Persistent primitive hypoglossal artery associated with proximal posterior inferior cerebellar artery aneurysm.
BACKGROUND
A persistent primitive hypoglossal artery (PPHA) is a rare anomaly. The association of PPHA with intracranial aneurysms of the artery has also been rarely reported. We surgically treated a case of PPHA associated with a ruptured saccular aneurysm at the proximal posterior inferior cerebellar artery (PICA).


METHODS
The patient was admitted because of subarachnoid hemorrhaging. Angiography and three-dimensional computed tomography (CT) angiography (3D-CTA) demonstrated a left PPHA entering the posterior fossa through the left large hypoglossal canal. The left vertebral artery was absent. A saccular aneurysm was found at the junction of the PPHA and the proximal PICA. 3D-CTA showed not only the aneurysm itself but also the anatomical relationship between the aneurysm and the surrounding structures. Therefore, 3D-CTA was very useful in planning the surgery. The neck of the aneurysm was clipped through a far lateral approach associated with a C1 laminectomy, because this case had a large posterior condylar emissary vein and the aneurysm was located just posteroinferior to the hypoglossal canal.


CONCLUSIONS
A case of PPHA associated with an aneurysm at the proximal PICA is reported. This case not only had a large hypoglossal canal but also had a huge posterior condylar emissary vein in the large posterior condylar canal. Anomalous structures associated with PPHA are also discussed. Finally, 3D-CTA proved to be very useful in planning the optimal surgical modality around the lateral portion of the foramen magnum.
Huynh-Le
Phuong
P
Department of Neurosurgery, Neurological Institute, Kyushu University, Japan.
Matsushima
Toshio
T
Muratani
Hiroshi
H
Hikita
Takashi
T
Hirokawa
Eiko
E
D017542:Aneurysm, Ruptured / Q000150:complications* / Q000000981:diagnostic imaging; D001159:Arterio-Arterial Fistula / Q000150:complications* / Q000000981:diagnostic imaging; D001488:Basilar Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging; D002343:Carotid Artery, Internal / Q000002:abnormalities* / Q000000981:diagnostic imaging; D002531:Cerebellum / Q000098:blood supply*; D002533:Cerebral Angiography; D006801:Humans; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed