Anomalous anastomosis between the external carotid artery and vertebrobasilar artery via the hypoglossal canal: a case report and review of literature

We report a case of an anomalous anastomosis formed between the external carotid artery (ECA) and the vertebrobasilar artery (VBA) and passing through the hypoglossal canal. A carotid–vertebrobasilar anastomosis of this kind is typically considered a variant of persistent primitive hypoglossal artery which usually originates from the internal carotid artery. However, the anastomotic vessel in this case had a common trunk with the occipital artery (OA), a remnant of the primitive proatlantal artery. The proximal and distal parts of the anastomotic vessel seemed to have been derived from the primitive proatlantal artery and the primitive hypoglossal artery, respectively. Thus, we propose that this ECA–VBA anastomosis, which passed through the hypoglossal canal and had a common trunk with the OA, be referred to as a dilated primitive hypoglossal–proatlantal anastomosis; that is, a dilated ascending pharyngeal artery rather than a variant of persistent primitive hypoglossal artery.