stacked side-by-side perpendicular to the neck rather than the conventional parallel placement. In complex aneurysms projecting away from the surgeon, the picket fence technique is impossible. Instead, fenestrated clips are applied in a reverse direction from neck-to-dome, using the blade heels to close the neck. This fenestration tube transmits the bifurcation. This video demonstrates a "reverse picket fence" clipping technique of an incidental, large anterior communicating artery (ACoA) aneurysm in a 52-yr-old woman. Bilaterally adherent A2-anterior cerebral artery (ACA) segments led to abortion of a prior clipping attempt at an outside hospital. After obtaining patient consent, a modified orbitozygomatic craniotomy was performed with gyrus rectus removal. Temporary clips were applied to A1-ACA for freeing the adherent A2-ACA segments from the dome. The aneurysm was clipped using a "reverse picket fence" technique transmitting the A1-A2-A2 bifurcation through the fenestration tube. Bilateral recurrent artery of Heubner was preserved. Indocyanine angiography demonstrated parent vessel patency with complete aneurysm exclusion. Postoperatively, the patient experienced short-term memory loss, which resolved over 6 mo with cognitive rehabilitation. The "reverse picket fence" technique can be considered for large aneurysms directed away from the surgeon, obviating the need for difficult dissection of adherent efferent arteries from aneurysmal sac. Adjusting the heel position of each fenestrated clip in this construct allows the patency of hidden perforators behind the aneurysm to be maintained. Video © Barrow Neurological Institute. Used with permission.

Embryology and variations of the recurrent artery of Heubner.

The recurrent artery of Heubner (RAH) is a very fascinating artery for various reasons. The first one is its early development in the embryologic and phylogenic life. The second one is the discrepancy between its diameter and its functional importance and the last but not least reason is the many variations of origin and course of this artery. For more than a century, numerous studies furnished important information about variations in origin, course, and parenchymal territory of the RAH. The most important anomaly concerning the RAH is the accessory middle cerebral artery and well-illustrates the complexity of its embryologic development. For these reasons, authors provide a review of anatomical variations of this artery that could be encountered with a particular attention given to the history and embryological knowledge.

Cerebral deep vascular architectures and subcortical infarcts

The lenticulostriate arteries (LSA) supply the lateral half of the head of the caudate nucleus, entire putamen, anterior limb, genu and the superior part of the internal capsule (IC) and a part of the corona radiata. The LSA consists with medial, intermediate and lateral branches. The medial branches perfuse the lateral segment of the globus pallidus, the head of the caudate nucleus and the anterior limb of the IC. The intermediate branches supply the anterior half of the LSA territory, while the lateral branches supply the posterior half. The anterior cerebral artery (ACA) perforators, predominantly Heubner's artery, perfuse the inferomedial part of the caudate head, the anteromedial part of putamen, the anterior part of the lateral segment of the globus pallidus and anterior limb of the internal capsule. Such territories can be represented by the anterior and ventral basal ganglions. The anterior choroidal artery (AChA) gives off three main groups of branches including the lateral branches that supply the medial temporal lobe, the medial branches that supply the cerebral peduncle and the superior branches that supply the internal capsule and the basal ganglia. The superior branches are further discriminated into proximal branches that supply the anterior one third of the posterior limb of internal capsule (PLIC) and the medial segment of the globus pallidus and distal branches that supply the posterior two-third of PLIC, retro-lenticular part of the internal capsule and the lateral thalamic nuclei. The superficial penetrating arteries, i.e. medullary arteries, arise from the cortical branches of the middle cerebral artery (MCA) and supply the deep white matter. Infarcts caused by the medullary artery occlusion are located in the centrum-semiovale and half of them were caused by embolic mechanism. The centrum-semiovale corresponds to cortical border-zone (BZ) while the corona radiate corresponds to internal BZ.

Ruptured Aneurysm of Recurrent Artery of Heubner: A Case Report

Ruptured Aneurysm of Recurrent Artery of Heubner: A Case Report

Prevalencia de la Arteria Estriada Medial Distal en una Muestra de Poblaciones Colombiana y Peruana

The distal medial striate artery is part of the brain circulation, born from the anterior cerebral artery generally at the level of the anterior communicating artery, although according to different studies its origin varies, being thus difficult to determine with accuracy. Its clinical importance lies in the prevalence of aneurysms found in this artery, which could later cause complications due to the region they irrigate, these being the somatic-vital and neuropsychological sequelae, in addition to its inadequate surgical approach without foreseeing the alterations that may be caused; Because of the above it is of vital importance that health professionals have prior knowledge of the anatomy and prevalence of this artery in the population. An observational descriptive study was carried out in which the distal medial striated artery in 70 brain cells, pieces from the Medicine amphitheatres of the Universidad de Ciencias Aplicadas y Ambientales U.D.C.A. (Bogota), the Universidad Cientifica del Sur UCSUR (Lima); fixed in 10 % formalin, morphometric measurements were made by automatic calibrator and the photographic record was taken with a Canon camera. Subsequently, the statistical analysis was executed through the IBM SPSS Statistics program 24. A prevalence of 88.6 % of at least one distal medial striate artery was found in the Colombian population and 97.1 % of the Peruvian population. An average external diameter of 0.64 mm was identified in the Colombian population and 0.68 mm in the Peruvian population. An average length of 2.5 cm was observed in both populations. The largest place of origin was evidenced in the A2 portion of the ACA with 37.1 % of the Colombian population and 51. 4 % of t he Peruvian populati on. The anat omy and t he corresponding anatomical variations of this artery must be adequately known to be able to perform an adequate neurological and neurosurgical approach.