The ascending pharyngeal artery is an artery in the neck that supplies the pharynx, developing from the proximal part of the embryonic second aortic arch it is the smallest branch of the external carotid and is a long, slender vessel, deeply seated in the neck, beneath the other branches of the external carotid and under the stylopharyngeus muscle. The most frequent origin of the posterior inferior cerebellar artery is from the intracranial segment of the vertebral artery. A case of aneurysm on a persistent hypoglossal artery treated. Jul 23, 2003 the primitive hypoglossal artery pha is a rare vascular anomaly, which belongs to the group of carotidbasilar anastomosis that may occur in adults. A woman presented with 75% stenosis of the right internal carotid artery ica with extension to the origin of a persistent hypoglossal artery pha. The variation in which the pica arises from the hypoglossal branch of the apa is thought to be related to the remnant of the primitive hypoglossal artery, and is referred to as a primitive hypoglossal artery variant. The persistent hypoglossal artery is the second most common carotidvertebrobasilar anomalous anastomosis the first being the trigeminal artery 1. After passing through an enlarged hypoglossal canal, it joins the basilar artery. This may be better achieved by ct andor mri than by conventional angiography. However, a hypoglossal artery arising from the external carotid artery eca and connecting directly with the posterior inferior cerebellar artery pica, instead of the basilar artery or the vertebral artery, is very rare. Persistent carotidbasilar artery anastomoses are rare vascular anomalies, including the trigeminal, otic, and hypoglossal arteries. The posterior inferior cerebellar artery pica is the largest branch of the vertebral artery and is one of three main arteries supplying the cerebellum.
Persistent hypoglossal artery is the second most common carotidbasilar anastomosis with a frequency of 0. The key finding to distinguish the persistent hypoglossal artery from the proatlantal artery that has nearly the same orientation is the identification of the foramen through which the artery passes. Failure of regression of one or more of these primitive anastomoses leads to persistent carotidvertebrobasilar anastomoses, of which persistent primitive trigeminal artery is the most common type 14. When intracanalicular enlargement of the hypoglossal canal is identified, this anomalous vessel should be the primary consideration in the differential diagnosis. Anterior inferior cerebellar and posterior inferior. Rare variant of persistent primitive hypoglossal artery. A unique variant of a right persistent hypoglossal artery arising from the common carotid artery with complex cardiovascular anomalies in a female neonatal patient. Persistent hypoglossal artery radiology reference article.
Variant anatomy of the hypoglossal nerve is very rare. It originates from the internal carotid artery at the levels of the upper cervical spines, courses through the hypoglossal canal, and anastomoses with the. Angiographic findings and clinical implications of persistent. Persistent primitive hypoglossal artery associated with lower basilar artery aneurysm. Persistent hypoglossal artery as a potential risk factor. The right subclavian artery in most variants aberrant right subclavian, right arch left heart joins the aorta distal to other great vessels and at an unfavorable curve. Hypoglossal nerve disorders may be caused by tumors, strokes, infections, injuries, or amyotrophic lateral sclerosis. Bilateral persistent primitive hypoglossal artery presenting with. The lingual vein passes medial to the hyoglossus, and the lingual artery passes deep to the hyoglossus. Fetal anastomotic connections between the developing internal carotid and basilar arterial. After passing through an enlarged hypoglossal canal, it joins the basilar artery inferiorly. The most commonly found vessel is the trigeminal artery, followed by the hypoglossal artery. We present a case demonstrating an unusual variant of the hypoglossal artery.
When the persistent trigeminal artery unites with the pica or the superior cerebellar artery instead of the basilar artery, the trigeminal artery is known as a trigeminal artery variant. Over 3 million unverified definitions of abbreviations and acronyms in acronym attic. The canals ofthepresentcasesand that ofconstans etal. Powerdopplerultrasonography spectral images obtained after the patient exercised the left arm.
Knowledge of this rare but important variant can have significant implications for medical. Rare variant of persistent primitive hypoglossal artery in. Seven prior cases of posterior circulation stroke in the setting of ppha have been described in the literature, with all but one case being attributable to atherosclerotic embolization from the internal carotid artery ica through the ppha. The authors present a rare case of a persistent primitive hypoglossal artery pha variant ending in the posterior inferior cerebellar artery pica without an interposed segment of the basilar artery and describe briefly the possible embryogenesis of this anomaly. Vertebral artery lateral spinal artery pica relationship. A rare case of persistent hypoglossal artery associated. Pha persistent primitive hypoglossal artery acronymattic. Aberrant anatomy of the hypoglossal nerve the journal of. Aberrant anatomy of the hypoglossal nerve volume 126 issue 5 s islam, g m walton, d howe. Here, we present a case of an unusual variant of a persistent primitive hypoglossal artery, which was found incidentally during an examination for a hypertensive thalamic haemorrhage. The corpus callosum is the largest of the commissural fibers, linking the cerebral cortex of the left and right cerebral hemispheres. Persistent hypoglossal artery pha, a rare embryological carotidbasilar.
