Cerebral Arterial Circle in Human Adult Cadavers

The main cerebral distribution center of 15-20% blood flow from the cardiac output is the cerebral arterial circle or circle of Willis, a nonagon of collateral vessels on the human brain base. At about 4 mm stage of the embryo, the primitive internal carotid arteries, which develop as cranial extensions of the paired dorsal aorta, are formed. Paired longitudinal neural arteries appear along the hindbrain and coalesce to form the basilar trunk at the 7- to 12-mm stage. The caudal division of the primitive internal carotid artery anastomoses with ipsilateral neural artery and becomes the posterior communicating artery. At the 40-mm stage the posterior cerebral arteries are as extensions of the posterior communicating arteries. The vertebrobasilar system develops and thus participates in the supply of the posterior cerebral artery through the segment between the basilar artery and the post-communicating part of the posterior cerebral artery. In that phase, the component vessels of the circle of Willis all have the same calibre. have the same calibre.  The posterior cerebral artery originates from the basilar bifurcation within the interpeduncular cistern. From its origin the artery curves superior to the corresponding oculomotor nerve in relation to the antero-medial portion of the cerebral peduncle and joins ipsilateral posterior communicating artery. The posterior communicating artery takes origin from the infero-lateral wall of the cerebral part of the internal carotid artery. It is encased in a sleeve of arachnoid along the course from the carotid cistern to the piercing of the interpeduncular cistern and junction with posterior cerebral artery. Topographically, the circle of Willis is divided on anterior and posterior parts. The anterior part composes five vascular components – bilateral cerebral parts of internal carotid arteries (communicating and choroid subparts) and the pre-communicating part of anterior cerebral arteries interconnected by the anterior communicating artery; the posterior part composes four vascular components. As a rule, the posterior part of the circle of Willis is normal as it is formed with posterior communicating artery and the pre-communicating part of the posterior cerebral artery on both sides, where the left and right pre-communicating parts of the posterior cerebral arteries have normal calibres which are larger in relation to posterior communicating arteries, as well as that posterior communicating arteries are not hypoplastic. The anterior communicating artery and posterior communicating arteries are designated as primary collateral pathways. Although the association of variations and aneurysms had been used as an argument in favor of a congenital theory of aneurismal development, it should be interpreted in terms of the hemodynamic stress caused by variations. However, a significantly higher percentage of complete posterior circle configurations were demonstrated on magnetic resonance angiograms in some patients rather than in the controlled subjects.  Basic statistic analysis of calibres of the pre-communicating part of the posterior cerebral artery and posterior communicating artery on both sides in the circle of Willis of human cadavers of different ages and genders. The least caliber of the pre-communicating parts of the right and left posterior cerebral arteries (0.89 and 0.80 mm) is found in a 75-year-old female and a 42-year-old male, while their largest caliber (3.69 and 3.60 mm) is found in 47-year-old and 80-year-old males. The least caliber of the right and left posterior communicating arteries (0.30 and 0.45 mm) is found in a 44-year-old and in a 64-year-old woman, while the largest caliber (2.86 and 3.31 mm) is found in 80-year old woman. Average values of the caliber and the standard deviations for right and left pre-communicating part of the posterior cerebral artery are 2.17 (±0.58) mm and 2.29 (±0.48) mm, as well 1.19 (±0.54) mm and 1.22 (±0.57) mm for the right and left posterior communicating artery, respectively. It is obvious that an incidence of bilateral adult type dominates (68.18%) and that the cases of bilateral transitory and fetal-transitory types as well some subtypes of bilateral fetal and adult types are missing; an unilateral adult configuration is associated with fetal or transitory configuration in about 25% of these adult cases; there is the least incidence (7.27) of bilateral fetal configuration in relation to other three patterns of posterior circle part. Anastomotic flow between carotid and basilar arteries is limited when one or both posterior communicating arteries are hypoplastic, while effective circulation across the circle and between its anterior and posterior components is restricted when both anterior and posterior anastomotic stems are hypoplastic, as well similar limitation of collateral flow results when all component stems of the circle are hypoplastic. The resistance to flow across the posterior communicating artery is greater than across the anterior communicating artery, because the posterior communicating artery is usually a longer vessel.  The relative importance of the calibre values of the brain arteries have thus been assessed, although no clear consensus is found among reports. One of limitations is also potential minor changes in the diameter of the vessels during time. Dysregulation of cerebral blood flow may allow relative ischemia to develop in thesetting of increased metabolic demand related to neuronal hyper excitability, may trigger cortical spreading depression, and may predispose individuals to ischemic lesions and stroke.

Since a significant inverse relationship existed between the diameters of ipsilateral posterior cerebral and posterior communicating arteries, as well as a smaller posterior communicating artery on the left would be associated with a larger posterior cerebral artery on that side.

Acknowledgements:

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