1
|
Shigematsu H, Yokota K, Hirayama A, Sorimachi T. Ruptured posterior inferior cerebellar artery aneurysm associated with persistent primitive hypoglossal artery: A case report. Radiol Case Rep 2024; 19:146-149. [PMID: 37941989 PMCID: PMC10628796 DOI: 10.1016/j.radcr.2023.09.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 11/10/2023] Open
Abstract
Until now, 9 cases of an association of a posterior inferior cerebellar artery (PICA) aneurysm with the persistent primitive hypoglossal artery (PPHA) have been reported. We reported a case of a ruptured PICA aneurysm associated with the PPHA, which was successfully treated by intravascular embolization using inflation of an endovascular occlusion balloon in the proximal artery to stabilize the microcatheter tip. A 19-year-old woman presenting headache and mild consciousness disturbance was admitted to our hospital. Head computed tomography (CT) showed a subarachnoid hemorrhage in the interpeduncular cistern. Right common carotid angiography revealed an aneurysm with a maximum diameter of 3.7 mm at the proximal PICA, which was fed from the common carotid artery (CCA) through the internal carotid artery (ICA) and the PPHA and the vertebral artery. During coil embolization, a pulsatile fluctuation of the microcatheter tip caused by the minimum curvature of the proximal arterial route from the aorta to the PPHA made the continuation of the coil embolization difficult. Then, we inflated an occlusion balloon in the PPHA to stabilize the microcatheter tip, and the coil embolization was performed under the blank roadmap fluoroscopy. The aneurysm disappeared completely with the preservation of the PICA on the postoperative angiogram. A case of ruptured PICA aneurysm with proximal PPHA, which was successfully embolized with the assist of a proximal occlusion balloon inflation. When the pulsative movement of a microcatheter tip made coil embolization difficult, this technique could be useful.
Collapse
Affiliation(s)
- Hideaki Shigematsu
- Department of Neurosurgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan
| | - Kazuma Yokota
- Department of Neurosurgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan
| | - Akihiro Hirayama
- Department of Neurosurgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan
| | - Takatoshi Sorimachi
- Department of Neurosurgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan
| |
Collapse
|
2
|
Park JS, Shin BS, Kang HG. Endovascular treatment for acute basilar artery occlusion via persistent primitive hypoglossal artery: A case report. Medicine (Baltimore) 2021; 100:e27998. [PMID: 35049208 PMCID: PMC9191366 DOI: 10.1097/md.0000000000027998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/11/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Although their effectiveness and safety have not yet been established, endovascular treatments have recently been applied in the treatment of acute basilar artery occlusion. If not identified, persistent primitive hypoglossal artery, a rare variant of the posterior circulation, could be a barrier to the successful treatment of basilar artery occlusion. PATIENT CONCERNS An 83-year-old woman, who had been undergoing treatment for hypertension for 20 years, visited our hospital 3 hours after the onset of acute unresponsive mental deterioration. The patient was unresponsive to painful stimuli, and the pupils were equal and miotic. DIAGNOSIS Brain computed tomography angiography confirmed complete occlusion of the distal basilar artery and revealed a dilated branch arising from the right internal carotid artery at the C2 vertebral level. INTERVENTIONS Endovascular thrombectomy was performed directly via the right femoral artery. Complete recanalization was achieved via manual aspiration thrombectomy. OUTCOMES Brain magnetic resonance imaging revealed multifocal cerebral infarctions in the bilateral thalamus, midbrain, and cerebellar vermis. The patient's neurological symptoms gradually improved. CONCLUSIONS This is a rare case of basilar artery occlusion that was successfully treated with mechanical thrombectomy through persistent primitive hypoglossal artery. It is important to consider the potential clinical implications of this rare vascular variant.
Collapse
Affiliation(s)
- Jung Soo Park
- Department of Neurosurgery, Jeonbuk National University Medical School and Hospital, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Byoung-Soo Shin
- Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
- Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju, South Korea
| | - Hyun Goo Kang
- Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
- Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju, South Korea
| |
Collapse
|
3
|
Ren X. Posterior fossa transient ischemic attack in the setting of bilateral persistent hypoglossal arteries: A case report and literature review. Medicine (Baltimore) 2021; 100:e27875. [PMID: 34766601 PMCID: PMC10545121 DOI: 10.1097/md.0000000000027875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/21/2021] [Accepted: 11/03/2021] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Persistent hypoglossal artery (PHA) is the second rare abnormal anastomosis of the internal carotid and vertebrobasilar arteries, and bilateral persistent hypoglossal arteries in particular have rarely been reported. This is the first case of bilateral persistent hypoglossal arteries presenting with posterior fossa transient ischemic attack (TIA). PATIENT CONCERNS We reported a 54-year old female with posterior fossa TIA due to the coexisting bilateral persistent hypoglossal arteries and left internal carotid artery stenosis. DIAGNOSIS The patient was diagnosed with posterior fossa TIA, bilateral persistent hypoglossal arteries and left internal carotid artery stenosis. INTERVENTIONS The patient was given aspirin 100 mg/qd and advised to avoid excessive neck movement. OUTCOMES Symptoms of intermittent subjective dizziness accompanied by nausea were relieved. LESSONS Although requires no special treatment, PHA could be accompanied by hypoplasia of vertebral arteries and posterior communicating arteries and becomes the main blood supply pathway for the posterior circulation. Accurate identification and evaluation of PHA is important of ensuring the safety of carotid interventions and identifying specific types of stroke.
