Huge Fenestration of the Vertebral Artery and Fenestrated Basilar Artery

Abstract

Background: Fenestrations, such as those of the vertebral artery (VA), are generally regarded as arterial slits. To the authors' knowledge, large fenestrations of the VA were reported twice previously, those morphological patterns being different. We hereby report a third pattern of such large fenestration of the VA. Methods: It was found serendipitously on the computed tomography angiograms of a 63 year-old male which were documented retrospectively. Results: The findings were as follows:1.the right VA entered the posterior fossa, crossed to the left side and joined the opposite VA to form the basilar artery;2.the right posterior inferior cerebellar artery was absent;3.the left VA entered the posterior fossa then it had a huge fenestration with 2 limbs: an anterior one, appearing as the main trunk of the VA coursing to form the BA, and a posterior, coiled one, inserted at both ends into the VA;4.that posterior limb of the left VA fenestration sent off 2 posterior inferior cerebellar branches;5.a slit-like fenestration of the basilar artery was also found. Conclusions: Large fenestrations of the VA could result if, during embryogenesis, the proximal segment of the lateral basivertebral anastomosis and the distal segment of the proatlantal artery persist. Large fenestrations of the VA bring into a narrow neurosurgical field an additional arterial trunk that should be carefully documented preoperatively in order to avoid hemorrhagic events.

Fenestrated Maxillary Artery

“…Arterial fenestrations are usually found in the vertebrobasilar and internal carotid systems 1,2. To the authors’ knowledge, fenestrations are quite rare findings in the ECA system.…”

“…An arterial fenestration occurs when an artery divides into 2 separate limbs (trunks, arms) that further reunite 1. Arterial fenestrations should be regarded as persisting unfused embryonic channels, being therefore congenital 1. In initial stages of development the ventral and dorsal aortae are connected by transient fenestrated channels, the first and second aortic arches 4.…”

“…An arterial fenestration occurs when an artery divides into 2 separate limbs (trunks, arms) that further reunite 1. Arterial fenestrations should be regarded as persisting unfused embryonic channels, being therefore congenital 1.…”

Bihemispheric Right Anterior Cerebral Artery, Fenestrated Origin of the Left Pericallosal Artery, Fenestrated Basilar Artery, Double Right Posterior Cerebral Artery

“…Key Words: Hair follicle, hairline, congenital deformity, hair transplantation C utis verticis gyrata is a rare disease that causes multiple furrows and folds of the scalp. [1][2][3] It was first defined by Robert in 1843, then later further classified as either primary or secondary by Polan and Butterworth. 4 However, the cases reported here differ from cases of CVG and appear consistent with a new form of the congenital disorder that has not yet, to our knowledge, been reported.…”

“…The 2 vertebral arteries (VAs) unite to form on clivus the basilar artery (BA). 1 From the basilar end leave the superior cerebellar arteries (SCAs) and posterior cerebral arteries (PCAs). The internal carotid artery (ICA) contributes the anterior choroidal artery (AChA), anterior cerebral artery (ACA), and middle cerebral artery (MCA).…”