The trunk was running forward and medially and later it was dividing. Knowledge of these anomalies is especially important in hepatobiliary and pancreatic surgery in order to avoid unnecessary complications. The primitive otic artery is the rarest of the four anomalous vessels. For verified definitions visit all trademarksservice marks referenced on this site are properties of their respective owners. The largesized pha originating from the cervical internal carotid artery passed through the hypoglossal canal together with the hypoglossal nerve and reached the posterior cranial fossa to anastomose the basilar artery. The hypoglossal nerve is the twelfth cranial nerve, and innervates all the extrinsic and intrinsic muscles of the tongue, except for the palatoglossus which is innervated by the vagus nerve. A case of symptomatic cervical carotid artery stenosis with persistent primitive hypoglossal artery ppha. Norihiko fujita, nobumitsu shimada, hiroshi takimoto, and tadayuki satou subject.
Bapuraj jr, ojili v, khandelwal n, shanbhogue ak, gupta sk. However, as mentioned above, tortuous candy cane arches can sometimes be easier to deal with via radial approach. Rare variant of persistent primitive hypoglossal artery in magnetic resonance angiography article pdf available in anatomia clinica 328. Hypoglossal canal definition of hypoglossal canal by. The authors present a case of persistent hypoglossal artery. Developmental anatomy of the distal vertebral artery in. We report an unusual intraoperative finding of an aberrant branch of the hypoglossal nerve, encountered during a facial reanimation procedure. The authors present a rare case of a persistent primitive hypoglossal artery pha variant ending in the posterior inferior cerebellar artery pica without an interposed segment of the basilar. Two cases of persistence of the primitive hypoglossal artery are reported with roentgenographic documentation of associated enlargement of the hypoglossal canal. The artery was clearly identified as a persistent hypoglossal artery.
The trigeminal artery is an artery that supplies the basilar artery with blood during human embryonic development. Manual aspiration thrombectomy for basilar infarction in the. Diagnosis is by imaging methods and angiotomography is the method most often employed. Aplasia of a1 was seen in 9 % of the patients n 156, and this was confirmed in all cases where the patients underwent dsa for diagnostic or therapeutic reasons fig. Carotid endarterectomy in the face of a persistent. Case report persistent primitive hypoglossal artery.
See vascular neuroembryology section for relevant origin of this vessel. Andoh k, tanohata k, moriya n, hagiwara h, lee j, sato m, yoshida t, nagashima t 2001 the posterior inferior cerebellar artery arising from the extracranial segment of the internal carotid artery via the hypoglossal canal without an interposed segment of the basilar artery. The persistent trigeminal artery pta was first reported at autopsy by richard quain in 1844 and via angiography by sutton in 1950. Basilar artery aneurysm treated with coil embolization via persistent primitive hypoglossal artery. The posterior inferior cerebellar artery arising from the.
Persistent hypoglossal artery with hypoplasia of the. The persistent hypoglossal artery pha is the second most common carotidvertebrobasilar artery anastomosis after trigeminal artery, with a prevalence of 0. Sep 30, 2019 a unique variant of a right persistent hypoglossal artery arising from the common carotid artery with complex cardiovascular anomalies in a female neonatal patient paul a miller, 1, kerby c oberg, 2 alex sun, 3 and adina achiriloaie 3. This artery is a rare remnant of the embryonic circulatory system that unites the proximal intracavernous segment of internal carotid artery ica with the middle or distal portion of the basilar artery ba. The hypoglossal artery usually arises as a robust branch of the internal carotid artery between the c1 and c3 level and traverses the hypoglossal canal to join the basilar artery. Ruptured aneurysm arising from a basilar artery fenestration and associated with a persistent primitive hypoglossal artery. The pha is a rare fetal variant of carotidbasilar anastomosis that elevates the risk of ischemia and embolic infarction within the posterior cerebral circulation in patients with carotid disease proximal to the anastomosis.
