Romanian Neurosurgery (Mar 2018)
Morphometric analysis of the arteries of Willis Polygon
Abstract
Objective: Willis polygon forms the basis of the arterial circulation of the cerebrum. Willis polygon is a vascular structure whom variations are not rare. Knowledge of the anatomy and preservation of its integrity is crucial for performing neurovascular surgery and intracranial tumour surgery. Because of the important vascular and neurological structures, approaches to this region are considered extremely risky. One of the main variations in-person basis is the diameter differences of the arteries, which forms Willis polygon, between the left and right hemispheres. About structure and variations, studies of Rhoton and Yasargil had formed the touchstone. Our aim is to contribute to the literature and clinical studies, to be done in the future, by comparing our results with previous studies about variations and morphometric features of Willis polygon. Methods: Arteries of 30 fresh cadaver brains were examined during autopsies in T.C. Ministry of Justice Istanbul Forensic Science Institute. Bilaterally anterior cerebral artery A1 segment lengths, distance between anterior communicating artery-callosomarginal artery outputs, posterior cerebral artery P1 segment lengths were measured using a digital calliper. After dissections and measures, photos of the region were taken and vascular anatomy and variations noted. From every single cerebrum samples were obtained from bilaterally A1, A2, callosomarginal artery, middle cerebral artery, posterior communicant artery, P1 and basilar artery. Samples were fixed by using 10% buffered-formalin. Taken samples were transported to Marmara University Faculty of Medicine, Department of Anatomy Laboratory. Samples were examined and interior diameters were measured under the microscope. Results: Our results with artery diameters and lengths were similar with literature. Different from literature, in anterior cerebral artery A1 segment, posterior cerebral artery P1 segment and posterior communicant artery no aplasia were noted. In 50% of the samples, callosomarginal artery were originate from A2 segment. In one case, we observed left and right pericallosal arteries were joined together at the end of the A2 segment and continued as a single pericallosal artery. We could not find any information about this variation in the literature. Conclusion: Before surgical operations, detailed knowledge of Willis polygon and evaluation of the pre-op cerebral angiography considering possible variations, reduce mortality and morbidity ratios. In addition, because of the role of flow gradients of Willis polygon in aneurysm formation, and in terms of better understanding the collateral circulation which is important in vascular occlusive diseases and vascular surgery, we believe, more anatomic studies about this region needed.
