FROMJHE SECTION ON NEURORADIOLOGY (DIRECrOR: S. CRONQVIST), DEPARTMENT OF DIAGNOSTIC RADIOLOGY, UNIVERSITY HOSPITAL, S-221 85 LUND, SWEDEN.
PERSISTENT HYPOGLOSSAL ARTERY, DIAGNOSTIC CRITERIA Report of a case JAN BRISMAR
The origin of the vertebra-basilar system is embryologically complex. Extensive dissections were made by PADGET (1948, 1954) and form the basis for the following description: In the 4 to 5 mm long (crown-rump length) human embryo (ovulation age 29 days), bilateral longitudinal neural arteries have just developed in the hindbrain region (Fig. 1 a). At this stage these arteries are supplied cranially by the primitive trigeminal arteries and caudally by the suboccipital intersegmental arteries. Two transitory branches from the paired aorta, the primitive otic artery and the primitive hypoglossal artery, also contribute. By the time the embryo is 5 to 6 mm long (Fig. I b), the posterior communicating artery has already developed and taken over the function from these temporary, primitive arteries, which then rapidly degenerate and disappear, the otic artery first, followed by the hypoglossal and trigeminal arteries. At the same stage the longitudinal neural arteries start to fuse, forming the basilar artery. During the 7 to 12 mm stage (ovulation age 32 days), the vertebral arteries are formed fram transverse anastomoses between adjacent cervical intersegmental arteries, beginning with the suboccipital intersegmental artery and proceeding downwards to the 6th cervical intersegmental artery, which forms the origin of the adult vertebral artery and the subclavian artery (Fig. I c). The normal Submitted for publication 11 March 1975.
160 Acta Radiologica Diagnosis 17 (1976) Fasc. 2 March
Downloaded from acr.sagepub.com at UNIVERSITY OF WINDSOR on September 18, 2015
PLRSISTLNT HYPOGLOSSAL ARTERY, DIAGNOSTIC CRITERIA
161
ICA " PTA/
HA
-j
POA -- ~ AA III .:: AA IV
PA PHA SOA CSA I CSA II CSA III CSAN CSAV CSA VI DA
a
b
c
Fig. 1. Simplified presentation of development of vcrtcbro-basilar arterial system in human embryo. AA III and IV 3rd and 4th aortic arch, HA basilar artery in formation, CSA I-VI cervical intersegmental arteries I VI, DA paired dorsal aorta, HA hyoid artery, ICA internal carotid artery, PA pulmonary artery in formation, PHA primitive hypoglossal artery, POA- primitive otie artery, PTA primitive trigeminal artery, SCA subclavian artery, SOA suboccipital intersegmental artery, VA vertebral artery in formation. a) 4 to 5 rnrn embryo. Bilateral longitudinal neural arteries in hindbrain region supplied by PHA, POA, PTA and SOA. b) 4 to 5 rnrn embryo. After development of PCA disappearance of PH A, POA and PTA. BA in formation. c) 7 to 12 mm embryo. VA in formation through transverse anastomoses between SOA and SCA I-VI.
lifetime of the primitive trigeminal, otic, and hypoglossal arteries is thus less than a week. As early as 1844 QUAIN described a persistent trigeminal artery found at autopsy and in 1889 BATUJEH reported a persistent hypoglossal artery. Single cases were then reported by several authors, but it was not until the introduction of cerebral angiography that clinical series large enough to allow an estimation of the frequency of these arteries became available. The first angiographic report on a persistent trigeminal artery was published by SUTTON (1950), and in the same year LINDGREN presented a case with a persistent hypoglossal artery. From large angiographic materials the frequency of a persistent trigeminal artery has been estimated at 0.1 to 0.2 per cent, while in all only 25 persistent hypoglossal arteries have been reported. No convincing report of a persistent otic artery has yet been published. A detailed review of these anomalous carotid-basilar anastomoses has been made by LIE (1968). The persistent trigeminal artery corresponds in its course to the primitive trigeminal artery. It leaves the internal carotid artery where this enters the cavernous sinus and passes posteriorly to join the basilar artery, normally between the origins of the superior cerebellar and anterior inferior cerebellar arteries (Fig. 2). II
765845
Downloaded from acr.sagepub.com at UNIVERSITY OF WINDSOR on September 18, 2015
162
JAN IlRISMAR
Fig. 2. Internal carotid angiography, lateral view. Persistent primitive trigeminal artery.
a
b
Fig. 3. Right common carotid angiography. a) Lateral and b) a.p. views. Persistent hypoglossal artery (~).
