Persistent Primitive Hypoglossal Artery Associated With Multiple Cerebral Aneurysms

Abstract

Persistent primitive hypoglossal artery is a rare anastomosis between the carotid and basilar arteries, and sometimes associated with cerebral aneurysms. However, association of persistent primitive hypoglossal artery with aneurysms located on arteries other than persistent primitive hypoglossal artery itself or posterior circulation is very rare. An 80-year-old woman suffered from subarachnoid hemorrhage, whose angiography demonstrated aneurysms on the left middle cerebral artery and anterior communicating artery, and the left persistent primitive hypoglossal artery. The middle cerebral artery aneurysm was the origin of hemorrhage. Although repeated craniotomy was necessary for the left middle cerebral artery aneurysm, both aneurysms were successfully clipped. In our case, neither aneurysm was located on an artery related to the persistent primitive hypoglossal artery. There is a possibility that cases of persistent primitive hypoglossal artery are accompanied by cerebral aneurysms on arteries other than the persistent primitive hypoglossal artery or in the posterior circulation.

A fenestrated persistent primitive hypoglossal artery harboring a ruptured aneurysm

“…Primitive arteries like the trigeminal artery, auricular artery, hypoglossal artery, as well as anterior atlantoaxial intersegmental artery form the transient vascular anastomotic pathways from the superior to the inferior parts between the primitive carotid and vertebrobasilar arteries during the development of the embryonic craniocerebral circulation [9,14,16] . These vascular anastomoses gradually degenerate and disappear [8,16] . If they do not degenerate and persist into birth or even adulthood, they can become permanent carotid-vertebrobasilar anastomoses [9,14,16] .…”

“…PPHA normally originates from the cervical segment of the ICA, at the plane of the C1–C3 vertebral bodies [4,9,14,16] . After entering the skull through the hypoglossal canal and anastomoses with the basilar artery, PPHA becomes the only artery to supply the basilar artery [8,9,14,16] . Its presence commonly concurs with the dysplasia of the posterior communicating arteries as well as vertebral arteries [9,14,16] .…”

“…The PPHA mostly originates from the internal carotid artery (ICA) and rarely from the external carotid artery [4] . Patients with PPHA usually have higher changes of developing intracranial aneurysms due the high intracranial hemodynamics [5–8] . Most often than not, the aneurysms are often found on other arteries and not the parent artery with the PPHA [8,9] .…”

“…[4] Patients with PPHA usually have higher changes of developing intracranial aneurysms due the high intracranial hemodynamics. [5][6][7][8] Most often than not, the aneurysms are often found on other arteries and not the parent artery with the PPHA. [8,9] However, a few cases of commitment occurrences of aneurysms on the parent PPHA artery have been reported.…”

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.…”