Anteromedial central branches of anterior communicating artery

The anteromedial central arteries arising from the anterior communicating artery (AComA)-commonly referred to as AComA perforators-constitute a subgroup of the broader group of anteromedial central arterial system. These small deep perforating branches originate from the anterior aspect of the Circle of Willis, predominantly emergeing from the middle third and posterior or posterosuperior aspect of the AComA. They course towards midline basal forebrain structures, entering primarily via the lamina terminalis and anterior perforated substance. AComA perforators exhibit considerable anatomical variability in number, calibre, and distribution; a review by Vogels et al. identified 0 to 11 perforators per vessel, with external diameters ranging from 0.05 to 1.8 mm.

Area of vascular distribution

The principal midline deep brain regions being supplied by the anteromedial central arteries of anterior communicating artery include the lamina terminalis, hypothalamus, corpus callosum, and anterior commissure, with variable contributions to the septum pellucidum and adjacent structures.

---Subcallosal and hypothalamic arteries

More individually recognizable vessels within the AComA perforator group include the subcallosal artery and hypothalamic arteries. The subcallosal artery supplies the midline structures including the corpus callosum, septum pellucidum and anterior commissural/subcallosal region, whereas the hypothalamic arteries supply principally the anterior hypothalamus and lamina terminalis.

Clinical correlate

They are clinically important during treatment of AComA aneurysms, as their injury or occlusion can produce hypothalamic and limbic dysfunction.

Relationship and distinction

The term anteromedial central arteries can be understood as a broader regional grouping of perforating arteries arising from the ACA–AComA complex. Some arise from the AComA and predominantly supply midline structures such as the lamina terminalis, hypothalamus, corpus callosum and anterior commissure, whereas others arise predominantly from A1 of the ACA and extend more extensively into the basal ganglia and internal capsule.

The recurrent artery of Heubner belongs to this same general perforating system but is distinguished as a named, relatively well-defined ACA perforator with a characteristic recurrent course and predominantly striatal and capsular distribution.