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Persistent primitive hypoglossal artery aneurysms--report of two cases
S Yamamoto1, I Sunada, Y Matsuoka
1Department of Neurosurgery, Yamamoto Daisan Hospital, Osaka.
Neurologia Medico-Chirurgica
|April 1, 1991
Summary
Ruptured intracranial aneurysms from the persistent primitive hypoglossal artery are rare. Surgical approaches may be challenging due to anatomical variations, requiring tailored techniques for successful aneurysm clipping.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Cerebrovascular Surgery
Background:
- Persistent primitive hypoglossal artery (PPHA) is a rare embryological variant.
- Ruptured saccular aneurysms arising from PPHA are exceptionally uncommon and pose significant surgical challenges.
- Subarachnoid hemorrhage (SAH) necessitates prompt and effective treatment.
Observation:
- Two patients presented with SAH due to ruptured PPHA aneurysms.
- A standard unilateral suboccipital approach was insufficient in one case due to a prominent jugular tubercle obstructing the surgical field.
- An extended unilateral-transcondylar-suboccipital approach, including jugular tubercle resection, facilitated successful clipping in the second patient.
Findings:
- The anatomical constraints posed by the jugular tubercle can impede standard surgical access to PPHA aneurysms.
- A modified surgical technique involving bone resection (jugular tubercle and foramen magnum rim) can overcome these limitations.
- Successful obliteration of PPHA aneurysms is achievable with tailored surgical strategies.
Implications:
- This case series highlights the importance of considering anatomical variations in surgical planning for PPHA aneurysms.
- Modified surgical approaches may be necessary for complex intracranial aneurysms.
- Improved understanding of surgical nuances can enhance outcomes for rare cerebrovascular pathologies.