Primitive Vertebrobasilar System Associated with a Ruptured Aneurysm
Kenji Yagia,
Koichi Satoha,
Junichiro Satomia and
Shinji Nagahiroa
a From the Department of Neurosurgery, School of Medicine, University of Tokushima, Tokushima, Japan
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FIG 1. Left vertebral angiogram, lateral view. The left VA terminates at the PICA.
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FIG 2. Right vertebral angiogram.
A, Early arterial phase.
B, Late arterial phase.
No normal vertebrobasilar junction is visualized. The BA is fed only via the PPLVB anastomosis. Flow is into the upper and lower BA via the BA-PPLVB anastomosis jointure. Note the saccular aneurysm at the left basilar anterior inferior cerebellar artery.
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FIG 3. Schematic representation of the vertebrobasilar system. The arrows indicate the anomalous flow. The PPLVB anastomosis supplies most of the basilar artery flow with some flow delivered by anomalous, thin, hypoplastic arteries (asterisk).
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FIG 4. Right vertebral angiogram depicting the vertebrobasilar system.
A, Digital subtraction angiogram in the anteroposterior view.
B, Three-dimensional angiograms in the left posterolateral oblique and posteroanterior view. Note the two indirect connections between the BA and the left VA, one through the PPLVB anastomosis, and the other through thin, serpentine arteries.
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FIG 5. Schema of fenestration or duplication in intracranial vertebrobasilar systems.
A, Basilar fenestration.
B, Duplication of the VA.
C, Premedullary duplication of the VA.
D, PPLVB anastomosis.
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AJNR - American Journal of Neuroradiology