Department of Radiology, Saitama Sekishinkai Hospital, 2-37-20 Irumagawa, Sayama, Saitama, 350-1305, Japan.
Neuroscience Center, Suzuki Neurosurgical Clinic, 2082, Kasahata, Kawagoe, Saitama, 350- 1175, Japan.
Surg Radiol Anat. 2024 Nov;46(11):1783-1788. doi: 10.1007/s00276-024-03478-8. Epub 2024 Sep 18.
To describe a case of an anomalous posterosuperior course of the V3 segment of the right vertebral artery (VA) that penetrated the occipital bone (wall of the jugular foramen).
A 33-year-old healthy woman underwent cranial magnetic resonance (MR) imaging and MR angiography from the upper cervical to the intracranial region using a 3-Tesla scanner to screen for asymptomatic brain lesions, including cerebrovascular diseases.
MR angiography showed no pathological arterial lesions such as aneurysms; however, there was an anomalous posterosuperior course of the V3 segment of the right VA. On MR angiographic source images and coronal reformatted images, the right VA was observed to penetrate the occipital bone lateral to the right hypoglossal canal and is located on the inferoposteromedial wall of the right jugular foramen and enter the posterior fossa at a higher level than the foramen magnum.
We present a case in which the right VA showed an anomalous posterosuperior course at the craniovertebral junction. It is extremely rare for a VA to take a higher course. To our knowledge, this is the first report of such a VA variation in the relevant English-language literature. We speculated that the right VA of our patient was formed by the persistence of one more cephalad primitive artery than the first intersegmental artery, not by the persistence of the primitive hypoglossal artery. Careful observation of MR angiographic source is useful and important for identifying the VA penetrating the occipital bone.
描述一例右侧椎动脉（VA）V3 段后上异常走行，穿透枕骨（颈静脉孔壁）。
一名 33 岁健康女性，使用 3.0T 磁共振扫描仪进行颅颈至颅内区域的头颅磁共振成像和磁共振血管成像，以筛查无症状性脑病变，包括脑血管疾病。
磁共振血管成像未显示动脉瘤等病理性动脉病变；然而，右侧 VA V3 段存在后上异常走行。在磁共振血管成像原始图像和冠状位重建图像上，观察到右侧 VA 穿过右侧舌下神经管外侧的枕骨，位于右侧颈静脉孔后下内侧壁，进入颅后窝的水平高于枕骨大孔。
我们报告一例颅颈交界处右侧 VA 出现异常后上走行。VA 走行较高极为罕见。据我们所知，这是相关英文文献中首例此类 VA 变异的报道。我们推测，患者右侧 VA 是由比第一节间动脉更多的一个颅侧原始动脉形成的，而不是由原始舌下动脉形成的。仔细观察磁共振血管成像原始图像对于识别穿透枕骨的 VA 非常有用和重要。
