1
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Yoshida S, Kamatani K, Takigawa K, Tashiro N, Hashiguchi Y, Yasaka M, Aikawa H, Go Y, Kazekawa K. Strategy of cerebral endovascular treatment for cervical internal carotid artery stenosis with a persistent primitive hypoglossal artery. Surg Neurol Int 2023; 14:308. [PMID: 37810314 PMCID: PMC10559564 DOI: 10.25259/sni_567_2023] [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: 07/06/2023] [Accepted: 08/11/2023] [Indexed: 10/10/2023] Open
Abstract
Background Persistent primitive hypoglossal artery (PPHA) is a rare residual arterial anastomosis. We placed a CASPER stent using Spider FX as an embolic protection device (EPD) in a patient with internal carotid artery (ICA) stenosis and PPHA. There are no reports of carotid artery stenting (CAS) using a CASPER stent for ICA stenosis with PPHA. We report the EPD strategy used in this case and the usefulness and precautions of CASPER stent insertion for cervical ICA stenosis in association with PPHA. Methods A 9Fr sheath was placed in the right femoral artery and a 9Fr Branchor balloon guide catheter was guided to the common carotid artery. A Spider FX was placed proximal to the bifurcation of the ICA and the PPHA. A 10 mm × 20 mm CASPER stent was deployed at the site of the stricture with no postoperative ischemic complications. Results There was no intra-stent occlusion, stenosis, or plaque protrusion immediately after surgery, and no postoperative ischemic complications were observed. Conclusion CASPER stent deployment with the Spider FX in the ICA and PPHA bifurcation can be considered to be an effective treatment method for ICA stenosis associated with PPHA. However, care should be taken in selecting the appropriate EPDs and stents depending on the location of the stenosis and bifurcation of the PPHA.
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Affiliation(s)
- Shinichiro Yoshida
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Japan
| | - Kaisei Kamatani
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Japan
| | - Kousuke Takigawa
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Japan
| | - Noriaki Tashiro
- Department of Cerebrovascular Medicine, Fukuoka Neurosurgical Hospital, Fukuoka, Japan
| | - Yoshiya Hashiguchi
- Department of Cerebrovascular Medicine, Fukuoka Neurosurgical Hospital, Fukuoka, Japan
| | - Masahiro Yasaka
- Department of Cerebrovascular Medicine, Fukuoka Neurosurgical Hospital, Fukuoka, Japan
| | - Hiroshi Aikawa
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Japan
| | - Yoshinori Go
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Japan
| | - Kiyoshi Kazekawa
- Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Japan
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2
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Murumkar V, Peer S, Saini J, Arvinda HR. Endovascular management of dissecting posterior cerebral artery aneurysm associated with persistent hypoglossal artery: A case report. J Vasc Bras 2021; 20:e20200142. [PMID: 34394204 PMCID: PMC8336981 DOI: 10.1590/1677-5449.200142] [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: 08/15/2020] [Accepted: 11/18/2020] [Indexed: 11/22/2022] Open
Abstract
Persistent embryological connections between the anterior and posterior circulations are rare entities. Persistent hypoglossal artery is the second most common persistent carotid-basilar anastomosis. As it is often associated with hypoplasia of vertebral arteries, it poses a challenge during endovascular interventions. We present a case of a 32-year-old woman who presented with occipital headache of four weeks’ duration. Magnetic Resonance Angiography showed hypoplastic vertebral arteries with a persistent hypoglossal artery arising from the cervical segment of the left internal carotid artery and supplying the entire posterior circulation, associated with a dissecting aneurysm of the right posterior cerebral artery. Endovascular parent vessel occlusion was performed for the dissecting posterior cerebral artery aneurysm by navigating the guide catheter, microwire, and microcatheter through the persistent hypoglossal artery because the vertebral arteries were hypoplastic. Post-intervention, the patient did not develop any neurological deficit and was discharged in a stable condition.
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Affiliation(s)
- Vivek Murumkar
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Sameer Peer
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Hanumanthapura Ramalingaiah Arvinda
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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3
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Shchanitsyn IN, Larin IV, Titova II, Sazonova NV, Sumin DI, Ionova TA, Bazhanov SP, Lobkov DV. Surgical treatment in symptomatic stenosis of the carotid artery and persistent primitive hypoglossal artery. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:159-168. [PMID: 34166357 DOI: 10.33529/angio2021220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Persistent primitive hypoglossal artery is a rare variant of intrauterine anastomosis between the carotid and basilar arteries, which may remain in adults. The presence of this artery in carotid artery atherosclerosis increases the risks for stroke in the carotid and basilar basins. Our clinical case illustrates successful carotid endarterectomy in the presence of an ipsilateral persistent primitive hypoglossal artery under cerebral oximetry control.
