Anatomical and radiological variations of the circle of Willis and its clinical correlations
Keywords:
anterior communicating artery, anterior cerebral artery, middle cerebral artery, posterior communicating artery, posterior cerebral arteryAbstract
Aim: To study of Circle of Willis both morphologically and radiologically and its variations in the branching pattern of the Circle of Willis and to correlate it clinically. Introduction: The circle of Willis (CoW) is an anastomotic arterial network on the base of the brain. Its major role is to provide efficient collateral circulation to cerebral and cerebellar tissue to prevent ischemia, and subsequent transient ischemic attack or stroke. The circle of Willis (CoW) is a vascular network formed at the base of skull in the interpeduncular fossa. Its anterior part is formed by the anterior cerebral artery, from either side. Anterior communicating artery connects the right and left anterior cerebral arteries. Posteriorly, the basilar artery divides into right and left posterior cerebral arteries and each join to ipsilateral internal carotid artery through a posterior communicating artery. Anterior communicating artery and posterior communicating arteries are important component of circle of Willis, acts as collateral channel to stabilize blood flow. In the present study, anatomical variations in the circle of Willis were noted and correlated those with clinically. Methods: 50 apparently normal formalin fixed brain specimens were collected from human cadavers.
Downloads
References
Ace Dodevski , Dobrila TosovskaLazarova , NadicaMitreska , VjolcaAliji , ElizabetaStojovskaJovanovska. Posterior cerebral artery – variation in the origin and clinical significance., Sec. Med. Sci., XXXV 1, 2014.
Alpers BJ, Berry RG, Paddison RM. Anatomical studies of the Circle of Willis in normal brain. Arch NeurolPsychiat. 1959;81:409–18.
Altinors N, Kars Z, Cerezci A, Oral N (1991) CT and angiography in a patient with three intracranial giant aneurysms. Acta Radiol 32(3):203–205
Anubasaha, BovindalaBhagyalakshmi, Shyamash Mandal, animayBanopadhyaya. ‘Variation of Posterior Communicating Artery in Human Brain: A morphological study.,J Med Sci 2013;
Arjal RK, Zhu T, Zhou Y (2014) The study of fetal-type posterior cerebral circulation on multislice CT angiography and its influence on cerebral ischemic strokes. Clin Imaging 38(3):221–225.
Barboriak DP, Provenzale JM (1997) Pictorial review: magnetic resonance angiography of arterial variants at the circle of Willis. Clin Radiol 52(6):429–436.
Battacharji SK, Hutchinson EC, McCall AJ. The Circle of Willis: The incidence of developmental abnormalities in normal and infracted brains. Brain. 1967;90:747–58.
Boehme AK, Esenwa C, Elkind MS (2017) Stroke risk factors, genetics, and prevention. Circ Res 120(3):472–495
Chuang YM, Liu CY, Pan PJ, Lin CP (2008) Posterior communicating artery hypoplasia as a risk factor for acute ischemic stroke in the absence of carotid artery occlusion. J Clin Neurosci 15(12):1376–1381.
de Monye C, Dippel DW, Siepman TA, Dijkshoorn ML, Tanghe HL, van der Lugt A (2008) Is a fetal origin of the posterior cerebral artery a risk factor for TIA or ischemic stroke? J Neurol 255(2):239–245.
Eftekhar B, Dadmehr M, Ansari S, Ghodsi M, Nazparvar B, Ketabchi E (2006) Are the distributions of variations of circle of Willis different in different populations?—results of an anatomical study and review of literature. BMC Neurol 6(1):22.
Fawcett E, Blachford JV. The Circle of Willis: An examination of 700 specimens. J Anat and Physiol. 1905;40:63–70.
Feigin VL, Krishnamurthi RV, Parmar P, Norrving B, Mensah GA, Bennett DA, Barker-Collo S, Moran AE, Sacco RL, Truelsen T, Davis S (2015) Update on the global burden of ischemic and hemorrhagic stroke in 1990–2013:the GBD 2013 study. Neuroepidemiology 45(3):161–176
Fetterman GH, Moran TJ. Anomalies of the Circle of Willis in relation to cerebral softening. Arch Pathol. 1941;32:251–57.
