The Venous Circle of Trolard: An Anatomical Study with Application to Approaches to the Basal Brain.

ABSTRACT

BACKGROUND: The arterial circle of Willis is a well-known and interconnecting set of blood vessels at the base of the brain. However, its lesser-known venous counterpart, the circle of Trolard, has had almost no attention in the extant medical literature. METHODS: Twenty-four adult human brains underwent dissection of the circle of Trolard. When identified, its component vessels and relationships with adjacent structures were confirmed and documented with photography and measured using microcalipers. RESULTS: A complete circle of Trolard was identified on 42% of specimens. Most (64%) incomplete circles were incomplete anteriorly with no anterior communicating vein. The anterior communicating veins joined the anterior cerebral veins superior to the optic chiasm and continued posteriorly. The anterior communicating veins had a mean diameter of 0.45 mm. The length of these veins ranged from 0.8 mm to 1.45 mm. Thirty-six percent of circles were incomplete posteriorly with lack of a posterior communicating vein. The posterior communicating veins were always larger and longer than the anterior cerebral veins. The posterior communicating veins had a mean diameter of 0.8 mm. The length of these veins ranged from 2.8 to 3.9 cm. In general, the circles of Trolard were more or less symmetrical. However, in 2 specimens, asymmetry existed. CONCLUSIONS: A better understanding of the venous circle of Trolard might decrease iatrogenic injury during approaches to the base of the brain and improve diagnoses based on imaging of the skull base. To our knowledge, this is the first anatomical study dedicated to the circle of Trolard.