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Affiliation(s)
- I N Shchanitsyn
- Neurosurgical Department, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, V.I. Razumovsky Saratov State Medical University of the RF Ministry of Public Health, Saratov, Russia
| | - I V Larin
- Department of Roentgenoendovascular Methods of Diagnosis and Treatment, Regional Clinical Hospital, Saratov, Russia
| | - Iu I Titova
- Neurosurgical Department, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, V.I. Razumovsky Saratov State Medical University of the RF Ministry of Public Health, Saratov, Russia
| | - N V Sazonova
- Neurosurgical Department, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, V.I. Razumovsky Saratov State Medical University of the RF Ministry of Public Health, Saratov, Russia
| | - D Iu Sumin
- Neurosurgical Department, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, V.I. Razumovsky Saratov State Medical University of the RF Ministry of Public Health, Saratov, Russia
| | - T A Ionova
- Neurosurgical Department, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, V.I. Razumovsky Saratov State Medical University of the RF Ministry of Public Health, Saratov, Russia
| | - S P Bazhanov
- Neurosurgical Department, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, V.I. Razumovsky Saratov State Medical University of the RF Ministry of Public Health, Saratov, Russia
| | - D V Lobkov
- Neurosurgical Department, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, V.I. Razumovsky Saratov State Medical University of the RF Ministry of Public Health, Saratov, Russia
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4
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Burgard M, Psathas E, Mordasini P, Medlin F, Menth M, Egger B, Oscar Mayer D. Symptomatic internal carotid artery stenosis in the presence of a persistent primary hypoglossal artery. Vascular 2020; 29:543-549. [PMID: 33175663 DOI: 10.1177/1708538120966514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Anatomic variations of the extracranial carotid artery are rare. Persistent primitive hypoglossal artery appears with a reported incidence between 0.03% and 0.2%. We report a case of recurrent transient ischemic attacks originating from proximal internal carotid artery stenosis associated with ipsilateral persistent primitive hypoglossal artery and give a review of the existing literature. METHODS A 78-year-old patient with a medical history of two previous transient ischemic attacks consulted our emergency department with an acute left hemispheric stroke. Intravenous thrombolysis permitted complete resolution of symptoms. Concurrent Computed Tomography (CT) and Magnetic Resonance (MR) angiography revealed an unstable plaque causing 50% stenosis of the left internal carotid artery with a persistent primitive hypoglossal artery dominantly perfusing the posterior circulation, and bilateral hypoplastic vertebral arteries. RESULTS Uneventful carotid artery stenting using a proximal protection device was performed, and the patient was discharged after 12 days. Six months follow-up was uneventful with a patent stent in the internal carotid artery. CONCLUSIONS Treatment of symptomatic carotid artery stenosis in the presence of persistent primitive hypoglossal artery is challenging. Management should be driven by patients' co-morbidities, the anatomical localization of the lesions and local expertise. In the case of a high origin of the persistent primary hypoglossal artery, carotid artery stenting with the use of a proximal cerebral protection device is probably the preferred and simplest approach.
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Affiliation(s)
- Marie Burgard
- Department of Surgery, Vascular Surgery Unit, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland
| | - Emmanouil Psathas
- Department of Surgery, Vascular Surgery Unit, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland
| | - Pasquale Mordasini
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, Bern, Switzerland
| | - Friedrich Medlin
- Department of Internal Medicine, Neurology Unit, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland
| | - Markus Menth
- Department of Surgery, Vascular Surgery Unit, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland
| | - Bernhard Egger
- Department of Surgery, Vascular Surgery Unit, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland
| | - Dieter Oscar Mayer
- Department of Surgery, Vascular Surgery Unit, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland
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5
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Shen H, Mei Q, Shen J, Zhang F. Persistent primitive hypoglossal artery presenting with perimesencephalic nonaneurysmal subarachnoid hemorrhage: A case report and review of literature. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2019.100650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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6
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Critical carotid artery stenosis involving a persistent primitive hypoglossal artery. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:177-180. [PMID: 32322770 PMCID: PMC7160526 DOI: 10.1016/j.jvscit.2020.01.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/30/2020] [Indexed: 11/23/2022]
Abstract
Persistent primitive hypoglossal artery (PPHA) is a rare internal carotid-vertebrobasilar anatomic variant. Awareness of this anomaly and its propensity for atherosclerotic disease is important to avoid misinterpretation of diagnostic studies and to allow appropriate interventional planning. As the predominant vascular supply to the anterior and posterior cerebral circulation, its luminal compromise can lead to devastating ischemic complications. Carotid endarterectomy and carotid stenting have both been performed to treat lesions involving a PPHA. Herein, we report a case of carotid endarterectomy involving a PPHA and discuss the clinical and surgical implications of a carotid lesion in the presence of a PPHA.
