The prevalence and anatomy of recurrent artery of Heubner: a meta analysis with neurosurgical considerations.

Abstract

The recurrent artery of Heubner (RAH) is typically the largest medial lenticulostriate branch of the anterior cerebral artery (ACA). Neurosurgical procedures such as aneurysm treatment on the anterior part of the circle of Willis can result in damage of the RAH leading to neurological deficits. The aim of this study was to identify the gaps and provide comprehensive data on the prevalence and anatomical characteristics of the RAH with neurosurgical considerations. The major electronic databases were thoroughly searched to identify the eligible studies. The information concerning study type, geographical origin, prevalence of the RAH, course and origin of the RAH, symmetry of origin and number of RAHs in each hemisphere, and morphometric data were extracted. The PRISMA guidelines were rigorously followed throughout the study. The AQUA tool was used to evaluate the reliability of included studies. A total of 34 studies (n = 3645 hemispheres) were included in the meta-analysis. The analysis revealed that the RAH was present in 97.5% (95%CI: 95.5-98.6) of the hemispheres, originating most frequently from the A2 segment (42.2%, 95%CI: 35.0-49.7) or the ACoA-ACA junction (41.6%, 95%CI: 34.0-49.6), and coursing anteriorly (47.6%, 95%CI: 38.7-56.6) or superiorly (43.9%, 95%CI: 34.4-53.8) in relation to ACA. Almost a quarter of patients had more than one RAH, which was on average 22.82 mm (SD: 1.35, 95%CI: 20.16-25.47; I² = 99.1%, p < 0.01) long and reached 0.76 mm (SD: 0.05, 95%CI: 0.66-0.85; I² = 99.4%, p < 0.01) in diameter. As the RAH is present in the majority of the population, it is important to be aware of the wide variations in its anatomy. This will help to prevent postoperative neurological deficits by avoiding undesirable complications during surgeries that are performed in close proximity to the anterior segment of the circle of Willis.