Ikedo Taichi, Itazu Takaaki, Imamura Hirotoshi, Inoue Yuto, Tabata Shinya, Shimonaga Koji, Hamano Eika, Yamada Kiyofumi, Mori Hisae, Iihara Koji, Kataoka Hiroharu
Department of Neurosurgery, Kyoto University, Kyoto, Japan.
Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Surg Neurol Int. 2025 May 16;16:185. doi: 10.25259/SNI_195_2025. eCollection 2025.
The primitive lateral basilovertebral anastomosis (PLBA) is a transient embryonic vessel in the vertebrobasilar system that typically regresses during cerebellar artery development. Persistent PLBA (PPLBA), which forms a vertebrobasilar duplication, is a rare vascular anomaly. This is the first reported case of multiple fusiform aneurysms associated with a PPLBA.
A 14-year-old girl was diagnosed with intracranial aneurysms before undergoing coronary artery bypass grafting surgery for myocardial infarction. Digital subtraction angiography showed two fusiform aneurysms on a PPLBA, connecting the left vertebral artery (VA) and the left anterior inferior cerebellar artery (AICA). After 3 years of follow-up, a new aneurysm developed at the origin of the PPLBA, proximal to the existing two aneurysms. Due to the AICA blood flow originating mainly from the basilar artery (BA) rather than the PPLBA, endovascular parent artery occlusion of the PPLBA was planned to prevent aneurysmal rupture and subarachnoid hemorrhage. Complete occlusion of all three aneurysms was achieved without complications.
Understanding the embryological anatomy of this rare vertebrobasilar duplication involving the PPLBA, AICA, BA, and VA facilitated the successful development of a therapeutic strategy. Aneurysms associated with PPLBA exhibit various vascular structures and can be treated effectively with tailored endovascular approaches.
原始外侧基底椎动脉吻合支（PLBA）是椎基底动脉系统中的一条短暂胚胎血管，通常在小脑动脉发育过程中退化。持续存在的PLBA（PPLBA）会形成椎基底动脉重复，是一种罕见的血管异常。这是首例报道的与PPLBA相关的多发梭形动脉瘤病例。
一名14岁女孩在因心肌梗死接受冠状动脉搭桥手术前被诊断出患有颅内动脉瘤。数字减影血管造影显示PPLBA上有两个梭形动脉瘤，连接左椎动脉（VA）和左小脑前下动脉（AICA）。经过3年随访，在PPLBA的起始处，即现有两个动脉瘤的近端，出现了一个新的动脉瘤。由于AICA血流主要起源于基底动脉（BA）而非PPLBA，计划对PPLBA进行血管内母动脉闭塞术，以预防动脉瘤破裂和蛛网膜下腔出血。成功实现了所有三个动脉瘤的完全闭塞，且无并发症发生。
了解这种涉及PPLBA、AICA、BA和VA的罕见椎基底动脉重复的胚胎解剖结构，有助于成功制定治疗策略。与PPLBA相关的动脉瘤表现出各种血管结构，采用定制的血管内治疗方法可有效治疗。