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7
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Choudhary G, Ahuja K, Khan R, Kubal W. Bilateral persistent primitive hypoglossal artery presenting with hemiplegia ✰. Radiol Case Rep 2018; 13:1072-1075. [PMID: 30228846 PMCID: PMC6137901 DOI: 10.1016/j.radcr.2018.04.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/14/2018] [Accepted: 04/16/2018] [Indexed: 11/23/2022] Open
Abstract
The manuscript describes an unusual vascular anomaly. Persistence of carotid-vertebrobasilar anastomosis is a rare occurrence with presence of bilateral hypoglossal arteries (HAs) rarer still. We present a case of bilateral persistent HAs with hypoplastic vertebral arteries which end into posterior inferior cerebellar arteries. The computed tomography and magnetic resonance imaging appearance, course, and other associations are discussed. A review of 6 cases of bilateral HA published in the world literature is also discussed.
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Affiliation(s)
- Gagandeep Choudhary
- Department of Radiology, University of Alabama in Birmingham, 619 19th Street South, JT 779, Birmingham, AL 35249-6835, USA
| | - Kriti Ahuja
- Department of Radiology, University of Alabama in Birmingham, 619 19th Street South, JT 779, Birmingham, AL 35249-6835, USA
| | - Rihan Khan
- Department of Radiology, Banner University Medical Center, Tucson, AZ, USA
| | - Wayne Kubal
- Department of Radiology, Banner University Medical Center, Tucson, AZ, USA
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8
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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.
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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.
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9
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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.
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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
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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.
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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
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11
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Zhang L, Song G, Chen L, Jiao L, Chen Y, Wang Y. Concomitant asymptomatic internal carotid artery and persistent primitive hypoglossal artery stenosis treated by endovascular stenting with proximal embolic protection. J Vasc Surg 2016; 63:237-40. [DOI: 10.1016/j.jvs.2014.04.066] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 04/30/2014] [Indexed: 10/25/2022]
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12
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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.
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Affiliation(s)
- David Kimball
- Department of Anatomical Sciences, School of Medicine, St. George's University, St. George, Grenada, West Indies
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13
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NII K, AIKAWA H, TSUTSUMI M, ONIZUKA M, NAKAU H, INOUE R, GO Y, KAZEKAWA K. Carotid Artery Stenting in a Patient With Internal Carotid Artery Stenosis and Ipsilateral Persistent Primitive Hypoglossal Artery Presenting With Transient Ischemia of the Vertebrobasilar System -Case Report-. Neurol Med Chir (Tokyo) 2010; 50:921-4. [DOI: 10.2176/nmc.50.921] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kouhei NII
- Department of Neurosurgery, Fukuoka University Chikushi Hospital
| | - Hiroshi AIKAWA
- Department of Neurosurgery, Fukuoka University Chikushi Hospital
| | | | - Masanari ONIZUKA
- Department of Neurosurgery, Fukuoka University Chikushi Hospital
| | - Hiroya NAKAU
- Department of Neurosurgery, Fukuoka University Chikushi Hospital
| | - Ritsurou INOUE
- Department of Neurosurgery, Fukuoka University Chikushi Hospital
| | - Yoshinori GO
- Department of Neurosurgery, Fukuoka University Chikushi Hospital
| | - Kiyoshi KAZEKAWA
- Department of Neurosurgery, Fukuoka University Chikushi Hospital
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14
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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]
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15
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Janzen A, Steinhuber CR, Bogdahn UR, Schuierer GR, Schlachetzki F. Ultrasound findings of bilateral hypoplasia of the vertebral arteries associated with a persistent carotid-hypoglossal artery. BMJ Case Rep 2009; 2009:bcr07.2008.0486. [PMID: 21686784 DOI: 10.1136/bcr.07.2008.0486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a 31-year-old female who was admitted to our neurology department for vertigo, partial left-sided hemihypesthesia and nuchal headache of subacute onset. Colour-duplex ultrasound disclosed bilateral low flow with a high resistance flow pattern in both vertebral arteries in the V2 segments, while the basilar artery had normal flow. CT angiography and MRI ruled out any ischaemic cerebral infarct and disclosed a persistent hypoglossal artery (PHA) originating from the left internal carotid artery (ICA). The patient was eventually treated for cervicobrachialgia. Persistent carotid-basilar anastomosis such as PHA may account for an atypical stroke pattern in carotid disease, aneurysms and arterovenous malformations. In retrospect, PHA is amendable to colour-Duplex investigation due to an abnormal ICA flow and a discrepancy between the vertebral and basilar flow patterns. Ultrasound investigation of the vertebrobasilar system remains a challenge as variants appear frequently; hypoplasia of the vertebral arteries should thus be confirmed using CT or MR angiography.
