A Case of Aneurysm on a Persistent Hypoglossal Artery Treated by Endovascular Coiling

We describe a 22-year-old woman admitted to hospital in emergency with nuchal headache and vomiting. CT scan disclosed subarachnoid hemorrhage. Digital subtraction angiography with three-dimensional rotational acquisitions showed a ruptured aneurysm of a right persistent primitive hypoglossal artery as the cause of symptoms and hemorrhage. The patient was successfully treated with endovascular coiling of the aneurysm. This is the second literature report describing endovascular treatment in this unusual condition.

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Persistent hypoglossal artery aneurysm: Case report and qualitative systematic review

Interventional Neuroradiology ◽

10.1177/1591019918809087 ◽

2018 ◽

Vol 25 (2) ◽

pp. 164-171

Author(s):

George H Tse ◽

Andrew Martin ◽

Richard A Dyde ◽

Stuart C Coley

Keyword(s):

Systematic Review ◽

Posterior Inferior Cerebellar Artery ◽

Artery Aneurysm ◽

Endovascular Coiling ◽

Persistent Hypoglossal Artery ◽

Randomised Study ◽

Hypoglossal Artery ◽

Qualitative Systematic Review ◽

Cerebellar Artery ◽

Patient Reported

A persistent hypoglossal artery was first described in 1889 and is one of the more common anatomical variations arising from aberration in normal development. Endovascular coiling has been recognised as a robust treatment for acutely ruptured intracranial arterial aneurysms, although specific data regarding an aneurysm arising from a persistent hypoglossal artery is lacking due to the low incidence. Here we report both the oldest patient reported to be treated with a persistent hypoglossal artery-associated aneurysm and also explicitly report endovascular treatment of a persistent hypoglossal artery aneurysm arising at the posterior inferior cerebellar artery origin. Qualitative systematic review of the available medical literature demonstrates limited evidence regarding treatment of persistent hypoglossal artery-associated aneurysms with the majority being carried out via open surgery. Ruptured posterior inferior cerebellar artery aneurysm arising from a persistent hypoglossal artery can be successfully and safely treated by endovascular therapy via the persistent hypoglossal artery. Randomised study of this situation is unlikely to be feasible; however, qualitative review of the literature reveals six such aneurysms that have been treated surgically, and this case appears to be the first via an endovascular means.

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Discrepancy between two-dimensional and three-dimensional digital subtraction angiography for the planning of endovascular coiling of small cerebral aneurysms <5 mm

Interventional Neuroradiology ◽

10.1177/1591019920925706 ◽

2020 ◽

Vol 26 (6) ◽

pp. 733-740

Author(s):

Te-Chang Wu ◽

Yu-Kun Tsui ◽

Tai-Yuan Chen ◽

Ching-Chung Ko ◽

Chien-Jen Lin ◽

...

Keyword(s):

Digital Subtraction Angiography ◽

Three Dimensional ◽

Cerebral Aneurysms ◽

Endovascular Coiling ◽

Parent Artery ◽

Two Dimensional ◽

Digital Subtraction ◽

Rotational Angiography ◽

Treatment Choices ◽

The Impact

Background To investigate the discrepancy between two-dimensional digital subtraction angiography and three-dimensional rotational angiography for small (<5 mm) cerebral aneurysms and the impact on decision making among neuro-interventional experts as evaluated by online questionnaire. Materials and methods Eight small (<5 mm) ruptured aneurysms were visually identified in 16 image sets in either two-dimensional or three-dimensional format for placement in a questionnaire for 11 invited neuro-interventionalists. For each set, two questions were posed: Question 1: “Which of the following is the preferred treatment choice: simple coiling, balloon remodeling or stent assisted coiling?”; Question 2: “Is it achievable to secure the aneurysm with pure simple coiling?” The discrepancies of angio-architecture parameters and treatment choices between two-dimensional-digital subtraction angiography and three-dimensional rotational angiography were evaluated. Results In all eight cases, the neck images via three-dimensional rotational angiography were larger than two-dimensional-digital subtraction angiography with a mean difference of 0.95 mm. All eight cases analyzed with three-dimensional rotational angiography, but only one case with two-dimensional-digital subtraction angiography were classified as wide-neck aneurysms with dome-to-neck ratio < 1.5. The treatment choices based on the two-dimensional or three-dimensional information were different in 56 of 88 (63.6%) paired answers. Simple coiling was the preferred choice in 66 (75%) and 26 (29.6%) answers based on two-dimensional and three-dimensional information, respectively. Three types of angio-architecture with a narrow gap between the aneurysm sidewall and parent artery were proposed as an explanation for neck overestimation with three-dimensional rotational angiography. Conclusions Aneurysm neck overestimation with three-dimensional rotational angiography predisposed neuro-interventionalists to more complex treatment techniques. Additional two-dimensional information is crucial for endovascular treatment planning for small cerebral aneurysms.