Isolated stenosis of a persistent hypoglossal artery visualized at 3d ct angiography. On coronal imaging, the jugular tubercle appears beaklike extending over the hypoglossal canal. A certain number of anatomic variants involving the distal vertebral artery va are explained by variations in size and connection of the lateral spinal artery lsa. Persistent hypoglossal artery and its variants diagnosed. The persistent primitive hypoglossal artery is a carotidvertebrobasilar anastomosis, which commonly arises from the internal carotid artery at the level of the c vertebrae, enters the skull base through the hypoglossal canal and supplies the basilar artery. However, unusual and extremely rare variants of pha have been reported, such as those arising from the external carotid artery eca 7 or ending in the. Posterior inferior cerebellar artery originating from the. Manual aspiration thrombectomy for basilar infarction in. Heart disease variants may also affect reproductive success. Jul 22, 2012 persistent hypoglossal artery pha is the second most common anastomosis between the carotid and vertebrobasilar systems and demonstrates some variations. This study examined the possible role of another branch of the va, the posterior spinal artery psa, in the development of similar vascular variations.
The first to do so is the otic artery, sequentially followed by the hypoglossal, trigeminal and the proatlantal intersegmental artery. Associated with persistent primitive hypoglossal artery. The hypoglossal nerve is the twelfth and last cranial nerve and supplies the tongue with motor control. We present an extremely rare case of a variant of persistent primitive hypoglossal artery, which was found incidentally in magnetic resonance angiography during an examination for dizziness. Persistent hypoglossal arteries with aneurysmal dilation. Laterally, in between the hyoglossus muscle and the mylohyoid muscle lay several important structures from upper to lower.
Normally, the trigeminal artery involutes after the formation of the posterior communicating artery. A rare case of persistent hypoglossal artery associated with. Variations of anterior cerebral artery in human cadavers. The trunk was running forward and medially and later it was dividing into upper lingual and lower superior thyroid branches. A persistent hypoglossal artery is one of the persistent carotidvertebrobasilar anastomoses. Another common variant was the hypoplastic v4 segment of the vertebral artery. We evaluated the prevalence of pha on computed tomography ct angiography. However, anatomical variations of intracranial arteries, particularly of the anterior communicating artery, have been found to be related to the development of.
A unique variant of a right persistent hypoglossal artery. Herein is presented a case of a patient with a pha, who had undergone a cerebral angiography due to investigation of subarachnoid hemorrhage. Variation of anterior cerebral artery is common in this study of indian human cadavers. Hypoglossal nerve disorders msd manual consumer version. A biopsy ofthe hypoglossal nerveinthat casewasnotdone. Generally, pha is a clinically silent anatomical variation.
Mr appearance of the persistent hypoglossal artery author. This anastomotic vessel arose from the external carotid artery eca, not internal carotid artery, and entered the hypoglossal canal to basilar artery. Additionally, the diagnostic alternatives for detection and assessment of pha and the spectrum of. The hypoglossal artery and hypoglossal canal bygeoffrey a. Disorders of the 12th cranial nerve hypoglossal nerve cause weakness or wasting atrophy of the tongue on the affected side. Persistent primitive hypoglossal artery ppha is a rare embryonic carotidvertebrobasilar artery anastomosis with a reported incidence of 0. Rare hepatic arterial anatomic variants in patients requiring.
Anatomical features and clinical relevance of a persistent. Durham, north carolina lthough there have been numerous reported cases ofpersistence ofthe primitive hspoglossal artery,7 there islittle information tobefound inthe literature concerning alterations of the hypoglossal. In addition, the ipsilateral vertebral artery and bilateral posterior communicating arteries were hypoplastic. Diagnosis and clinical implications sunil v furtado 1, kalyan reddy 2, nilesh khandelwal 2, as hegde 1 1 department of neurosurgery, sri satya sai institute of higher medical sciences, bangalore, india 2 department of radiology, sri satya sai institute of. Variant origin of thyrolingual trunk from left common carotid. To our knowledge, this is the fourth reported case of. We also evaluated characteristic features of pha and its variants on magnetic resonance mr angiography.
Hence, it may be adequate to consider the pica arising from the extracranial segment of the ica via the hypoglossal canal as a pha variant. The ppha usually arises from internal carotid artery ica between the c1 and c3 levels and traverses the hypoglossal canal to join the basilar artery ba. Persistent primitive hypoglossal artery associated with lower. Persistent bilateral hypoglossal arteries has entering the skull through. We present the case of an uncommon variant of the hypoglossal artery arising from the eca that connected directly with.
