Though shalt not covet your neighbor’s….
There is really nothing special about Heubner artery — its simply the most medial of lenticulostriates. Really, why should the lateral group not feel cheated?
In the MCA and ACA pages, we treat broadly the notion that all lenticulostriates are created equal — and Heubner is not more equal than others. its a balance — there can be dominance of any lenticulostriates — lateral, medial, whatever. Defining the “classic” territory of Heubner is an exercise in futility. Its all about balance.
Here is a very large Heubner (arrows), with a few branches of its own (arrowheads) arising from ACOM region, and taking over all medial and some lateral lenticulostriates (dashed arrow) which are thus small in caliber. Why not
Cross eye stereo
Anaglyph
View from back shows small caliber of lateral lenticulostriates (dashed arrows) — again balance — big Heubner means small lateral group. A very small and very lateral branch (ball arrow) is probably taking care of external capsule area
Anaglyph view from back
View from above shows its A1-A2 junction origin
Another large Heubner (arrows) taking care of most lenticulostriate territory. Only the very lateral one is M1 origin (dashed arrows)
Heubner is best seen from contralateral injections (on DSA), with its territory unobscured by other ipsilateral branches
DYNA VR images. The ipsilateral Heubner (also proximal A2 origin) is dashed arrows
An elegant, if inconstant, way to see Heubner territory is by looking at CBCT MIP images. In this case, the territory is well seen (ovals)
Heubner Infarct After Pipeline ACOM aneurysm embolization
Happens in about 5% of cases in our experience. Usually asymptomatic. Below is an example of a coil and Pipe treated aneurysm — delayed caudate infarct (arrow). Note origin of the Heunber from the proximal A2. Delayed MRA (no angio available) shows enlargement of the right A1 — example of vascular remodeling or rearrangement — by placing Pipeline into left A1-A2, the very small rihgh A1 grows and becomes a significant part of A2 supply.
Not bad huh — lots more on ACA page
