Anat Cell Biol.  2021 Sep;54(3):399-403. 10.5115/acb.21.093.

Rare anastomosis between the ascending pharyngeal and vertebral arteries via the hypoglossal canal: A cadaveric case report

• Bordes SJ
• Zarrintan S
• Iwanaga J
• Loukas M
• Dumont AS
• Tubbs RS

• KMID: 2521053
• DOI: http://doi.org/10.5115/acb.21.093

Abstract

We present a rare case of external carotid artery-vertebral artery anastomosis via the ascending pharyngeal artery, diagnosed upon cadaveric dissection. The ascending pharyngeal artery gave rise to a branch to the hypoglossal canal, which is a variation of a true persistent fetal hypoglossal artery. Knowledge of persistent carotid-vertebrobasilar anastomoses is important as these fetal vessels can contribute significantly to the posterior cerebral circulation. Only 10 cases of external carotid artery-vertebrobasilar artery anastomoses have been reported to our knowledge, and our case presents the first cadaveric dissection of this rare variation.

Keyword

Ascending pharyngeal artery; Persistent fetal hypoglossal artery; Hypoglossal artery; Hypoglossal canal; Vertebral artery

Figure

• 

  Fig. 1 The four persistent carotid-vertebrobasilar anastomoses.

• 

  Fig. 2 Variant anastomosis i.e., hypoglossal artery (arrows) between the ascending pharyngeal artery (APA) and ipsilateral vertebral artery (VA4) via the hypoglossal canal, which has been dissected open and the hypoglossal nerve (CNXII) reflected inferiorly. Note the internal carotid artery (ICA) with its proximal part to the left and its distal part to the right and reflected up. Also note the external carotid artery (ECA) and third segment of the vertebral artery (VA3). The left vertebral artery where the anastomosis is seen is shown giving off the posterior inferior cerebellar artery (PICA). The sympathetic trunk is elevated with suture and the pharyngeal branches of the ascending pharyngeal artery are shown at the green arrows.

• 

  Fig. 3 Zoomed in photo of Fig. 2. Note the hypoglossal artery (arrows) traveling from the ascending pharyngeal artery and joining the ipsilateral and intracranial vertebral artery. The left posterior inferior cerebellar artery (PICA) is shown arising from the vertebral artery (VA4) segment of the vertebral artery near the joining of the hypoglossal artery.

• 

  Fig. 4 The case reported herein following excision. PICA, posterior inferior cerebellar artery.

• 

  Fig. 5 Adult patient found to have a persistent hypoglossal artery (arrowhead) emerging from the hypoglossal canal on 3 dimensional reconstruction from a contrasted head and neck computed tomography. The vertical continuation of the vessel is the basilar artery.

• 

  Fig. 6 Hypoglossal artery (black arrows) arises from the right internal carotid artery (outlined white arrow). The right external carotid artery is indicated by the black arrowhead.

Reference

References

1. inivas MR Sr, Vedaraju KS, Manjappa BH, Nagaraj BR. 2016; Persistent primitive hypoglossal artery (PPHA) - a rare anomaly with literature review. J Clin Diagn Res. 10:TD13–4. DOI: 10.7860/JCDR/2016/15556.7116. PMID: 26894148. PMCID: PMC4740676.

2. Uchino A, Saito N, Okada Y, Kozawa E, Nishi N, Mizukoshi W, Inoue K, Nakajima R, Takahashi M. 2013; Persistent hypoglossal artery and its variants diagnosed by CT and MR angiography. Neuroradiology. 55:17–23. DOI: 10.1007/s00234-012-1074-0. PMID: 22821359.

3. Uchino A, Saito N, Kurita H. 2018; Anastomosis of the external carotid artery and the V3 segment of the vertebral artery (presumed persistent second cervical intersegmental artery) diagnosed by CT angiography. Surg Radiol Anat. 40:233–6. DOI: 10.1007/s00276-017-1906-z. PMID: 28765987.

4. Yamamoto R, Mori N, Nakae Y, Tanaka F, Johkura K. 2019; Anomalous anastomosis between the external carotid artery and vertebrobasilar artery via the hypoglossal canal: a case report and review of literature. Surg Radiol Anat. 41:849–52. DOI: 10.1007/s00276-019-02205-y. PMID: 30729985.

5. Brismar J. 1976; Persistent hypoglossal artery, diagnostic criteria. Report of a case. Acta Radiol Diagn (Stockh). 17:160–6. DOI: 10.1177/028418517601700204. PMID: 1274653.

6. Hacein-Bey L, Daniels DL, Ulmer JL, Mark LP, Smith MM, Strottmann JM, Brown D, Meyer GA, Wackym PA. 2002; The ascending pharyngeal artery: branches, anastomoses, and clinical significance. AJNR Am J Neuroradiol. 23:1246–56. PMID: 12169487. PMCID: PMC8185735.

7. Iwanaga J, Simonds E, Choi PJ, Oskouian RJ, Tubbs RS. 2018; Anatomical study of the posterior ascending artery: application to C2 pedicle screw placement. World Neurosurg. 112:e662–5. DOI: 10.1016/j.wneu.2018.01.118. PMID: 29374610.

8. Uchino A, Saito N. 2011; Persistent hypoglossal artery arising from the external carotid artery diagnosed by MR angiography. Surg Radiol Anat. 33:543–5. DOI: 10.1007/s00276-010-0769-3. PMID: 21203762.

9. Lasjaunias P, Théron J, Moret J. 1978; The occipital artery. Anatomy-normal arteriographic aspects-embryological significance. Neuroradiology. 15:31–7. DOI: 10.1007/BF00327443. PMID: 643171.

10. Okahara M, Kiyosue H, Mori H, Tanoue S, Sainou M, Nagatomi H. 2002; Anatomic variations of the cerebral arteries and their embryology: a pictorial review. Eur Radiol. 12:2548–61. DOI: 10.1007/s00330-001-1286-x. PMID: 12271398.

11. Ascher E, Hingorani A, Markevich N, Schutzer R, Yorkovich WR, Kallakuri S, Tsemekhim B. 2003; Carotid surgery without external carotid endarterectomy: a 6-year clinical experience with 1027 cases. Eur J Vasc Endovasc Surg. 25:458–61. DOI: 10.1053/ejvs.2002.1867. PMID: 12713786.

12. Iwanaga J, Singh V, Ohtsuka A, Hwang Y, Kim HJ, Moryś J, Ravi KS, Ribatti D, Trainor PA, Sañudo JR, Apaydin N, Şengül G, Albertine KH, Walocha JA, Loukas M, Duparc F, Paulsen F, Del Sol M, Adds P, Hegazy A, Tubbs RS. 2021; Acknowledging the use of human cadaveric tissues in research papers: recommendations from anatomical journal editors. Clin Anat. 34:2–4. DOI: 10.1002/ca.23671. PMID: 32808702.