PMC5405127_01
(A) Three-dimensional reconstruction of computed tomography angiography showing an aneurysm located at the bifurcation of the right persistent primitive hypoglossal artery (PPHA) and two posterior cerebral arteries (black arrow), and the right PPHA entering the skull via the right hypoglossal canal (blue arrow) and supplying the circle of Willis. (B) Digital subtraction arteriogram of the right common carotid artery (CCA) showing the PPHA (black arrow) originating from the CCA and an aneurysm in the apex (blue arrow). The right internal carotid artery was absent.
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F1
CT angiography and digital subtraction arteriogram revealed a broad-neck basilar bifurcation aneurysm and the presence of a PPHA originating from the right common carotid artery, turning posterior, entering the skull through the hypoglossal canal, and extending as the basilar artery (Figure 1).
(A) Digital subtraction arteriogram (DSA) of the aortic arch showing the hypoplasia of both vertebral arteries (arrows). (B) Lateral view of DSA of the left common carotid artery showing the hypoplasia of the left internal carotid artery at the initial segment (black arrow) and occlusion above the beginning of the left ophthalmic artery (blue arrow). (C) DSA of the left subclavian artery showing the hypoplasia of the left vertebral artery (arrow). (D) Lateral view of DSA showing the occlusion of the left vertebral artery above the beginning of posterior meningeal artery (arrow).
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F2
The right internal carotid artery (ICA) was absent, while the left ICA was occlusive above the beginning of the left ophthalmic artery (Figure 2).
Digital subtraction arteriogram of the right common carotid artery showing the aneurysm was completely clipped.
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F3
Finally, the aneurysm was clipped successfully (Figure 3).