Gardner E, Gray DJ, O'Rahilly R. Anatomy a regional study of human structure. 3rd edition. W.B. Saunders Company; Philadelphia, Toronto, London: 1969; 60- 555.
GBD 2016 Causes of Death Collaborators (2017) Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390(10100):1151–1210
GBD 2016 DALYs and HALE Collaborators (2017) Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390(10100):1260–1344 7.
Hakim A, Gralla J, Rozeik C, Mordasini P, Leidolt L, Piechowiak E, Ozdoba C, El Koussy M (2018)Anomalies and normal variants of the cerebral arterial supply: a comprehensive pictorial review with a proposed workflow for classification and significance.J Neuroimaging 28(1):14–35.
Hashemi SM, Mahmoodi R, Amirjamshidi A (2013) Variations in the Anatomy of the Willis’ circle: a 3-year cross-sectional study from Iran (2006–2009). Are the distributions of variations of circle of Willis different in different populations? Result of an anatomical study and review of literature. Surg Neurol Int 4:65.
Hillen B (1986) The variability of the circle of Willis: univariate and bivariate analysis. Acta Morphol Neerl-Scand 24(2):87–101.
Hoksbergen AW, Legemate DA, Csiba L, Csati G, Siro P, Fulesdi B (2003) Absent collateral function of the circle of Willis as risk factor for ischemic stroke. Cerebrovasc Dis 16(3):191–198.
K.Ranil D De Silva, Rukmal Silva, DhammikaAmaratunga, WSL Gunasekera and Rohan W.Jayesekera,’Types of the cerebral arterial circle in a Srilankan population’-BioMed 2016 pg 1471-75.
Kalula N.T Kayembe, MasakiyoSasahara, and Fumitada Hazama. “Cerebral Aneurysms and Variations in the Circle of Willis” Stroke Vol 15, No 5, 1984.
Kamath S. Observations on the length and diameter of the vessels forming the Circle of Willis. J Anat. 1981;133:419–23.
Karatas, A., Coban, G., Cinar, C., Oran, I., & Uz, A. (2015). Assessment of the circle of Willis with cranial tomography angiography. Medical Science Monitor, 21, 2647–2652.
Karatas, A., Yilmaz, H., Coban, G., Koker, M., & Uz, A. (2016). The anatomy of circulus arteriosus cerebri (circle of Willis): A study in Turkish population.Turkish Neurosurgery, 26, 54–61.
Klimek-Piotrowska, W., Rybicka, M., Wojnarska, A., Wójtowicz, A., Koziej, M., & Hołda, M. K. (2016). A multitude of variations in the configuration of the circle of Willis: An autopsy study. Anatomical Science International, 91, 325–333.
Kondori BJ, Azemati F, Dadseresht S (2017) Magnetic resonance angiographic study of anatomic variations of the circle of Willis in a population in Tehran. Arch Iran Med 20(4):235–239.
Krabbe-Hartkamp MJ, Van der Grond J, De Leeuw FE, De Groot JC, Algra A, Hillen B, Breteler MM, Mali WP (1998) Circle of Willis: morphologic variation on three-dimensional time-of-flight MR angiograms. Radiology 207(1):103–111.
Mamatha H, D’Souza AS, Pallavi, Suhani S,’Human cadaveric study of the morphology of the basilar artery’, Med J,2012 Nov;53(11):760-763.
Miralles M, Dolz JL, Cotillas J, Aldoma J, Santiso MA, Giménez A, Capdevila A, Cairols. “The role of the Circle of Willis in carotid occlusion: assessment with phase contrast MR angiography and transcranial duplex” ,Eur J VascEndovasc Surg. 1995 Nov;10(4):424-30.
