Persistent Nonfused Segments of the Basilar Artery: Longitudinal versus Axial Nonfusion
Brian L. Hoha,b,
James D. Rabinova,
Johnny C. Pryora,
Joshua A. Hirscha,
Elizabeth C. Doolingc and
Christopher S. Ogilvyb
a Endovascular Neurosurgery and Interventional Neuroradiology Service, Departments of Neurosurgery and Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
b Cerebrovascular Surgery Service, Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
c Pediatric Neurology Service, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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FIG 1. Patient 1 (longitudinal nonfusion of basilar artery), a 3-year-old boy who presented with generalized tonic-clonic seizure.
A, Consecutive axial images of T2-weighted brain MR imaging study demonstrate the two flow voids of the separate nonfused duplicated basilar arteries.
B, Two-dimensional time-of-flight reconstructions of MRA demonstrate the two separate nonfused duplicated basilar arteries.
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FIG 2. Patient 2 (axial nonfusion of basilar artery), a 43-year-old man who presented with transient episodes of vertigo, tongue numbness, and diplopia.
A, Two-dimensional time-of-flight reconstructions of MRA demonstrate signal intensity dropout at the basilar artery trunk. This was originally interpreted as basilar artery stenosis.
B, Lateral projection left vertebral artery injection DSA demonstrates the left vertebral artery terminates in the left posterior inferior cerebellar artery.
C, Lateral projection right vertebral artery injection DSA demonstrates that the right vertebral artery terminates in the right posterior inferior cerebellar artery.
D, Anteroposterior projection, and E, lateral projection right internal carotid artery injection DSA, demonstrate the separate nonfused midbasilar trunk segment supplying the bilateral anterior inferior cerebellar arteries and bilateral superior cerebellar arteries and supplied via a persistent trigeminal remnant artery. There is a fetal origin right posterior cerebral artery, which supplies a separate distal basilar segment.
F, Lateral projection left common carotid artery injection DSA demonstrates the fetal origin left posterior cerebral artery.
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