Collapse
Affiliation(s)
- Xiaolu Ren
- Department of Neurosurgery and Laboratory of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, People's Republic of China
- Institute of Neurology, Lanzhou University, Lanzhou, People's Republic of China
| |
Collapse
|
4
|
Kawamura K, Tokugawa J, Watanabe M, Fujita N, Teramoto S, Kimura T, Ito Y, Nakao Y, Yamamoto T. Persistent Primitive Hypoglossal Artery with Ipsilateral Symptomatic Carotid Artery Stenosis and Cerebral Aneurysm. J Stroke Cerebrovasc Dis 2021; 30:106099. [PMID: 34536812 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/29/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Persistent primitive hypoglossal artery (PPHA) is a rare type of persistent carotid-basilar anastomosis sometimes associated with other vascular lesions. We treated an extremely rare case of PPHA with concomitant ipsilateral symptomatic cervical internal carotid artery (ICA) stenosis and unruptured aneurysm. CASE PRESENTATION A 67-year-old woman visited our institution with acute onset of diplopia. Magnetic resonance imaging revealed multiple acute infarctions in the right anterior and posterior circulations. Digital subtraction angiography demonstrated the right PPHA concomitant with ipsilateral cervical ICA stenosis and an unruptured ICA aneurysm with maximum diameter of 8 mm. The multiple infarctions were considered to result from artery-to-artery embolism due to microthrombi from the ICA plaque passed along the PPHA, so carotid endarterectomy was performed as the first step with preoperative modified Rankin Scale (mRS) grade 1. During the operation, the patient had impaired ICA perfusion due to internal shunt catheter migration into the PPHA followed by acute infarction in the right hemisphere causing mild left hemiparesis. The patient was transferred to the rehabilitation hospital with mRS grade 3. After 3 months of rehabilitation, the patient recovered to mRS grade 1 and clipping surgery for the unruptured right ICA aneurysm was performed as the second step with uneventful postoperative course. CONCLUSION The treatment strategy should be carefully considered depending on the specific blood circulation for such cases of PPHA with unique vasculature.
Collapse
Affiliation(s)
- Kaito Kawamura
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan; Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan.
| | - Joji Tokugawa
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.
| | - Mitsuya Watanabe
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.
| | - Naohide Fujita
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan; Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan.
| | - Shinichiro Teramoto
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan; Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan.
| | - Takaoki Kimura
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan; Department of Neurosurgery, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan.
| | - Yoshitaka Ito
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan; Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical Centre, Tokyo, Japan.
| | - Yasuaki Nakao
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.
| | - Takuji Yamamoto
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.
| |
Collapse
|
5
|
He S, Wei ML, Xie F, Richard SA. A fenestrated persistent primitive hypoglossal artery harboring a ruptured aneurysm: A case report. Medicine (Baltimore) 2021; 100:e26904. [PMID: 34397921 PMCID: PMC8360458 DOI: 10.1097/md.0000000000026904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/26/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Persistent primitive hypoglossal artery (PPHA) is a rare and permanent carotid-vertebrobasilar anastomoses. Patients with PPHA usually have higher changes of developing intracranial aneurysms due the high intracranial hemodynamics. Although cases of PPHA alone and PPHA with aneurysms have been reported in literature, cases of fenestrated PPHA harboring a ruptured aneurysm have seldomly be reported in literature. We present a rare occurrence of a fenestrated PPHA harboring a reputed aneurysm. PATIENTS CONCERNS A 43-year-old woman was presented with a sudden-onset severe headache and nausea. DIAGNOSIS Computerized tomography scan showed third, fourth, and bilateral ventricular hemorrhages. Computed tomographic angiogram showed a PPHA with fenestration malformation and a cystic protrusion consistent with an aneurysm. INTERVENTION The patient underwent a successful stent-assisted coil embolization via the trans-arterial route under general anesthesia. OUTCOMES Two years follow-up revealed no recurrence of her symptomatology and she is currently well and go about her normal daily life. CONCLUSION Fenestrated PPHAs harboring aneurysms may be more prone to rupture because of the fenestration and connective tissue weakness of the artery as well as changes in hemodynamics of the already malformed and weak artery.
