A Persistent Primitive Hypoglossal Artery As the Sole Supply to the Brain Associated with a Basilar Bifurcation Aneurysm

Abstract

The persistent primitive hypoglossal artery (PPHA) is the second most common persistent carotid–vertebrobasilar anastomosis, with an incidence of 0.027–0.26%. PPHAs change the hemodynamics of the carotid and vertebrobasilar system and may be associated with intracranial vascular anomalies, but basilar bifurcation aneurysms were rarely reported. We describe the first case of a PPHA as the sole supply to the brain associated with a basilar bifurcation aneurysm and review the literature. We reported a 34-year-old woman who presented with subarachnoid hemorrhage due to a ruptured basilar bifurcation aneurysm. Digital subtraction arteriogram revealed a right PPHA as the sole supply to the brain. The aneurysm was successfully clipped under intraoperative neurophysiology.

Persistent hypoglossal artery aneurysm: Case report and qualitative systematic review

“…Incidental PHA in the presence of a ruptured intracranial aneurysm arising at another site has been reported in at least seven patients. 9,[31][32][33][34][35][36] There has only been one reported aneurysm treatment relating to a PHA arising from the external carotid artery and this must be considered an extremely unusual anatomical variation. 29…”

Case Report: Persistent Primitive Hypoglossal Artery Accompanied by a Basilar Bifurcation Aneurysm Treated by Y-Stent-Assisted Coil Embolization

“…Our literature review identified several reports of the treatment of PPHA accompanied by a basilar bifurcation aneurysm ( Table 1) (3,(5)(6)(7)(18)(19)(20)(21). The reported techniques were surgical clipping and coil embolization.…”

“…The incidence of this persistent carotid-vertebrobasilar anastomosis is 0.027-0.26% (2). Due to an anomalous structure of the vessel wall, posterior circulation blood supply from the ICA, and exposure to unusual hemodynamic stress, PPHA patients often have intracranial anomalies, such as aneurysms (3)(4)(5)(6)(7)(8)(9). PPHA disrupts hemodynamic stability between the carotid and vertebrobasilar system.…”

Unusual case of persistent primitive hypoglossal artery with anterior choroidal artery aneurysm in Chiari type I malformation

“…Past reviews reported that 26%–27.6% had aneurysms and that were located mainly (about 85%) in the posterior circulation, especially at the PPHA-BA junction. [ 7 10 11 12 13 ] Some of them caused cerebral infarction or subarachnoid hemorrhage and required surgical treatment. Recently, neuroendovascular therapy has tended to be selected, such as mechanical thrombectomy, carotid artery stenting, or intraaneursymal coiling.…”