Microsurgical Neurovascular Anatomy of the Brain: The Anterior Circulation (Part I)

Microsurgical Neurovascular Anatomy of the Brain: The Anterior Circulation (Part I)


  • Alice Giotta Lucifero Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
  • Matias Baldoncini Laboratory of Neuroanatomic Microsurgical-LaNeMic-II Division of Anatomy, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
  • Nunzio Bruno Division of Neurosurgery, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, Bari, Italy
  • Nicola Tartaglia Surgical Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
  • Antonio Ambrosi Surgical Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
  • Gian Luigi Marseglia Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy; Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
  • Renato Galzio Neurosurgery Unit, Maria Cecilia Hospital, Cotignola, Italy
  • Alvaro Campero LINT, Facultad de Medicina, Universidad Nacional de Tucumán, T4000 Tucumán, Argentina; Department of Neurological Surgery, Hospital Padilla, T4000 Tucumán, Argentina
  • Juha Hernesniemi Juha Hernesniemi International Center for Neurosurgery, Henan Provincial People’s Hospital, Zhengzhou, China
  • Sabino Luzzi Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.


Anterior Cerebral Artery, Anterior Communicating Artery, External Carotid Artery, Internal Carotid Artery, Middle Cerebral Artery, Perforating Arteries



Treatment of cranial neurovascular pathology requires a detailed understanding of the brain, head, and neck vasculature.

This study aims at a comprehensive overview of the microsurgical anatomy of the anterior cerebral circulation.


Five formalin-fixed adult cadaveric heads were used. Common carotid arteries, vertebral arteries, and internal jugular veins were injected with colored latex (red for arteries and blue for veins). The heads were dissected under a surgical microscope with magnifications ranging between 3× to 40× focusing on the anterior circulation. A synoptic approach was used to describe in detail the segments, branches, perforating arteries, veins, and vascular territories of the cerebral arteries and veins.


The anterior arterial circulation of the brain is provided by the internal carotid artery (ICA), anterior cerebral artery (ACA), middle cerebral artery (MCA), anterior communicating artery (ACoA), and perforating arteries. Perforating arteries of the anterior circulation arise from the ICA, ACA, MCA, ACoA, and posterior communicating artery (PCoA). The distal segments and collateral branches of the ICA, ACA, and MCA give the arterial supply to the largest part of the forebrain, whereas perforating arteries of the anterior circulation are related to the striatum, thalamus, and basal ganglia. The ACoA is the core functional anastomosis between the left and right ICA systems. The external carotid artery provides the vascular supply to the region of the face, head, and neck, and most of the meninges. The internal jugular venous system is composed of the internal and external jugular veins, which constitutes the outflow of the cerebral and facial venous system, respectively.


Thorough knowledge of the topographic, cisternal, and functional anatomy of the anterior circulation of the brain is critical for surgery of the supratentorial lesions.


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How to Cite

Microsurgical Neurovascular Anatomy of the Brain: The Anterior Circulation (Part I). Acta Biomed [Internet]. 2021 Aug. 26 [cited 2024 Jun. 16];92(S4):e2021412. Available from: https://www.mattioli1885journals.com/index.php/actabiomedica/article/view/12116

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