Collapse
Affiliation(s)
- Sen He
- Department of Neurosurgery, The First People's Hospital of Ziyang City, No.66 Rende West Road, Ziyang, PR China
| | - Ming-Li Wei
- Department of Respiratory, The First People's Hospital of Ziyang City, No.66 Rende West Road, Ziyang, PR China
| | - Fei Xie
- Department of Neurosurgery, The First People's Hospital of Ziyang City, No.66 Rende West Road, Ziyang, PR China
| | - Seidu A. Richard
- Department of Medicine, Princefield University, Ho-Volta Region, Ghana West Africa
| |
Collapse
|
6
|
Zhang L, Chen X, Jia L, Dong L, Wang J, Liu P, Lv M. Case Report: Persistent Primitive Hypoglossal Artery Accompanied by a Basilar Bifurcation Aneurysm Treated by Y-Stent-Assisted Coil Embolization. Front Neurol 2021; 12:621610. [PMID: 33746878 PMCID: PMC7966712 DOI: 10.3389/fneur.2021.621610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/26/2021] [Indexed: 12/03/2022] Open
Abstract
Successful embolization of a basilar bifurcation aneurysm associated with a persistent primitive hypoglossal artery (PPHA) using Y-stent-assisted coiling.
Collapse
Affiliation(s)
- Longhui Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiheng Chen
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Luqiong Jia
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Linggen Dong
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiejun Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Peng Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ming Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
7
|
Zeng S, Yang D, Yang H, Xu LS, Xu MH. A persistent primitive hypoglossal artery-posterior inferior cerebellar artery convergence aneurysm treated by stent-assisted coil embolization: A case report. Medicine (Baltimore) 2019; 98:e17151. [PMID: 31574820 PMCID: PMC6775390 DOI: 10.1097/md.0000000000017151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
RATIONALE Persistent primitive hypoglossal artery (PPHA) is often associated with intracranial anomalies such as aneurysms. Surgical treatment of aneurysms on the PPHA is challenging due to that the posterior circulation depends solely on PPHA. PATIENT CONCERNS A case of an 83-year-old woman with a large aneurysm on PPHA presented with vertigo was reported. DIAGNOSIS Three-dimensional angiogram revealed a wide-neck aneurysm on the PPHA. INTERVENTIONS The aneurysm was successfully treated using a novel low-profile visualized intraluminal support stent-assisted coiling technique. OUTCOMES No complications occurred during the procedure. The final angiogram confirmed the patency of the posterior inferior cerebellar artery and the parent artery and its distal branches. LESSONS Our case suggests that stent-assisted coil embolization is safe and effective for the treatment of aneurysms on the PPHA.
Collapse
|
8
|
Tse GH, Martin A, Dyde RA, Coley SC. Persistent hypoglossal artery aneurysm: Case report and qualitative systematic review. Interv Neuroradiol 2018; 25:164-171. [PMID: 30394836 DOI: 10.1177/1591019918809087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A persistent hypoglossal artery was first described in 1889 and is one of the more common anatomical variations arising from aberration in normal development. Endovascular coiling has been recognised as a robust treatment for acutely ruptured intracranial arterial aneurysms, although specific data regarding an aneurysm arising from a persistent hypoglossal artery is lacking due to the low incidence. Here we report both the oldest patient reported to be treated with a persistent hypoglossal artery-associated aneurysm and also explicitly report endovascular treatment of a persistent hypoglossal artery aneurysm arising at the posterior inferior cerebellar artery origin. Qualitative systematic review of the available medical literature demonstrates limited evidence regarding treatment of persistent hypoglossal artery-associated aneurysms with the majority being carried out via open surgery. Ruptured posterior inferior cerebellar artery aneurysm arising from a persistent hypoglossal artery can be successfully and safely treated by endovascular therapy via the persistent hypoglossal artery. Randomised study of this situation is unlikely to be feasible; however, qualitative review of the literature reveals six such aneurysms that have been treated surgically, and this case appears to be the first via an endovascular means.