Downloaded from acr.sagepub.com at UNIVERSITY OF WINDSOR on September 18, 2015
PERSISTENT HYPOGLOSSAL ARTERY, DIAGNOSTIC CRITERIA
a
163
b
Fig. 4. Angiography of hypoglossal artery. a) Lateral view. Filling of carotid siphon through posterior communicating artery (-
PERSISTENT HYPOGLOSSAL ARTERY, DIAGNOSTIC CRITERIA Report of a case JAN BRISMAR
The origin of the vertebra-basilar system is embryologically complex. Extensive dissections were made by PADGET (1948, 1954) and form the basis for the following description: In the 4 to 5 mm long (crown-rump length) human embryo (ovulation age 29 days), bilateral longitudinal neural arteries have just developed in the hindbrain region (Fig. 1 a). At this stage these arteries are supplied cranially by the primitive trigeminal arteries and caudally by the suboccipital intersegmental arteries. Two transitory branches from the paired aorta, the primitive otic artery and the primitive hypoglossal artery, also contribute. By the time the embryo is 5 to 6 mm long (Fig. I b), the posterior communicating artery has already developed and taken over the function from these temporary, primitive arteries, which then rapidly degenerate and disappear, the otic artery first, followed by the hypoglossal and trigeminal arteries. At the same stage the longitudinal neural arteries start to fuse, forming the basilar artery. During the 7 to 12 mm stage (ovulation age 32 days), the vertebral arteries are formed fram transverse anastomoses between adjacent cervical intersegmental arteries, beginning with the suboccipital intersegmental artery and proceeding downwards to the 6th cervical intersegmental artery, which forms the origin of the adult vertebral artery and the subclavian artery (Fig. I c). The normal Submitted for publication 11 March 1975.
160 Acta Radiologica Diagnosis 17 (1976) Fasc. 2 March
Downloaded from acr.sagepub.com at UNIVERSITY OF WINDSOR on September 18, 2015
PLRSISTLNT HYPOGLOSSAL ARTERY, DIAGNOSTIC CRITERIA
161
ICA " PTA/
HA
-j
POA -- ~ AA III .:: AA IV
PA PHA SOA CSA I CSA II CSA III CSAN CSAV CSA VI DA
a
b
c
Fig. 1. Simplified presentation of development of vcrtcbro-basilar arterial system in human embryo. AA III and IV 3rd and 4th aortic arch, HA basilar artery in formation, CSA I-VI cervical intersegmental arteries I VI, DA paired dorsal aorta, HA hyoid artery, ICA internal carotid artery, PA pulmonary artery in formation, PHA primitive hypoglossal artery, POA- primitive otie artery, PTA primitive trigeminal artery, SCA subclavian artery, SOA suboccipital intersegmental artery, VA vertebral artery in formation. a) 4 to 5 rnrn embryo. Bilateral longitudinal neural arteries in hindbrain region supplied by PHA, POA, PTA and SOA. b) 4 to 5 rnrn embryo. After development of PCA disappearance of PH A, POA and PTA. BA in formation. c) 7 to 12 mm embryo. VA in formation through transverse anastomoses between SOA and SCA I-VI.
lifetime of the primitive trigeminal, otic, and hypoglossal arteries is thus less than a week. As early as 1844 QUAIN described a persistent trigeminal artery found at autopsy and in 1889 BATUJEH reported a persistent hypoglossal artery. Single cases were then reported by several authors, but it was not until the introduction of cerebral angiography that clinical series large enough to allow an estimation of the frequency of these arteries became available. The first angiographic report on a persistent trigeminal artery was published by SUTTON (1950), and in the same year LINDGREN presented a case with a persistent hypoglossal artery. From large angiographic materials the frequency of a persistent trigeminal artery has been estimated at 0.1 to 0.2 per cent, while in all only 25 persistent hypoglossal arteries have been reported. No convincing report of a persistent otic artery has yet been published. A detailed review of these anomalous carotid-basilar anastomoses has been made by LIE (1968). The persistent trigeminal artery corresponds in its course to the primitive trigeminal artery. It leaves the internal carotid artery where this enters the cavernous sinus and passes posteriorly to join the basilar artery, normally between the origins of the superior cerebellar and anterior inferior cerebellar arteries (Fig. 2). II
765845
Downloaded from acr.sagepub.com at UNIVERSITY OF WINDSOR on September 18, 2015
162
JAN IlRISMAR
Fig. 2. Internal carotid angiography, lateral view. Persistent primitive trigeminal artery.
a
b
Fig. 3. Right common carotid angiography. a) Lateral and b) a.p. views. Persistent hypoglossal artery (~).
Downloaded from acr.sagepub.com at UNIVERSITY OF WINDSOR on September 18, 2015
PERSISTENT HYPOGLOSSAL ARTERY, DIAGNOSTIC CRITERIA
a
163
b
Fig. 4. Angiography of hypoglossal artery. a) Lateral view. Filling of carotid siphon through posterior communicating artery (-
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