PMC8336981_01
Diagnosis of the dissecting aneurysm of the right posterior cerebral artery associated with persistent hypoglossal artery. a) Maximum intensity projection magnetic resonance angiogram image showing a dissecting aneurysm involving the P2-P3 segment of the right posterior cerebral artery (white arrow). A persistent hypoglossal artery (blue arrow) is noted medial to the left internal carotid artery (black arrow) and joining the basilar trunk. b) Lateral maximum intensity projection magnetic resonance angiogram showing the persistent hypoglossal artery (white arrow) arising from the dorsal aspect of the left internal carotid artery (black arrow). c) Axial magnetic resonance angiogram section at the level of the hypoglossal canal showing the persistent hypoglossal artery (white arrow) traversing the left hypoglossal canal. d) Maximum intensity projection magnetic resonance angiogram of the neck showing bilateral hypoplasia of vertebral arteries (black arrows).
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Magnetic Resonance Imaging (MRI) showed evidence of an aneurysm, 2.1 x 1.5 cm in size, involving the right posterior cerebral artery at the P2-P3 junction (Figure 1A). An anomalous vascular channel was found to arise from the left cervical internal carotid artery at the C1-C2 junction (Figure 1B), coursing through the left hypoglossal canal along with the hypoglossal nerve (Figure 1C). Vertebral arteries were found to be hypoplastic bilaterally (Figure 1D).
Endovascular approach through the persistent hypoglossal artery for occlusion of the right P2-P3 segment. a) Digital subtraction angiogram with the guide catheter in the left internal carotid artery (white arrow) showing the persistent hypoglossal artery (blue arrow) arising from the cervical segment of the left internal carotid artery and supplying the posterior circulation. A dissecting aneurysm (black arrow) is noted involving the P2-P3 segment of the right posterior cerebral artery with narrowing of the segment proximal to the aneurysm. b) Digital subtraction angiogram with guide catheter in the persistent hypoglossal artery (white arrow). The microcatheter (black arrow) was navigated through the PHA into the right posterior cerebral artery to reach the desired location for parent artery occlusion. c) Parent artery occlusion of the P2-P3 segment of the right posterior cerebral artery with coils (black arrow). No residual filling of the aneurysm is seen. d) Maximum intensity projection of the magnetic resonance angiogram showing no residual filling of the aneurysm with occlusion of the P2-P3 segment of the right posterior cerebral artery (black arrow).
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Angiogram was obtained, showing an aneurysm involving the right P2-P3 posterior cerebral artery with proximal narrowed segment (pearl and string sign) suggestive of dissecting aneurysm (Figure 2A). An excelsior SL-10 straight tip microcatheter (Stryker Neurovascular, USA) was taken over synchro 0.014" microwire (Stryker Neurovascular, USA) and the right posterior cerebral artery was cannulated (Figure 2B). There was normal filling of other arteries of the posterior circulation (Figure 2C and 2D).