Vol 80, No 4 (2021)
Original article
Published online: 2020-12-05

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Anatomical variations and morphometric properties of the circulus arteriosus cerebri in a cadaveric Malawian population

C. Nyasa1, A. Mwakikunga12, L. H. Tembo12, C. Dzamalala1, A. O. Ihunwo2
Pubmed: 33330970
Folia Morphol 2021;80(4):820-826.

Abstract

Background: Knowledge of the anatomy of the circulus arteriosus cerebri (CAC) is important in understanding its role as an arterial anastomotic structure involved in collateral perfusion and equalisation of pressure, and may explain observed variations in neurovascular disease prevalences across populations. This study was aimed at understanding the anatomical configuration and morphometric properties of the CAC in Malawian population.
Materials and methods: Brains were collected from 24 recently-deceased black Malawian human cadavers during medico-legal autopsies. Photographs of the CACs were taken using a camera placed at a 30 cm height from the base of the brain. Whole-circle properties and segmental vessel parameters were analysed using the OSIRIS computer programme, paying attention to completeness, typicality, symmetry, and segmental vessel diameters and lengths.
Results: The complete-circle configuration was found in 69.57% of the CACs. Of these, 37.5% were typical, representing an overall typicality prevalence of 26.09%. Vessel asymmetry was observed in 30.43% of cases. There were 7 cases of vessel aplasia and 12 cases of vessel hypoplasia. The posterior communicating artery (PcoA) was the most variable (with 12 variations), widest (7.67 mm) and longest (27.7 mm) vessel while the anterior communicating artery (AcoA) was the shortest (0.78 mm). Both the AcoA and the PcoA were the narrowest vessels (0.67 mm) in this study. CAC variations in Malawian populations appeared to be similar to those observed in diverse populations.
Conclusions: Anatomical variations of the CAC exist in Malawian population and should be taken into consideration in clinical practice.

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References

  1. Ansari S, Dadmehr M, Eftekhar B, et al. A simple technique for morphological measurement of cerebral arterial circle variations using public domain software (Osiris). Anat Cell Biol. 2011; 44(4): 324–330.
  2. De Silva KR, Silva R, Amaratunga D, et al. Types of the cerebral arterial circle (circle of Willis) in a Sri Lankan population. BMC Neurol. 2011; 11: 5.
  3. De Silva KR, Silva R, Gunasekera WSL, et al. Prevalence of typical circle of Willis and the variation in the anterior communicating artery: A study of a Sri Lankan population. Ann Indian Acad Neurol. 2009; 12(3): 157–161.
  4. Eftekhar B, Dadmehr M, Ansari S, et al. Are the distributions of variations of circle of Willis different in different populations? Results of an anatomical study and review of literature. BMC Neurol. 2006; 6: 22.
  5. El Kh, Azouzi M, Bellakhdar F, et al. Anatomical configuration of the circle of Willis in the adult studied by injection techniques. Apropos of 100 brains. Neurochirugie. 1985; 31(4): 287–293.
  6. Eliasziw M, Henderson RD, Fox A, et al. Angiographically defined collateral circulation and risk of stroke in patients with severe carotid artery stenosis. Stroke. 2001; 31(1): 128–132.
  7. Gunnal SA, Farooqui MS, Wabale RN. Anatomical variability of the posterior communicating artery. Asian J Neurosurg. 2018; 13(2): 363–369.
  8. Gunnal SA, Farooqui MS, Wabale RN. Anatomical variations of the circulus arteriosus in cadaveric human brains. Neurol Res Int. 2014; 2014: 687281.
  9. Hurst K, Musicki K, Molnár Z, et al. Cerebral cross-perfusion and the Circle of Willis: does physiology trump anatomy? J Vasc Diagnostics Interv. 2017; 5: 35–40.
  10. Iqbal S. A comprehensive study of the anatomical variations of the circle of willis in adult human brains. J Clin Diagn Res. 2013; 7(11): 2423–2427.
  11. Koker M, Karatas A, Yilmaz H, et al. The anatomy of circulus arteriosus cerebri (circle of willis): a study in turkish population. Turk Neurosurg. 2015; 26(1): 54–61.
  12. Koziej M, Klimek-Piotrowska W, Rybicka M, et al. A multitude of variations in the configuration of the circle of Willis: an autopsy study. Anat Sci Int. 2015; 91(4): 325–333.
  13. Lazorthes G, Gouaze A, Santini J, et al. The arterial circle of the brain (circulus arteriosus cerebri). Anat Clin. 1979; 1(3): 241–257.
  14. Liebeskind D. Collateral circulation. Stroke. 2003; 34(9): 2279–2284.
  15. McCarthy P, Delassus P, Fahy P, et al. An experimental investigation of the hemodynamic variations due to aplastic vessels within three-dimensional phantom models of the circle of Willis. Ann Biomed Eng. 2013; 42(1): 123–138.
  16. Nagawa E, Mwaka E, Kalungi S. Bilateral hypoplasia of the posterior communicating artery: a morphological case report. Anat Physiol. 2017; 7(4): 276.
  17. Nixon AM, Gunel M, Sumpio BE. The critical role of hemodynamics in the development of cerebral vascular disease. J Neurosurg. 2010; 112(6): 1240–1253.
  18. Ozaki T, Handa H, Tomimoto K, et al. Anatomical variations of the arterial system of the base of the brain. Nihon Geka Hokan (Arch Jap Chir). 1977; 46(1): 3–17.
  19. Pascalau R, Padurean VA, Bartos D, et al. The geometry of the circle of willis anatomical variants as a potential cerebrovascular risk factor. Turk Neurosurg. 2019; 29(2): 151–158.
  20. Riggs H. Variation in form of circle of Willis. Arch Neurol. 1963; 8(1): 8.
  21. Rosner J, Reddy V, Lui F. Neuroanatomy, Circle of Willis. [Updated 2020 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan.
  22. Siddiqi H, Ansar T, Fasih S. Variations in cerebral arterial circle of Willis in patients with hemorrhagic stroke: a computed tomography angiographic study. J Rawalpindi Med Coll. 2013; 17(2): 215–218.
  23. Songsaeng D, Geibprasert S, Willinsky R, et al. Impact of anatomical variations of the circle of Willis on the incidence of aneurysms and their recurrence rate following endovascular treatment. Clin Radiol. 2010; 65(11): 895–901.
  24. van Raamt AF, Mali WP, van Laar PJ, et al. The fetal variant of the circle of Willis and its influence on the cerebral collateral circulation. Cerebrovasc Dis. 2006; 22(4): 217–224.
  25. Zulu H, Buumba PN. Anatomical Variations of the Circle of Willis as seen at the University Teaching Hospital, Lusaka, Zambia. J Prev Rehabil Med. 2017; 1(2): 61–66.