Collapse
Affiliation(s)
- George H Tse
- Department of Neuroradiology, Royal Hallamshire Hospital, Sheffield, UK
| | - Andrew Martin
- Department of Neuroradiology, Royal Hallamshire Hospital, Sheffield, UK
| | - Richard A Dyde
- Department of Neuroradiology, Royal Hallamshire Hospital, Sheffield, UK
| | - Stuart C Coley
- Department of Neuroradiology, Royal Hallamshire Hospital, Sheffield, UK
| |
Collapse
|
9
|
Varvari I, Bos EM, Dinkelaar W, van Es AC, Can A, Hunfeld M, Du R, Dammers R, Volovici V. Fatal Subarachnoid Hemorrhage from an Aneurysm of a Persistent Primitive Hypoglossal Artery: Case Series and Literature Overview. World Neurosurg 2018; 117:285-291. [PMID: 29940384 DOI: 10.1016/j.wneu.2018.06.119] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/12/2018] [Accepted: 06/14/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Persistent carotid-basilar connections have a prevalence of 0.14%. Recognizing such persistent fetal anastomoses between the carotid and the vertebrobasilar circulation is of great importance because they are reportedly associated with an increased prevalence of intracranial aneurysms. METHODS We report the case of a 15-year-old female patient who presented with a World Federation of Neurosurgical Societies grade 5 subarachnoid hemorrhage from an aneurysm at the junction of a persistent primitive hypoglossal artery and the posterior inferior cerebellar artery origin. Supratentorially, unfortunately, there was no parenchymal blush or cortical venous return. Eventually, a multidisciplinary decision was made to withdraw care. RESULTS Fifty-seven cases were reported in the literature to date of persistent hypoglossal arteries, 16 of which presented with an associated aneurysm, 5 with an arteriovenous malformation, and 6 with a subarachnoid hemorrhage. Our case is the youngest patient reported so far. Hypoplasia or aplasia of the vertebral artery often were encountered (36 and 13 cases, respectively), as well as carotid artery stenosis (15 cases). CONCLUSIONS Although uncommon, it is important to recognize persistent carotid-basilar connections, since they have a considerable hemodynamic impact on the posterior cerebral circulation via the carotid system. A critical reduction in the carotid blood flow will, therefore, have ischemic consequences in the posterior cerebral territories. In addition, such connections might be associated with anomalies of the vessel wall and be predisposed to aneurysm formation. The endovascular neurointerventionalist, as well as the vascular and skull base neurosurgeon, need to be aware of their anatomy and variations.
Collapse
Affiliation(s)
- Ioana Varvari
- Department of Adult Mental Health, Tees, Esk and Wear Valleys NHS Trust, United Kingdom
| | - Eelke M Bos
- Department of Neurosurgery, Erasmus MC University Medical Center, Erasmus MC Stroke Center, Rotterdam, The Netherlands
| | - Wouter Dinkelaar
- Department of Radiology, Erasmus MC University Medical Center, Erasmus MC Stroke Center, Rotterdam, The Netherlands
| | - Ad C van Es
- Department of Radiology, Erasmus MC University Medical Center, Erasmus MC Stroke Center, Rotterdam, The Netherlands
| | - Anil Can
- Department of Neurosurgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Maayke Hunfeld
- Department of Pediatric Neurology, Erasmus MC University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Rose Du
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ruben Dammers
- Department of Neurosurgery, Erasmus MC University Medical Center, Erasmus MC Stroke Center, Rotterdam, The Netherlands; Department of Pediatric Neurosurgery, Erasmus MC University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Victor Volovici
- Department of Neurosurgery, Erasmus MC University Medical Center, Erasmus MC Stroke Center, Rotterdam, The Netherlands; Department of Medical Decision Making, Erasmus MC, Rotterdam, The Netherlands.
| |
Collapse
|
10
|
Vasović L, Trandafilović M, Vlajković S, Djordjević G, Daković-Bjelaković M, Pavlović M. Unilateral Aplasia versus Bilateral Aplasia of the Vertebral Artery: A Review of Associated Abnormalities. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7238672. [PMID: 28932744 PMCID: PMC5592402 DOI: 10.1155/2017/7238672] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/04/2017] [Indexed: 11/18/2022]
Abstract
Morphological characteristics of 108 cases of uni- and bilateral aplasia of the vertebral artery (VA) in reports or images of retrospective studies, including one recent case, published between 1967 and 2016 are analyzed. Incidence, gender, persistence of carotid-vertebrobasilar anastomosis (CVBA), associated with other vascular variants, and vascular pathology in each group of uni- and bilateral VA aplasia are mutually compared. Most of the cases of VA aplasia in ages 31 to 80 were discovered in USA, Japan, and India. The bilateral VA aplasia is more common in the male gender than in the female one. The side of the VA aplasia had a significant effect on the side of CVBA persistence. Associated aplasia of other arteries was more common in cases of unilateral VA aplasia. The left VA was more commonly hypoplastic in cases of single right VA aplasia than the right VA in cases of single left VA aplasia. Aneurysms of definitive arteries were more frequent in cases of single right VA aplasia than in cases of single left VA aplasia. We claim that the aplasia of the VA probably depends on genetic factors in some races, while diseases are expressed usually in persons over 30 years of age.
