Endovascular management of dissecting posterior cerebral artery aneurysm associated with persistent hypoglossal artery: A case report / Tratamento endovascular do aneurisma dissecante da artéria cerebral posterior associado à artéria hipoglossa persistente: relato de caso

Abstract Persistent embryological connections between the anterior and posterior circulations are rare entities. Persistent hypoglossal artery is the second most common persistent carotid-basilar anastomosis. As it is often associated with hypoplasia of vertebral arteries, it poses a challenge during endovascular interventions. We present a case of a 32-year-old woman who presented with occipital headache of four weeks' duration. Magnetic Resonance Angiography showed hypoplastic vertebral arteries with a persistent hypoglossal artery arising from the cervical segment of the left internal carotid artery and supplying the entire posterior circulation, associated with a dissecting aneurysm of the right posterior cerebral artery. Endovascular parent vessel occlusion was performed for the dissecting posterior cerebral artery aneurysm by navigating the guide catheter, microwire, and microcatheter through the persistent hypoglossal artery because the vertebral arteries were hypoplastic. Post-intervention, the patient did not develop any neurological deficit and was discharged in a stable condition.

Resumo Conexões embriológicas persistentes entre as circulações anterior e posterior são entidades raras. A artéria hipoglossa persistente é a segunda anastomose carotídeo-basilar persistente mais comum. Como está frequentemente associada à hipoplasia das artérias vertebrais, apresenta um desafio durante as intervenções endovasculares. Apresentamos o caso de uma mulher de 32 anos que apresentou cefaleia occipital com duração de quatro semanas. A angiografia por ressonância magnética mostrou artérias vertebrais hipoplásicas com artéria hipoglossa persistente surgindo do segmento cervical da artéria carótida interna esquerda e suprindo toda a circulação posterior com um aneurisma dissecante da artéria cerebral posterior direita. A oclusão endovascular do vaso parental foi realizada para o aneurisma da dissecção da artéria cerebral posterior pela passagem de cateter guia, microfio e microcateter pela artéria hipoglossa persistente, pois as artérias vertebrais eram hipoplásicas. Após a intervenção, a paciente não apresentou déficit neurológico e recebeu alta em uma condição estável.

Aneurismas del complejo arteria cerebral anterior / arteria comunicante anterior: resultados del tratamiento quirúrgico / Aneurysms of the anterior cerebral artery-anterior communicating artery complex: results of the surgical treatment

Los aneurismas del complejo arteria cerebral anterior-arteria comunicante anterior figuran entre los más frecuentes de localización intracraneal y, debido a su variabilidad anatómica y características hemodinámicas, constituyen un reto especial para cualquier esfuerzo terapéutico. Con el objetivo de caracterizarlos y evaluar los resultados del tratamiento quirúrgico de estas lesiones, se estudian los pacientes operados en el Servicio de Neurocirugía del Hospital Clinicoquirúrgico Hermanos Ameijeiras, entre enero de 1983 y agosto de 1998. Se observó que el 71,1 por ciento de la muestra egresó en excelente estado; el 13,44 por ciento, con secuelas mínimas; el 3,48 por ciento, con secuelas graves y que la mortalidad fue del 11,53 por ciento. Se concluye que estos aneurismas son más frecuentes en el sexo masculino, en la cuarta y quinta décadas de la vida (media de 39,9 años) y que el tamaño crítico de ruptura se ubica mayoritariamente entre 6 mm y 11 mm. De igual forma se observó que la edad, el tamaño sacular, el vasoespasmo y la ruptura transoperatoria influyen sobre los resultados y que la influencia de estas dos últimas complicaciones es muy fuerte. El infarto cerebral isquémico fue la causa de muerte más frecuente(AU)

The aneurismas of the complex artery cerebral previous communicating previous-artery figures among the most frequent in localization intracraneal and, due to their hemodynamic anatomical and characteristic variability, they constitute a special challenge for any therapeutic effort. With the objective of to characterize them and to evaluate the results of the surgical treatment of these lesions, the patients are studied operated in the Service of Neurosurgery of the Hospital Clinicoquirúrgico Siblings Ameijeiras, among January of 1983 and I wither of 1998. It was observed that 71,1 percent of the sample egresó in excellent state; 13,44 percent, with minimum sequels; 3,48 percent, with serious sequels and that the mortality was of 11,53 percent. You concludes that these aneurismas is more frequent in the masculine sex, in the fourth and fifth decades of the life (he/she mediates of 39,9 years) and that the critical size of rupture is located for the most part between 6 mm and 11 mm. Of equal he/she is formed he/she observed that the age, the size sacular, the vasoespasmo and the rupture transoperatoria influence on the results and that the influence of these last two complications is very strong. The infarto cerebral isquémico was the cause of more frequent death(AU)

Anatomía quirúrgica de la arteria vertebral, segmento distal intradural / Surgical anatomy of the vertebral artery, distal and intradural

La anatomía quirúrgica microvascular de las arterias vertebral (distal e intradural), póstero-cerebelosa inferior y de la unión vértebro-basilar es muy variable, por lo que es muy importante delinear algunas guías para la cirugía de aneurismas de estas localizaciones. La arteria vertebral izquierda es dominante, llevando un mayor aporte sanguíneo que la del lado derecho, ocasionando mayor incidencia de aneurismas de ese lado, con una mayor incidencia en mujeres (2:1). Revisamos la antatomía quirúrgica microvascular teniendo en mente el abordaje dorsolateral suboccipita ampliado. Palabras claves: anatomía quirúrgica, anatomía microvascular,arteria vertebral, arteria póstero-cerebelosa inferior, unión vértebro-basilar