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R. Shane Tubbs, Andrew J. DeNardo, and Aaron A. Cohen-Gadol

Intercavernous communication between the left and right internal carotid arteries is an uncommon entity. The authors report a case involving a pediatric patient who was found to have such a vascular anomaly. Such variations should be known by the neurosurgeon so as to avoid misdiagnosis and potential iatrogenic injury.

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Nobuyuki Genkai, Kouichirou Okamoto, Toshiharu Nomura, and Hiroshi Abe

aneurysms associated with a partial vertebrobasilar duplication or a PPHA have been reported; however, case reports focusing on the origin of the ASA and endovascular treatment of ruptured aneurysms in association with both vascular variations are extremely limited. Lessons The primitive trigeminal artery (PTA), primitive otic or acoustic artery (POA), primitive hypoglossal artery (PHA), and proatlantal intersegmental artery (ProA) are persistent fetal anastomoses existing between the carotid and vertebrobasilar arteries. 1 , 4–6 These emerge at the 4- to 5-mm

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Takashi Yoshimoto and Jiro Suzuki

Saltzman 4, 5 described a distinct pathological entity characterized histologically by large medial defects plus occasional defects in the internal elastic membrane; they concluded that the structure is either an aneurysmal or preaneurysmal lesion. On the contrary, some authors have concluded on the basis of histological studies that a small bulge is a normal vascular variation. 2 Documentation of the transition of the funnel-shaped bulge into a larger aneurysm, and its subsequent rupture, is rare. 1, 11, 13 All reported cases have been bilateral posterior

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Fred Epstein, Joseph Ransohoff, and Gleb N. Budzilovich

responsible for the bleeding. On the basis of our study, we believe that (as defined by the accepted radiological criteria) the junctional dilatation is a normal vascular variation. Although medial defects admittedly may be found in some instances, these need not be considered necessarily pathological or a site of predilection for aneurysm formation. Indeed, Glynn 2 in 1940 found medial defects in 80% of the bifurcations he examined. He also showed that the unsupported elements of the vessel wall are capable of withstanding pressures of 600 mm of mercury without bulging

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Daniel J. Blizzard, Michael A. Gallizzi, Robert E. Isaacs, and Christopher R. Brown

variations: angiographic evaluation of 855 consecutive patients . Diagn Interv Radiol 12 : 183 – 186 , 2006 8 Patel VC , Park DK , Herkowitz HN : Lateral transpsoas fusion: indications and outcomes . ScientificWorldJournal 2012 : 893608 , 2012 9 Praveen Kumar M , Suseelamma D , Saritha S , Lingaswamy V : Multiple renal vascular variations . Open Access Sci Rep 1 : 1 – 2 , 2012 10 Rao TR : Aberrant renal arteries and its clinical significance: a case report . Int J Anat Var 4 : 37 – 39 , 2011 11 Rodgers WB , Gerber EJ

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Heinz Fankhauser, Shuji Kamano, Tetsu Hanamura, Kazuyoshi Amano, and Hiroshi Hatanaka

direct relation with the vascular abnormality was considered unlikely. A tentative diagnosis of infarction or intramedullary hemorrhage was made. Although these lesions are rare in a young person, spinal cord infarction in children subject to minor trauma has been described. 1 The abnormally low origin of the PICA, as with many other vascular variations, probably has no significance in disease. Its neurosurgical importance lies in the fact that it can easily be injured during lateral cervical puncture or high laminectomy. References 1. Ahmann PA

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Howard Yonas, Sue Patre, and Robert J. White

bifurcation that congenitally lacked an internal elastica. The anomalous bridging vessel we have observed, although rare, is not unique. In 1907, Blackburn 1 noted a similar conformation in his study of the cerebral vascular variations of 220 insane patients. He reported that the anterior spinal artery “‘occasionally takes its origin’ from a short transverse trunk joining the two vertebrals.” The embryological explanation for this anomaly is found in the study of the 7- to 12-mm fetus. According to Padget, 10 the midline basilar and anterior spinal arteries are

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Birgitta K. Velthuis, Maarten S. van Leeuwen, Theodoor D. Witkamp, Lino M. P. Ramos, Jan Willem Berkelbach van der Sprenkel, and Gabriël J. E. Rinkel

hemorrhage. Neurosurgery 41 : 522 – 528 , 1997 Anderson GB, Findlay JM, Steinke DE, et al: Experience with computed tomographic angiography for the detection of intracranial aneurysms in the setting of acute subarachnoid hemorrhage. Neurosurgery 41: 522–528, 1997 5. Aydin IH , Takçi E , Kadioglu HH , et al : Vascular variations associated with anterior communicating artery aneurysms-an intraoperative study. Minim Invas Neurosurg 40 : 17 – 21 , 1997 Aydin IH, Takçi E, Kadioglu HH, et al: Vascular

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Toru Horikoshi, Iwao Akiyama, Zentaro Yamagata, Masao Sugita, and Hideaki Nukui

–1850, 2000 3. Aydin IH , Takci E , Kadioglu HH , et al : Vascular variations associated with anterior communicating artery aneurysms—an intraoperative study. Minim Invasive Neurosurg 40 : 17 – 21 , 1997 Aydin IH, Takci E, Kadioglu HH, et al: Vascular variations associated with anterior communicating artery aneurysms—an intraoperative study. Minim Invasive Neurosurg 40: 17–21, 1997 4. Barboriak DP , Provenzale JM : Pictorial review: magnetic resonance angiography of arterial variants at the Circle

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Taiki Isaji, Muneyoshi Yasuda, Reo Kawaguchi, Masahiro Aoyama, Aichi Niwa, Takahiro Nakura, Naoki Matsuo, and Masakazu Takayasu

that VA variations are not associated with the presence of PP. For safe dissection and instrumentation in patients with a PP, we do not have to worry too much about vascular variation and can simply focus on osseous structures, as in the general population. Conclusions We studied 142 consecutive patients who underwent 3D CTA to investigate anatomical variations in the VA and atlas. PICAs from the V 3 segment of the VA in the atlantooccipital space were the most common and were found to be more common on the nondominant VA. Three-dimensional CTA is the diagnostic