Collapse
Affiliation(s)
- L. Vasović
- Department of Anatomy, Faculty of Medicine, University of Niš, 81 Blvd. Dr. Zoran Djindjić, 18000 Niš, Serbia
| | - M. Trandafilović
- Department of Anatomy, Faculty of Medicine, University of Niš, 81 Blvd. Dr. Zoran Djindjić, 18000 Niš, Serbia
| | - S. Vlajković
- Department of Anatomy, Faculty of Medicine, University of Niš, 81 Blvd. Dr. Zoran Djindjić, 18000 Niš, Serbia
| | - G. Djordjević
- Health Center Niš, 15 Vojvode Tankosića St., 18000 Niš, Serbia
| | - M. Daković-Bjelaković
- Department of Anatomy, Faculty of Medicine, University of Niš, 81 Blvd. Dr. Zoran Djindjić, 18000 Niš, Serbia
| | - M. Pavlović
- Department of Anatomy, Faculty of Medicine, University of Niš, 81 Blvd. Dr. Zoran Djindjić, 18000 Niš, Serbia
| |
Collapse
|
11
|
Saito N, Tanikawa R, Tsuboi T, Noda K, Ota N, Miyata S, Matsukawa H, Yanagisawa T, Sakakibara F, Kinoshita Y, Miyazaki T, Kamiyama H, Tokuda S. Posterior Inferior Cerebellar Artery Thrombosed Aneurysm Associated with Persistent Primitive Hypoglossal Artery Successfully Treated with Condylar Fossa Approach. NMC Case Rep J 2017; 4:93-96. [PMID: 28840087 PMCID: PMC5566692 DOI: 10.2176/nmccrj.cr.2016-0233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/23/2017] [Indexed: 11/20/2022] Open
Abstract
A 68-year-old woman presented with generalized seizure due to the left internal carotid artery (ICA) aneurysmal compression of the ipsilateral medial temporal lobe. Computed tomography angiography (CTA) revealed multiple aneurysms of the right persistent primitive hypoglossal artery (PPHA), the right ICA, and the right anterior cerebral artery (ACA). The right PPHA originated from the ICA at the level of the C1 and C2 vertebral bodies and passed through the hypoglossal canal (HC). The PPHA aneurysm was large and thrombosed, which was located at the bifurcation of the right PPHA and the right posterior inferior cerebellar artery (PICA), projecting medially to compress the medulla oblongata. Since this patient had no neurological deficits, sequential imaging studies were performed to follow this lesion, which showed gradual growth of the PPHA aneurysm with further compression of the brain stem. Although the patient remained neurologically intact, considering the growing tendency clipping of the aneurysm was performed. Drilling of the condylar fossa was necessary to expose the proximal portion of the PPHA inside the HC. The key of this surgery was the preoperative imaging studies to fully understand the anatomical structures. The PPHA was fully exposed from the dura to the corner its turning inferiorly without damaging the occipital condylar facet. Utilizing this technique, the neck ligation of the aneurysm was safely achieved without any surgical complications.
Collapse
Affiliation(s)
- Norihiro Saito
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Toshiyuki Tsuboi
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Kosmo Noda
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Nakao Ota
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Shirou Miyata
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Hidetoshi Matsukawa
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Takeshi Yanagisawa
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Fumihiro Sakakibara
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Yu Kinoshita
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Takanori Miyazaki
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Sadahisa Tokuda
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| |
Collapse
|
12
|
Huang M, Moisi M, Zwillman ME, Volpi JJ, Diaz O, Klucznik R. Transient Ischemic Attack in the Setting of Carotid Atheromatous Disease with a Persistent Primitive Hypoglossal Artery Successfully Treated with Stenting: A Case Report. Cureus 2016; 8:e464. [PMID: 26929891 PMCID: PMC4762695 DOI: 10.7759/cureus.464] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Fetal brain perfusion is supplied by the primitive dorsal aorta anteriorly, longitudinal neural arteries posteriorly, and anastomotic transverse segmentals. Most notable of these connections are the primitive trigeminal, otic, hypoglossal, and proatlantal arteries. With cranial-cervical circulatory maturation and development of the posterior communicating segments and vertebro-basilar system, these primitive segmental anastomoses normally regress. Anomalous neurovascular development can result in persistence of these anastomoses. Due to its territory of perfusion, the persistent primitive hypoglossal artery (PPHA) is associated with vertebral artery and posterior communicating artery hypoplasia or aplasia. As a consequence, primary blood supply to the hindbrain comes chiefly from this single artery. Although usually clinically silent, PPHA is susceptible to common cerebrovascular disorders including athero-ischemic disease and saccular aneurysmal dilation to name a few. We present a case of transient ischemic attack in a patient with a PPHA and proximal atherosclerotic disease treated by endovascular stenting.