Oumer M, Alemayehu M, Muche A (2021) Association between circle of Willis and ischemic stroke: a systematic review and meta-analysis. BMC Neurosci 22(1):1–228.
Raghavendren ,Shirol V, Daksha Dixit, Anil Kumar Reddy Y , Desai SP. “Circle of Willis and its variations; Morphometric study in adult human cadavers. International Journal of Medical Research and Health Science, Volume 3 Issue 2 (April - Jun).
S.Iqbal, “ A Comprehensive Study of the Anatomical Variations of the Circle of Willis in Adult Human Brains, JCDR/2013, PG 687- 691.
Schomer DF, Marks MP, Steinberg GK, Johnstone IM, Boothroyd DB, Ross MR, Pelc NJ, Enzmann DR (1994) The anatomy of the posterior communicating artery as a risk factor for ischemic cerebral infarction. N Engl J Med 330(22):1565–1570.
Shaban A, Albright K, Gouse B, George A, Monlezun D, Boehme A, Beasley TM, Martin-Schild S (2015) The impact of absent A1 segment on ischemic stroke characteristics and outcomes. J Stroke Cerebrovasc Dis 24(1):171–175.
Shaban A, Albright KC, Boehme AK, Martin-Schild S (2013) Circle of Willis variants: fetal PCA. Stroke Res Treat 2013:105937.
Shahan CP, Fabian TC, Gray RI, Croce MA (2016) Impact of circle of Willis anatomy in blunt cerebrovascular injury-related stroke. J Am Coll Surg 223(4):S153–S154.
Thaib, P. K. P., & Rahaju, A. S. (2022). Clinicopathological profile of clear cell renal cell carcinoma. International Journal of Health & Medical Sciences, 5(1), 91-100. https://doi.org/10.21744/ijhms.v5n1.1846
Vaibhav V. Sande, Sanjay P.Wanjari, Suvarna V. Sande,’Variation of the anterior part of Circle of Willis-A dissection study’,Int J Adv Med.2016;3(2):353-356.
Van Overbeeke JJ, Hillen B, Tulleken CA (1991) A comparative study of the circle of Willis in fetal and adult life. The configuration of the posterior bifurcation of the posterior communicating artery. J Anat 176:45
van Seeters T, Hendrikse J, Biessels GJ, Velthuis BK, Mali WP, Kappelle LJ, van der Graaf Y (2015) Completeness of the circle of Willis and risk of ischemic stroke in patients without cerebrovascular disease. Euroradiology 57(12):1247–1251.
Widana, I.K., Sumetri, N.W., Sutapa, I.K., Suryasa, W. (2021). Anthropometric measures for better cardiovascular and musculoskeletal health. Computer Applications in Engineering Education, 29(3), 550–561. https://doi.org/10.1002/cae.22202
Willis, T. (1664). Cerebri Anatome: Cui Accessit Nervorum Descriptio et Usus. London: Oxford Publishing House.
Windle BCA. On the arteries forming Circle of Willis. J. Anat and Phy. 1888; 22:289.
Yu-Ming Chuang ,Chih-Yang Liu, Po-Jung Pan Ching-Po Lin. “Anterior Cerebral Artery A1 Segment Hypoplasia May Contribute to A1 Hypoplasia Syndrome”., EurNeurol 2007;57:208–211.
Published
How to Cite
Issue
Section
Copyright (c) 2022 International journal of health sciences

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles published in the International Journal of Health Sciences (IJHS) are available under Creative Commons Attribution Non-Commercial No Derivatives Licence (CC BY-NC-ND 4.0). Authors retain copyright in their work and grant IJHS right of first publication under CC BY-NC-ND 4.0. Users have the right to read, download, copy, distribute, print, search, or link to the full texts of articles in this journal, and to use them for any other lawful purpose.
Articles published in IJHS can be copied, communicated and shared in their published form for non-commercial purposes provided full attribution is given to the author and the journal. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
This copyright notice applies to articles published in IJHS volumes 4 onwards. Please read about the copyright notices for previous volumes under Journal History.