Bypass anomaly of the vertebral artery associated with cerebral aneurysm and arteriovenous malformation

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✓ In a series of 1107 patients with cerebrovascular disease studied by four-vessel angiography, the authors have found 10 cases of a bypass anomaly of the vertebral artery. Six of the cases also had cerebral aneurysms, and two cerebral arteriovenous malformations. The authors discuss the possible origins for this relationship.

Article Information

Address reprint requests to: Tahashi Tomita, M.D., Department of Neurosurgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.

© AANS, except where prohibited by US copyright law.

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Figures

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    Case 1. Upper Left: Right carotid angiogram showing a saccular aneurysm of the anterior communicating artery (arrow). Lower Left and Right: Left brachial angiograms reveal the bypass formation anomaly. Arrow points to the original vertebral artery.

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    Case 3. Right brachial angiogram showing bypass formation anomaly from the atlas into the skull. The original vertebral artery (large arrow), an aneurysm of the right internal carotid artery (upper arrow), and the posterior inferior cerebellar artery (lower arrow) are also shown.

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    Case 9. Left brachial angiogram shows a small bypass formation anomally, the so-called “Insel Bildung” (arrow).

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    Drawing of bypass formation anomaly (from posterior view) showing the original vertebral artery (arrow).

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    Left: Schema of development of embryonic artery at 28 days (5.5 mm). No vertical artery has developed; the cervical intersegmental arteries are given off from the paired arota (after Padget). Right: Embryonic artery at 32 days (9 mm). The vertebral artery has developed from the cervical intersegmental arteries, which represent bilateral longitudinal neural arteries (after Padget).

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