Collapse
Affiliation(s)
- Meng Huang
- Department of Neurosurgery, Houston Methodist Neurological Institute
| | - Marc Moisi
- Neurosurgery, Swedish Neuroscience Institute
| | | | - John J Volpi
- Neurology, Houston Methodist Neurological Institute
| | - Orlando Diaz
- Radiology, Houston Methodist Neurological Institute
| | | |
Collapse
|
13
|
Kimball D, Ples H, Miclaus GD, Matusz P, Loukas M. Persistent hypoglossal artery aneurysm located in the hypoglossal canal with associated subarachnoid hemorrhage. Surg Radiol Anat 2014; 37:205-9. [PMID: 24744136 DOI: 10.1007/s00276-014-1285-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 03/06/2014] [Indexed: 11/29/2022]
Abstract
The hypoglossal artery is one of four primitive anastomoses between the internal carotid artery and vertebrobasilar system that regresses in the sixth week of fetal development. A persistent hypoglossal artery (PHA) is generally an incidental finding but may also be associated with aneurysms or arteriovenous malformations. We present a rare case of a PHA with an associated bleeding intracranial PHA aneurysm located in the hypoglossal canal.
Collapse
Affiliation(s)
- David Kimball
- Department of Anatomical Sciences, School of Medicine, St. George's University, St. George, Grenada, West Indies
| | | | | | | | | |
Collapse
|
14
|
Timi JRR, Coelho LODM, Pasini RS. Persistence of a hypoglossal artery: case report. J Vasc Bras 2014. [DOI: 10.1590/jvb.2014.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The authors present a case of persistent hypoglossal artery. Persistent hypoglossal artery is the second most common carotid-basilar anastomosis with a frequency of 0.02% to 0.09% and it can be associated with cerebrovascular disease. Diagnosis is by imaging methods and angiotomography is the method most often employed.
Collapse
|
15
|
Matsushima K, Kawashima M, Matsushima T, Hiraishi T, Noguchi T, Kuraoka A. Posterior condylar canals and posterior condylar emissary veins—a microsurgical and CT anatomical study. Neurosurg Rev 2013; 37:115-26. [DOI: 10.1007/s10143-013-0493-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Revised: 02/01/2013] [Accepted: 03/10/2013] [Indexed: 11/28/2022]
|
16
|
|
17
|
Clerici AM, Craparo G, Cafasso G, Micieli C, Bono G. De-novo headache with transient vertebro-basilar symptoms: role of embryonic hypoglossal artery. J Headache Pain 2011; 12:639-43. [PMID: 22008898 PMCID: PMC3208046 DOI: 10.1007/s10194-011-0394-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 10/05/2011] [Indexed: 11/06/2022] Open
Abstract
We report the case of a 56-year-old man with acute onset of de-novo stabbing, pulsating and diffuse headache with subsequent appearance (within few minutes) of posterior fossa symptoms (vomiting, postural instability, anisocoria, incoordination, dysarthria, retropulsion) lasting 9–12 h. Recurrent hypertensive crises were detected during the acute observation in the Emergency Room, even in the absence of previous history of hypertension. Once subarachnoid hemorrhage and focal lesions (vascular and non-vascular) were excluded, brain computerized tomography-angiography and digital subtraction angiography disclosed the presence of left persistent primitive hypoglossal artery with bilateral vertebral artery hypoplasia and a slight aneurysmal dilation of the anterior communicating artery. Brain magnetic resonance study performed 24 h after onset of symptoms was negative for recent ischemic lesions. The clinical features of this rare vascular condition are discussed as a possible cause of magnetic resonance (diffusion weighted imaging) negative vertebro-basilar transient ischemic attack.
Collapse
Affiliation(s)
- Angelo Maurizio Clerici
- Neurology Unit, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Viale Borri 57, 21100, Varese, Italy.
| | | | | | | | | |
Collapse
|
18
|
Hui FK, Schuette AJ, Cawley CM. Endovascular Treatment of an Aneurysm of a Persistent Primitive Hypoglossal Artery With Complete Resolution of Brainstem Compressive Symptoms: Case Report. Neurosurgery 2011; 68:E854-7; discussion E857. [DOI: 10.1227/neu.0b013e3182077d75] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE:
Aneurysms of the posterior circulation may manifest with neurological deficits related to mass effect on the brainstem. We present an unusual case of an aneurysm resulting in selective lower-extremity weakness and gait instability.