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Affiliation(s)
- Annette Janzen
- University of Regensburg, Neurology, Universitaetsstr. 84, Regensburg, 93053, Germany
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16
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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]
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17
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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.
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Affiliation(s)
- Gerasimos M Baltsavias
- Neuroendovascular Department, Interbalkan European Medical Centre, 57001 Thessaloniki, Greece.
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Atkin GK, Grieve PP, Vattipally VR, Ravikumar KH, Das SK. The Surgical Management of Aortic Root Vessel Anomalies Presenting in Adults. Ann Vasc Surg 2007; 21:525-34. [PMID: 17521875 DOI: 10.1016/j.avsg.2007.04.001] [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: 12/17/2006] [Revised: 04/08/2007] [Accepted: 04/09/2007] [Indexed: 11/23/2022]
Abstract
Anomalies of the aortic root vessels may present in adults and are common incidental findings during standard vascular imaging. Knowledge of their presentation and management is important for surgeons dealing with vascular pathology within these anomalous vessels. A comprehensive literature search was conducted and a review of the current opinion performed on the embryology, clinical features, and surgical treatment of aortic root vessel anomalies, with particular emphasis on their management in adults. A classification system for aortic arch anomalies based on arch configuration is presented: (1) double aortic arch, (2) right aortic arch, (3) left aortic arch with abnormal branching, and (4) interrupted aortic arch. Anomalies of the aortic root vessels may be classified based on their presence or absence, their anomalous size or course, or their atypical origin, bifurcation, or subsequent branching pattern. A symptomatic aberrant right subclavian artery may be encountered by vascular surgeons, and a right supraclavicular approach would appear the most appropriate method of repair. Knowledge of aortic arch and root vessel anomalies is important for any clinician dealing with cardiothoracic, head and neck, or intracranial pathology. Vascular surgeons may encounter these anomalies during routine practice and may need to deal with their clinical sequelae.
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Affiliation(s)
- G K Atkin
- Department of Vascular Surgery, Hillingdon Hospital, Pield Heath Road, Hillingdon, Middlesex, UK.
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Grand M, Nepper-Rasmussen J. Aneurysm of persistent primitive hypoglossal artery occluded with guglielmi detachable coils. Interv Neuroradiol 2005; 11:247-50. [PMID: 20584482 DOI: 10.1177/159101990501100308] [Citation(s) in RCA: 4] [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: 11/15/2022] Open
Abstract
SUMMARY The persistent primitive hypoglossal artery is rare remnant of one of the four embryonal carotid-basilar anastomoses. It is present in 0.02- 0.26% of all cerebral angiogram. 14 cases of PHA aneurysms have been reportede in the literature and as far as we know no case in which endovascular embolization was used as a treatment. We present a case with subarachnoid haemorrhage due to aneurysm of persistent primitive hypoglossal artery. The aneurysm was successfully occluded with Guglielmi detachable coils. The SAH resolved and recovery was uneventful.
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Affiliation(s)
- M Grand
- Department of Radiology Odense University Hospital; Denmark -
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Thayer WP, Gaughen JR, Harthun NL. Surgical revascularization in the presence of a preserved primitive carotid-basilar communication. J Vasc Surg 2005; 41:1066-9. [PMID: 15944613 DOI: 10.1016/j.jvs.2005.03.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Anomalous arteries that connect the anterior and posterior cranial arterial systems are unusual variants that can severely alter normal patterns of cerebral blood flow. Persistent trigeminal, hypoglossal, otic, and proatlantal arteries have been described. This report illustrates the technical aspects of carotid endarterectomy with an ipsilateral preserved primitive carotid-basilar communication. Identification of the internal carotid and hypoglossal arteries, maintenance of cerebral perfusion, arteriotomy closure, preoperative imaging, the use of shunts, and reconstruction strategy are discussed. Preoperative angiography and detailed, individualized surgical strategy should be used to ensure a successful endarterectomy in patients with preserved primitive carotid-basilar communications.
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Affiliation(s)
- Wesley P Thayer
- Department of Surgery, Division of Vascular Surgery, University of Virginia, Charlottesville, VA, USA
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