A comprehensive study of the anatomical variations of the circle of willis in adult human brains

Abstract

Background: Cerebrovascular diseases such as stroke, aneurysms and arterio-venous malformations are very much prevalent in our country. Circle of Willis, as an anastomotic polygon at the base of the brain forms an important collateral network to maintain adequate cerebral perfusion. Changes in the normal morphology of the circle may condition the appearance and severity of symptoms of cerebrovascular disorders, such as aneurysms, infarctions and other vascular anomalies. A possible link between abnormalities of the circle of Willis and the mentally ill patients has been observed.

Aim and objectives: The aim of the present study is to have an intimate knowledge of the variations in the cerebral arterial circle and to clarify the clinical importance of these variations in certain forms of cerebrovascular diseases. So an attempt was made to analyse the anatomical variations of the circle in a random population.

Material and methods: The work was based on fifty adult brains from persons died of diverse causes. The materials were obtained during routine autopsy studies. The base of the brain including the brain stem with intact arterial circle was preserved in 10% formalin for 10 days. The circle of Willis and its major branches were carefully dissected under water using a magnifying lens. The variations were recorded and photographed.

Results: Majority of the circles (52%) showed anomalies. Hypoplasia was the most frequent anomaly and was found in 24% of the brains. Accessory vessels in the form of duplications/triplications of anterior communicating artery were seen in 12% of the circles. The embryonic origin of the posterior cerebral artery from the internal carotid persisted in 10% of the circles. An incomplete circle due to the absence of one or other posterior communicating artery was found in 6% of the specimens.Variations are more frequent in posterior half of the circle.

Conclusion: The anatomical variations of the circle of Willis were probably genetically determined, develop in early embryonic stage and persist in post natal life. The amplitude of neck movements, racial, environmental and hemodynamic factors may also modify these variations. These anomalies may alter the occurrence, severity of symptoms, treatment options and recovery from certain cerebrovascular disorders viz., stroke and aneurysms. A detailed knowledge of the vascular variants is useful to surgeons in planning their shunt operations, choice of the patients and also keeps away inadvertent vascular traumas during surgeries.

Keywords: Anastomosis; Aneurysms; Cerebrovascular disorders; Circle of Willis; Hypoplasia.

[Table/Fig-1]:

Photograph of the Normal circle of Willis

[Table/Fig-2]:

Photograph of the hypoplastic Posterior and Anterior communicating arteries. a) Hypoplastic ACOA; b) Hypoplastic PCOAs

[Table/Fig-4A]:

Photograph of the duplications of Anterior communicating artery. c) Duplicated ACOAs

[Table/Fig-4B]:

Photograph of the triplications of Anterior communicating artery. d) Triplicated ACOAs

[Table/Fig-5]:

Photograph of the triplicate Anterior cerebral arteries e) Triplicate ACAs

[Table/Fig-6A]:

Photograph of the bilateral embryonic origin of Posterior cerebral from Internal carotid arteryf) Bilateral embryonic origin of PCAs

[Table/Fig-6B]:

Photograph of the unilateral embryonic origin of Posterior cerebral from Internal carotid artery g) Unilateral embryonic origin of PCA