CLINICAL PRESENTATION:
A 61-year-old man presents with progressively worsening gait instability over the course of several months. A magnetic resonance image and computed tomographic angiogram demonstrate a persistent hypoglossal artery associated with an aneurysm invaginating into the pontomedullary junction. The patient manifested only lower-extremity symptoms. An endovascular approach through the right internal carotid artery and persistent primitive hypoglossal artery was assayed, coiling off the aneurysm with complete angiographic occlusion. One month after the procedure, the patient reported marked improvement in symptoms with residual difficulty walking. At the 1-year postprocedure interval, he reported nearly complete resolution of symptoms.
CONCLUSION:
Endovascular therapy of an aneurysm invaginating into the brainstem is safe and efficacious.
Collapse
Affiliation(s)
- Ferdinand K. Hui
- Cleveland Clinic Foundation Cerebrovascular Center Neurological Institute, Cleveland, Ohio
| | | | | |
Collapse
|
19
|
Diagnosis and surgical management of extracranial PICA aneurysms presenting through subarachnoid haemorrhage: Case report and review of the literature. Clin Neurol Neurosurg 2009; 111:758-61. [PMID: 19651470 DOI: 10.1016/j.clineuro.2009.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Revised: 03/21/2009] [Accepted: 05/26/2009] [Indexed: 11/21/2022]
|
20
|
Terayama R, Toyokuni Y, Nakagawa S, Nakatsuji K, Nakama H, Yamaai T, Ichikawa H, Sugimoto T. Persistent hypoglossal artery with hypoplasia of the vertebral and posterior communicating arteries. Anat Sci Int 2009; 86:58-61. [DOI: 10.1007/s12565-009-0062-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Accepted: 09/15/2009] [Indexed: 12/01/2022]
|
21
|
De Blasi R, Medicamento N, Chiumarullo L, Salvati A, Maghenzani M, Dicuonzo F, Carella A. A case of aneurysm on a persistent hypoglossal artery treated by endovascular coiling. Interv Neuroradiol 2009; 15:175-8. [PMID: 20465895 DOI: 10.1177/159101990901500206] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2009] [Accepted: 04/05/2009] [Indexed: 11/16/2022] Open
Abstract
SUMMARY We describe a 22-year-old woman admitted to hospital in emergency with nuchal headache and vomiting. CT scan disclosed subarachnoid hemorrhage. Digital subtraction angiography with three-dimensional rotational acquisitions showed a ruptured aneurysm of a right persistent primitive hypoglossal artery as the cause of symptoms and hemorrhage. The patient was successfully treated with endovascular coiling of the aneurysm. This is the second literature report describing endovascular treatment in this unusual condition.
Collapse
Affiliation(s)
- R De Blasi
- Department of Neuroradiology, Bari University Hospital; Bari, Italy -
| | | | | | | | | | | | | |
Collapse
|
22
|
Baldi S, Zander T, Rabellino M, Maynar M. Stent-Assisted Coil Embolization of a Wide-Neck Aneurysm of a Persistent Primitive Hypoglossal Artery. Cardiovasc Intervent Radiol 2008; 32:352-5. [DOI: 10.1007/s00270-008-9415-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2008] [Revised: 07/18/2008] [Accepted: 07/22/2008] [Indexed: 11/24/2022]
|
23
|
Hypoglossal artery: a review of normal and pathological features. Neurosurg Rev 2008; 31:385-95; discussion 395-6. [DOI: 10.1007/s10143-008-0145-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 01/14/2008] [Accepted: 03/23/2008] [Indexed: 10/22/2022]
|
24
|
Bapuraj JR, Ojili V, Khandelwal N, Shanbhogue AKP, Gupta SK. Basilar artery aneurysm treated with coil embolization via persistent primitive hypoglossal artery. ACTA ACUST UNITED AC 2008; 51 Suppl:B340-3. [PMID: 17991102 DOI: 10.1111/j.1440-1673.2007.01759.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A saccular aneurysm at the basilar artery bifurcation associated with a persistent primitive hypoglossal artery (PPHA) was successfully treated by endovascular occlusion with Guglielmi detachable coils. As both vertebral arteries were aplasitc, a microcatheter was advanced via PPHA. To the best of our knowledge, this is the first case report describing the treatment of a basilar top aneurysm through the PPHA.
Collapse
Affiliation(s)
- J R Bapuraj
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | | | | | | | | |
Collapse
|
25
|
Uysal E, Velioglu M, Kara E, Albayram S, Islak C, Kocer N. Persistent Hypoglossal Artery Associated with a Ruptured Ipsilateral Posterior Inferior Cerebellar Artery Aneurysm. Neuroradiol J 2007; 20:570-573. [DOI: 10.1177/197140090702000516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
A rare case of persistent hypoglossal artery in conjuction with a ruptured aneurysm at the left proximal posterior inferior cerebellar artery (PICA) is presented. A ruptured PICA aneurysm was successfully treated by endovascular occlusion of the aneurym with coiling.
