INCOMPLETE CIRCLE OF WILLIS POLÍGONO DE WILLIS INCOMPLETO David Gonçalves Nordon , Aristeu de Almeida Camargo Neto , Rodrigo Rejtman Guimarães , Orlando Fermozelli Rodrigues Júnior 1 1 1 2 35 Rev. Fac. Ciênc. Méd. Sorocaba, v. 12, n. 2, p. 35 - 36, 2010 1. Acadêmico do curso de Medicina – FCMS/PUC-SP 2. Professor do Depto. de Morfologia e Patologia – FCMS/PUC-SP Recebido em 29/6/2010. Aceito em 10/8/2010. Contato: [email protected] The intracranial circulation is guaranteed by the interconnections established in the circle of Willis; if the internal carotid artery on one side is occluded for any reason, the blood flow to this side of that brain can be maintained by the other arteries from the circle. However, defects in the arteries composing the circle is quite common; an article by Merkkola et al, published in The Annals of Thoracic Surgery, in 2006, shows us that 22% of the anterior communicant arteries and 46% of the posterior communicant arteries (left, right, or both) are missing in the general population. Such abnormalities are especially important when performing carotid surgeries, or correction of proximal aortic dissections, as they can provoke brain ischemia, if they are not noticed in time. Here we present a picture (figure 1) of an incomplete circle of Willis from an autopsy, in which both posterior communicant arteries are missing. The posterior cerebral arteries originated from the internal carotid artery, and there were three thin vases connecting them to the basilar artery. In the second picture (figure 2), we present the arteries dissected from the brain, separated from each other. In the same patient, we also found an abnormality in the heart circulation; the posterior descending artery was originated from the left, rather than the right coronary, and presented a left pattern of dominance, instead of a right one. A picture, however, is not presented, as this abnormality was only discovered once we dissected each heart blood vessel. MEDICINA POR IMAGEM / MEDICINE BY IMAGE Figure 1. In situ Circle of Willis. 1: Anterior cerebral arteries. 2: Medium Cerebral Arteries. 3: Posterior Cerebral Arteries. 4: Superior Cerebellar Arteries. 5: Basilar Artery. 6: Internal Carotid Arteries (cut).

Incomplete Circle of Willis

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Arterial abnormality found within intracranial circulation during an autopsy. Article published in Revista da Faculdade de Ciências Médicas de Sorocaba, 2010.

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INCOMPLETE CIRCLE OF WILLISPOLÍGONO DE WILLIS INCOMPLETO

David Gonçalves Nordon , Aristeu de Almeida Camargo Neto , Rodrigo Rejtman Guimarães , Orlando Fermozelli Rodrigues Júnior1 1 1 2

Rev. Fac. Ciênc. Méd. Sorocaba, v. 12, n. 2, p. 35 - 36, 20101.Acadêmico do curso de Medicina – FCMS/PUC-SP2. Professor do Depto. de Morfologia e Patologia – FCMS/PUC-SPRecebido em 29/6/2010. Aceito em 10/8/2010.

Contato: [email protected]

The intracranial circulation is guaranteed by theinterconnections established in the circle of Willis; if theinternal carotid artery on one side is occluded for any reason, theblood flow to this side of that brain can be maintained by theother arteries fromthecircle.

However, defects in the arteries composing the circle isquite common; an article by Merkkola et al, published in TheAnnals of Thoracic Surgery, in 2006, shows us that 22% of theanterior communicant arteries and 46% of the posteriorcommunicant arteries (left, right, or both) are missing in thegeneral population. Such abnormalities are especiallyimportant when performing carotid surgeries, or correction ofproximal aortic dissections, as they can provoke brain ischemia,if they arenotnoticed in time.

Here we present a picture (figure 1) of an incompletecircle of Willis from an autopsy, in which both posteriorcommunicant arteries are missing. The posterior cerebral arteriesoriginated from the internal carotid artery, and there were threethin vases connecting them to the basilar artery. In the secondpicture (figure 2), we present the arteries dissected from the brain,separatedfromeachother.

In the same patient, we also found an abnormality in theheart circulation; the posterior descending artery was originatedfrom the left, rather than the right coronary, and presented a leftpattern of dominance, instead of a right one.Apicture, however,is not presented, as this abnormality was only discovered oncewedissected each heartblood vessel.

MEDICINA POR IMAGEM / MEDICINE BY IMAGE

Figure 1. In situ Circle of Willis. 1: Anterior cerebral arteries. 2: Medium Cerebral Arteries. 3: Posterior Cerebral Arteries. 4: SuperiorCerebellarArteries. 5: BasilarArtery. 6: Internal CarotidArteries (cut).

Rev. Fac. Ciênc. Méd. Sorocaba, v. 12, n. 3, p. 35 - 36, 2010

Acknowledgments

We would like to thank Mr. Claudio Theodoro andMr. Fernando Longhini, autopsy technicians from Centro

de Ciências Médicas e Biológicas of PUC-SP, who have beenhelping us throughout our work.

Figure 2. Dissected Circle of Willis. 1:Anterior cerebral arteries. 2: Medium CerebralArteries. 3: Posterior CerebralArteries. 4: Superior CerebellarArteries. 5: BasilarArtery. 6: Internal CarotidArteries (cut).