Cohen José E, Gomori John M, Leker Ronen R
Department of Neurosurgery, Hadassah University Medical Center, Jerusalem, Israel.
Neurol Res. 2010 Dec;32(10):1027-32. doi: 10.1179/016164110X12767786356273. Epub 2010 Aug 16.
Internal carotid artery (ICA) agenesis has been usually reported as an asymptomatic condition in association with other congenital anomalies. However, it is less well described in the context of clinical neurological syndromes.
Five cases of ICA agenesis are reviewed. The diagnosis of ICA agenesis was based on the absence of bony carotid canal on computed tomography. Brain CT and magnetic resonance image (MRI) scans were done in all the patients and four vessels digital angiograms were obtained in two. Clinical presentation, coexistent radiological findings and associated abnormalities are reviewed.
The initial presentations were pulsatile tinnitus, ischemic stroke, migraine, Horner's syndrome, and subarachnoid hemorrhage. Collateral circulation was supplied via the posterior communicating artery and the anterior communicating artery. Ophthalmic artery was supplied by meningeal arteries. On CT, all cases demonstrated agenesis of the bony carotid canal. Smaller cavernous sinus were detected in all cases, enlargement of the foramen spinosum was found in three patients and hyper-pneumatization of the petrous apex was detected in two cases. In one patient a cerebral aneurysms was detected and treated with an endovascular approach. Other associated vascular abnormalities were aortic origin of the vertebral artery in two patients, ICA coiling in two cases and fenestration of basilar artery in one case.
ICA agenesis is usually asymptomatic but occasionally may be associated with ischemic stroke. Collateral supply is usually effective in preventing stroke but may become inefficient leading to ischemia. Associated anomalies such as cerebral aneurysms are commonly depicted on the same side as the ICA agenesis and may represent a potential life-threatening condition.
颈内动脉（ICA）发育不全通常被报道为与其他先天性异常相关的无症状情况。然而，在临床神经综合征背景下对其描述较少。
回顾了5例ICA发育不全病例。ICA发育不全的诊断基于计算机断层扫描显示无骨性颈动脉管。所有患者均进行了脑部CT和磁共振成像（MRI）扫描，其中2例进行了四血管数字血管造影。回顾了临床表现、并存的影像学表现及相关异常情况。
初始表现为搏动性耳鸣、缺血性卒中、偏头痛、霍纳综合征和蛛网膜下腔出血。通过后交通动脉和前交通动脉形成侧支循环。眼动脉由脑膜动脉供血。CT显示所有病例均无骨性颈动脉管。所有病例均检测到较小的海绵窦，3例患者发现棘孔扩大，2例患者发现岩尖气化过度。1例患者检测到脑动脉瘤并采用血管内治疗。其他相关血管异常包括2例患者椎动脉起源于主动脉、2例患者ICA迂曲和1例患者基底动脉开窗。
ICA发育不全通常无症状，但偶尔可能与缺血性卒中相关。侧支供血通常可有效预防卒中，但可能会变得无效而导致缺血。诸如脑动脉瘤等相关异常通常与ICA发育不全位于同一侧，可能代表一种潜在的危及生命的情况。