Collapse
Affiliation(s)
- E. Uysal
- Department of Radiology, Sisli Etfal Training and Research Hospital; Instanbul, Turkey
- Department of Radiology, Division of Neuroradiology, Cerrahpasa Medical School; Instanbul, Turkey
| | - M. Velioglu
- Department of Radiology, Division of Neuroradiology, Cerrahpasa Medical School; Instanbul, Turkey
| | - E. Kara
- Department of Radiology, Division of Neuroradiology, Cerrahpasa Medical School; Instanbul, Turkey
| | - S. Albayram
- Department of Radiology, Division of Neuroradiology, Cerrahpasa Medical School; Instanbul, Turkey
| | - C. Islak
- Department of Radiology, Division of Neuroradiology, Cerrahpasa Medical School; Instanbul, Turkey
| | - N. Kocer
- Department of Radiology, Division of Neuroradiology, Cerrahpasa Medical School; Instanbul, Turkey
| |
Collapse
|
26
|
Baltsavias GM, Chourmouzi D, Tasianas N, Drevelengas A, Damianovski D, Jovkovski S. Ruptured aneurysm of a persistent primitive hypoglossal artery treated by endovascular approach—case report and literature review. ACTA ACUST UNITED AC 2007; 68:338-43; discussion 343. [PMID: 17719985 DOI: 10.1016/j.surneu.2006.10.053] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Accepted: 10/10/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND A persistent PHA is the second most common of the embryonic carotid-basilar anastomoses that fail to regress in the embryo. The fact that PHA often is functionally a single artery providing blood to the posterior circulation poses challenging therapeutic problems in case of an aneurysm located on the PHA. CASE DESCRIPTION A 46-year-old woman presented with SAH due to a large ruptured aneurysm of the left PHA. Identification of such an artery by CT angiogram is the proposed cold standard. The aneurysm was obliterated by coil embolization. To our knowledge, this is the first reported case of aneurysm located on a primitive persistent hypoglossal artery that was endovascularly treated. CONCLUSION Aneurysms located on a persistent PHA can be treated safely and effectively via an endovascular approach.
Collapse
Affiliation(s)
- Gerasimos M Baltsavias
- Neuroendovascular Department, Interbalkan European Medical Centre, 57001 Thessaloniki, Greece.
| | | | | | | | | | | |
Collapse
|
27
|
Conforto AB, de Souza M, Puglia P, Yamamoto FI, da Costa Leite C, Scaff M. Bilateral occipital infarcts associated with carotid atherosclerosis and a persistent hypoglossal artery. Clin Neurol Neurosurg 2007; 109:364-7. [PMID: 17224233 DOI: 10.1016/j.clineuro.2006.12.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2006] [Revised: 12/10/2006] [Accepted: 12/11/2006] [Indexed: 11/19/2022]
Abstract
The persistent hypoglossal artery (PHA) is the second most common persistent embryological carotid-basilar connection and usually represents an incidental finding in cerebral arteriograms. The hypoglossal artery connects the primordial carotid artery with the longitudinal neural arteries, which later form the basilar artery. The PHA leaves the internal carotid artery as an extracranial branch, enters the skull through the anterior condyloid foramen, the hypoglossal canal and joins the caudal portion of the basilar artery. We report magnetic resonance and digital subtraction angiography findings in the first case of bilateral occipital infarctions associated with PHA and carotid atherosclerosis. The probable mechanism underlying bilateral occipital infarcts was embolism from the carotid territory to the posterior cerebral arteries. PHA may present a challenge in diagnosis and management of patients with carotid atherosclerosis and vertebrobasilar ischemia.
Collapse
|
28
|
Gupta AK. Cerebral Arteriovenous Malformation Embolized through Persistent Primitive Hypoglossal Artery: A Case Report. Interv Neuroradiol 2005; 11:241-6. [PMID: 20584481 DOI: 10.1177/159101990501100307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2005] [Accepted: 08/25/2005] [Indexed: 11/17/2022] Open
Abstract
SUMMARY Carotid-vertebral anastomoses are commonly detected as incidental findings. But sometimes these channels are important for the clinical condition of the patient. Here a case of right thalamo- capsular arteriovenous malformation is described where a persistent primitive hypoglossal artery was the only route for embolization of the arteriovenous malformation.
Collapse
Affiliation(s)
- A K Gupta
- Department of Radiology Sree Chitra Tirunal Institute for Medical Sciences and Technology; Trivandrum, India -
| |
Collapse
|