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Brain and Nerve No to Shinkei Volume 56, Issue 3 （March 2004）

Brain and Nerve 脳と神経 56巻3号（2004年3月発行）

Japanese English

症例報告

内頸動脈から直接分岐した後下小脳動脈について－persistent primitive hypoglossal arteryの異型の1例－ The Posterior Inferior Cerebellar Artery Arising from the Internal Carotid Artery Directly : A Variant of the Persistent Primitive Hypoglossal Artery 中西愛彦 ¹ , 杉野敏之 ¹ , 森川和要 ¹ , 大川直澄 ¹ , 福住明夫 ² Naruhiko Nakanishi ¹ , Toshiyuki Sugino ¹ , Kazutoshi Morikawa ¹ , Naosumi Ohkawa ¹ , Akio Fukusumi ² ¹星ヶ丘厚生年金病院脳神経外科 ²星ヶ丘厚生年金病院放射線科 ¹Department of Neurosurgery, Hoshigaoka Kouseinenkin Hospital ²Department of Radiology, Hoshigaoka Kouseinenkin Hospital キーワード： variant of persistent primitive hypoglossal artery , posterior inferior cerebellar artery , carotid angiography , MR angiography Keyword: variant of persistent primitive hypoglossal artery , posterior inferior cerebellar artery , carotid angiography , MR angiography pp.253-257

発行日 2004年3月1日 Published Date 2004/3/1

DOI https://doi.org/10.11477/mf.1406100261

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Abstract 文献概要
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　要旨　内頸動脈から椎骨脳底動脈を経由することなく，直接に後下小脳動脈が造影された1例を経験した。症例は33歳男性で，頭痛の精査目的で入院した。MR angiography（MRA）と左内頸動脈造影で，左中大脳動脈分岐部に囊状動脈瘤を認めた。右頸動脈造影では，内頸動脈頭蓋外走行部から直接に後下小脳動脈が造影された。この血管は，MRA元画像の解析により舌下神経管内を通ることが確認されたので，persistent primitive hypoglossal arteryの異型と診断した。内頸動脈から胎生期遺残血管を介して脳底動脈および後頭蓋窩の動脈が造影されることはよく知られているが，椎骨脳底動脈を経由せずに直接に後下小脳動脈が造影される例はきわめて稀である。その発生過程について推察した。

　We reported a rare case of the posterior inferior cerebellar artery arising from the internal carotid artery directly.

　A 33-year-old male was admitted to our hospital with the complaint of throbbing type headache. CT showed no abnormal findings. A saccular aneurysm at the bifurcation of the left midlle cerebral artery was revealed by MR angiography and the left internal carotid angiography. The right internal carotid angiography demonstrated an anomalous branch originating at the level of the C1/2 in the cervical portion of the internal carotid artery. This branch terminated as the posterior inferior cerebellar artery without an interposed segment of the vertebro-basilar artery. The ipsilateral vertebral artery was aplasia. T2-weighted MR image showed a flow-void penetrating the right hypoglossal canal. This vessel was confirmed an artery passing through the hypoglossal canal with the source images of the three-dimensional time-of-flight MR angiography. We diagnosed it as a kind of variant of the persistent primitive hypoglossal artery.

　The persistent primitive hypoglossal artery is composed of the proximal segment derived from the primitive hypoglossal artery, and the distal segment consisting of portions of the lateral anastomotic channels （primitive lateral basilo-vertebral anastomosis） which give rise to the posterior inferior cerebellar artery. We speculated that this variant resulted from the persistence of the proximal segment, which communicated with the stem of the posterior inferior cerebellar artery via the distal segment, and next, the disconnection of the posterior inferior cerebellar artery origin with the vertebral artery due to the aplasia of right vertebral artery and the involution of the distal segment connected to the basilar artery.

（Received : January 15, 2004）