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Effect of choice of treatment modality on the incidence of shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage

Journal of Neurosurgery ◽

10.3171/2017.9.jns171806 ◽

2019 ◽

Vol 130 (3) ◽

pp. 949-955 ◽

Cited By ~ 2

Author(s):

Masaomi Koyanagi ◽

Hitoshi Fukuda ◽

Masaaki Saiki ◽

Yoshihito Tsuji ◽

Benjamin Lo ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Propensity Score ◽

Endovascular Treatment ◽

Treatment Modality ◽

Propensity Score Analysis ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Endovascular Coiling ◽

Surgical Clipping ◽

Propensity Score Model ◽

Poor Outcomes

OBJECTIVEShunt-dependent hydrocephalus (SDHC) may arise after aneurysmal subarachnoid hemorrhage (aSAH) as CSF resorptive mechanisms are disrupted. Using propensity score analysis, the authors aimed to investigate which treatment modality, surgical clipping or endovascular treatment, is superior in reducing rates of SDHC after aSAH.METHODSThe authors’ multicenter SAH database, comprising 3 stroke centers affiliated with Kyoto University, Japan, was used to identify patients treated between January 2009 and July 2016. Univariate and multivariate analyses were performed to characterize risk factors for SDHC after aSAH. A propensity score model was generated for both treatment groups, incorporating relevant patient covariates to detect any superiority for prevention of SDHC after aSAH.RESULTSA total of 566 patients were enrolled in this study. SDHC developed in 127 patients (22%). On multivariate analysis, age older than 53 years, the presence of intraventricular hematoma, and surgical clipping as opposed to endovascular coiling were independently associated with SDHC after aSAH. After propensity score matching, 136 patients treated with surgical clipping and 136 with endovascular treatment were matched. Propensity score–matched cohorts exhibited a significantly lower incidence of SDHC after endovascular treatment than after surgical clipping (16% vs 30%, p = 0.009; OR 2.2, 95% CI 1.2–4.2). SDHC was independently associated with poor neurological outcomes (modified Rankin Scale score 3–6) at discharge (OR 4.3, 95% CI 2.6–7.3; p < 0.001).CONCLUSIONSSDHC after aSAH occurred significantly more frequently in patients who underwent surgical clipping. Strategies for treatment of ruptured aneurysms should be used to mitigate SDHC and minimize poor outcomes.

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Three-Dimensional Digital Subtraction Angiography for Endovascular Treatment of Direct Carotid-Cavernous Fistula

Neurologia medico-chirurgica ◽

10.2176/nmc.50.404 ◽

2010 ◽

Vol 50 (5) ◽

pp. 404-406 ◽

Cited By ~ 3

Author(s):

Shinya KOHYAMA ◽

Shoichiro ISHIHARA ◽

Fumitaka YAMANE ◽

Ryuzaburo KANAZAWA ◽

Hideaki ISHIHARA ◽

...

Keyword(s):

Endovascular Treatment ◽

Digital Subtraction Angiography ◽

Three Dimensional ◽

Digital Subtraction ◽

Carotid Cavernous Fistula ◽

Cavernous Fistula ◽

Direct Carotid Cavernous Fistula

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Persistent primitive hypoglossal artery visualized on three-dimensional computerized tomography angiography

Journal of Neurosurgery ◽

10.3171/jns.1998.89.6.1069 ◽

1998 ◽

Vol 89 (6) ◽

pp. 1069 ◽

Cited By ~ 5

Author(s):

Shinichiro Maeshima ◽

Fuminori Ozaki ◽

Osamu Masuo ◽

Hiroo Yamaga ◽

Ryuji Okita ◽

...

Keyword(s):

Computerized Tomography ◽

Three Dimensional ◽

Hypoglossal Artery ◽

Computerized Tomography Angiography ◽

Persistent Primitive Hypoglossal Artery

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Three dimensional CT angiography versus digital subtraction angiography in the detection of intracranial aneurysms in subarachnoid hemorrhage

Journal of NeuroInterventional Surgery ◽

10.1136/jnis.2010.002246 ◽

2010 ◽

Vol 2 (4) ◽

pp. 385-389 ◽

Cited By ~ 23

Author(s):

C. J. Prestigiacomo ◽

A. Sabit ◽

W. He ◽

P. Jethwa ◽

C. Gandhi ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Digital Subtraction Angiography ◽

Ct Angiography ◽

Intracranial Aneurysms ◽

Three Dimensional ◽

Digital Subtraction

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Endovascular treatment for acute basilar artery occlusion via persistent primitive hypoglossal artery

Medicine ◽

10.1097/md.0000000000027998 ◽

2021 ◽

Vol 100 (48) ◽

pp. e27998

Author(s):

Jung Soo Park ◽

Byoung-Soo Shin ◽

Hyun Goo Kang

Keyword(s):

Endovascular Treatment ◽

Basilar Artery ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Hypoglossal Artery ◽

Persistent Primitive Hypoglossal Artery

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Subarachnoid hemorrhage caused by a rupture of a spinal arteriovenous malformation

Acta chirurgica iugoslavica ◽

10.2298/aci0802051r ◽

2008 ◽

Vol 55 (2) ◽

pp. 51-53 ◽

Cited By ~ 1

Author(s):

D.V. Radulovic ◽

M.Lj. Rakic ◽

B.D. Nestorovic ◽

T.M. Milojevic ◽

B.M. Djurovic ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Neck Pain ◽

Arteriovenous Malformation ◽

Endovascular Treatment ◽

Neurological Examination ◽

Abrupt Onset ◽

Spinal Angiography ◽

Digital Subtraction ◽

Cervicothoracic Junction ◽

Spinal Arteriovenous Malformation

The authors report on a patient presenting with subarachnoid hemorrhage that was caused by a rupture of an spinal combined arteriovenous malformation at cervicothoracic junction. The patient was a 30-year-old female, who had exhibited an abrupt onset of severe low neck and occipital pain with radiation into shoulders and vomiting. Neurological examination revealed severe meningism without motor or sensory deficit. Digital subtraction angiography did not demonstrate any intracranial source of bleeding, whereas spinal angiography revealed a spinal arteriovenous malformation at cervicothoracic junction. Endovascular treatment of the malformation was considered for this patient. Occipital and neck pain with radiation into shoulders and severe meningism are clues pointing to a spinal origin of the haemorrhage.

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