Feb 20, 2018 the key finding to distinguish the persistent hypoglossal artery from the proatlantal artery that has nearly the same orientation is the identification of the foramen through which the artery passes. Summary located inferior to the cerebral cortices, and supe. Persistent primitive hypoglossal artery associated with. Apr 14, 2010 we present an extremely rare case of a variant of persistent primitive hypoglossal artery, which was found incidentally in magnetic resonance angiography during an examination for dizziness. Unusual variant of persistent primitive hypoglossal artery. Vertebral artery fenestration in reality codominant lateral spinal artery the lateral spinal artery is an important cervical intradural vessel which is homologous with the lateral medullary segmetn of the pica in the brain and with the posterior spinal arteries in the thoracic. The persistent hypoglossal artery is the second most common carotidvertebrobasilar artery anastomosis, following the persistent trigeminal artery, with a prevalence of 0. It is second in frequency to the trigeminal artery which is present approximately six. We describe two cases of patients undergoing pancreatoduodenectomy for abnormalities in the head of the. Abstractthe persistent hypoglossal artery is rare vascular anomalies. Combined with occipital condyle the coronal appearance is reminiscent of an eagle seen in profile, making this a convenient landmark 3,4. A carotidvertebrobasilar anastomosis of this kind is typically considered a variant of persistent primitive hypoglossal artery which usually originates from the internal carotid artery.
It originates from the extracranial internal carotid artery as a large collateral branch, ascends vertically, passes through the hypoglossal canal and continues as the basilar trunk. Persistent hypoglossal artery pha is the second most common anastomosis between the carotid and vertebrobasilar systems and demonstrates some variations. Persistent fetal carotidbasilar anastomoses are rare, occurring in less than 1% of the general population. We present a case demonstrating an unusual variant of the hypoglossal artery arising from the external carotid artery. A unique variant of a right persistent hypoglossal artery arising from the common carotid artery with complex cardiovascular anomalies in a female. It arises from the distal cervical ica, usually between c1 and c3.
The eleven cerebellar arteries originating from the internal carotid artery were considered to be persistent primitive trigeminal artery variants. Intracranial arterial variants, of which there are many, are collectively common. Tic douloureux caused by primitive trigeminal artery or its variant in. Intracranial arteries variants radiology reference. We report a case of a left sided primitive hypoglossal artery detected by. A case is reported in which there was a variant origin of thyrolingual trunk from left common carotid artery 2 cm below its bifurcation in the neck. Anatomical features and clinical relevance of a persistent trigeminal. A unique variant of a right persistent hypoglossal artery arising from the common carotid artery with complex cardiovascular anomalies in a female neonatal patient persistent primitive hypoglossal artery is a carotidvertebrobasilar anastomosis, which commonly arises from the internal carotid artery at the level of the c cervical vertebrae.
None of the reports on pta variant, which is an anomalous cerebellar artery arising from the internal carotid artery without anastomosis to the basilar artery, has. Left vertebral artery digital subtraction angiography, lateral projection a and townes projection b, showing the persistent hypoglossal artery that arose from the cervical segment of the internal carotid artery apparently followed the normal course of vertebral arteries and then took a slight dorsal course to enter the cranium via the hypoglossal canal before joining the. However, in some cases, the artery persists into adulthood and can cause medical complications, including intracranial aneurysms. Persistent primitive hypoglossal artery ppha, a remnant of embryonal circulation, is a rare variant of the posterior cerebral circulation. The trigeminal artery is an artery that supplies the basilar artery with blood during human. Common and uncommon intracranial arterial anatomic. We report the case of a 50year old man with right hypoglossal artery, ipsilateral hypoplasic internal carotid artery, associated with left proximal subclavian stenosis with subclavian steal syndrome.
In this paper, we describe a rare case of unruptured cerebral aneurysm associated with persistent primitive otic artery variant. Carotid artery stenting for symptomatic stenosis of the. Rare variant of persistent primitive hypoglossal artery, arising from the external carotid artery article in neurologia medicochirurgica 527. The anastomotic vessel arose from the external carotid artery and joined the vertebral artery through the hypoglossal canal. Persistent hypoglossal artery pha this is essentially hypoglossal division taken to the extreme. It is second in frequency to the trigeminal artery which is present approximately six times as often. Their clinical significance may be variable but knowledge and recognition of these variants is fundamental, especially if surgical or endovascular treatments e. The nerve arises from the hypoglossal nucleus in the medulla as a number of small rootlets, passes through the hypoglossal canal and down through the. Diagnostic therapeutic considerations concerning carotid thromboendarterectomy and gary a. Double embolic protection during carotid artery stenting. Persistent hypoglossal artery and its variants diagnosed by.