The recurrent artery of Heubner (medial striate artery) is the largest of the perforating arteries to the basal ganglia, arising from the ACA at or near the A1-A2 junction adjacent to the anterior communicating artery. It recurs back and laterally to enter the anterior perforated substance, supplying the head of the caudate nucleus, the anterior putamen, the anterior limb of the internal capsule, and the septal nuclei.
The recurrent artery of Heubner is the most frequently injured perforating artery during anterior communicating artery aneurysm clipping, as it arises in this crowded surgical field and is easily mistaken for a small cortical branch. Its injury produces contralateral hemiplegia predominantly affecting the face and arm (anterior capsule), abulia, and personality change from orbitofrontal and caudate involvement. Infarction of its territory produces a distinctive neuropsychological syndrome of amnesia, confabulation, and frontal executive dysfunction.
The recurrent artery of Heubner arising near the anterior communicating artery complex is at risk during AComm aneurysm clipping; its sacrifice produces a characteristic syndrome of contralateral face and arm hemiplegia, memory impairment, confabulation, and orbitofrontal personality change from caudate, anterior capsule, and septal infarction.
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