Posterior Inferior Cerebellar Artery Supplied by the Jugular Branch of the Ascending Pharyngeal Artery Diagnosed by MR Angiography: Report of Two Cases

Abstract

The posterior inferior cerebellar artery (PICA) is extremely rarely supplied by the artery passing through the hypoglossal canal. This anomalous artery can arise from the cervical internal carotid artery or ascending pharyngeal artery (APA). We present what we believe is the first report of PICA supplied by the jugular branch of the APA that passes through the medial side of the jugular foramen pars vascularis, diagnosed using magnetic resonance angiography. To avoid ischemic brain complications during head and neck surgeries and interventional radiologic procedures, preoperative recognition of anomalously originating pial arteries from the APA is important.

Anomalous origin of the posterior inferior cerebellar artery from the jugular branch of the ascending pharyngeal artery: A case report

“…Although abnormalities in which the PICA originates from the hypoglossal branch of the APA are considered variants of the PHA [ 6 ], our patient had anastomosis between the APA and the PICA via the jugular foramen. This has been previously described in only one prior report [ 8 ]. Uchino and Suzuki considered that this variant was formed because of the anastomosis between the posterior meningeal artery (PMA) and the PICA [ 8 ].…”

“…This has been previously described in only one prior report [ 8 ]. Uchino and Suzuki considered that this variant was formed because of the anastomosis between the posterior meningeal artery (PMA) and the PICA [ 8 ]. The PMA usually arises from the VA but occasionally from the hypoglossal or jugular branches of the APA [ 2 ].…”

Posterior Inferior Cerebellar Artery Originating from the Jugular Branch of the Ascending Pharyngeal Artery

“…6,7) The variation in which the PICA originates from the jugular branch of the APA, as seen in the present case, has only been reported in three previous cases in the literature. 8,9) This variation seems to have a different embryological background to the primitive hypoglossal artery variant, as the vessel does not pass through the hypoglossal canal. Uchino et al 8) suggested that this variant vessel was established due to the complementation between the meningeal vessels arising from the APA and those of the vertebral artery, and because anastomosis can develop between the meningeal vessels and the PICA as a pial vessel.…”

Novel Vascular Anastomoses and Moyamoya Disease in a Woman with Down Syndrome

“…First, though it is exceedingly rare to have the PICA supplied by the jugular branch of the APA, this is the first reported case with an ICA origin of that APA. 1,2 The fact that both PICAs in this patient originate from the anterior circulation should remind clinicians that in unexplained posterior circulation infarctions, vascular anatomy should be explored, as carotid-vertebrobasilar anastomoses such as these are rare, but possible. Lastly, the conjunction of moyamoya disease and anomalies of the vertebrobasilar system in a patient with Down syndrome raises interesting questions about the influence of trisomy 21 on the developing vasculature.…”