JNET 3:39-41, 2009 Image of the Issue

Persistent primitive dorsal ophthalmic associated with paraclinoid aneurysm

Michihiro TANAKA1)

1) Department of Neurosurgery, Kameda Medical Center

＜Corresponding Address : Department of Neurosurgery Kameda Medical Center,  Higashi-cho Kamogawa city Chiba E-mail: [email protected]＞ Received March ,  : Accepted January , 

Embryogenesis of the OA is highly complex, and atypical Fig. 1 . This aneurysm was located on the anterior clinoid origin of the OA has been considered rare,,, . The author process. Left internal carotid angiography showed that the illustrates a case of a persistent primitive dorsal ophthalmic ophthalmic artery OA arose from the intracavernous artery DOA associated with a paraclinoid internal carotid portion of the ICA and entered the orbital cavity via the artery ICA aneurysm and discusses the embryology of the superior orbital fissure SOF . This was also confirmed with OA. high resolution multi detector CT and could be recognized as a persistent of the ILT infero lateral trunk . Case Illustration Discussion Case: A -year-old woman presented with a coincidental unruptured asymptomatic aneurysm originating from the left According to Padget , a branch of the ICA, called the supero-lateral wall of the supraclinoid segment of the ICA primitive DOA, emerges in the sequential development of the

Fig. 1 Digital subtraction angiography lateral view, left and D rotation angiography oblique view, right showing that the ophthalmic artery comes from the intracavernous portion of the ICA and runs through the SOF. Note the atypical origin and course of the ophthalmic artery.

JNET Vol.3 No.1 May 2009 39 Tanaka M.

A1 M I

VOA

SOF SOF

DOA（ILT in adult） DOA（ILT in adult） A B C illustrated case Fig. 2 Schematic representation of regression of the VOA and persistent DOA A： The proximal part of the VOA disappears rapidly at the -mm stage of the embryo, and the vessel then arises from the ICA, as in the adult configuration. B： This is the normal development and configuration of the DOA and the adult type of the OA.The DOA regresses dotted line and becomes the infero lateral trunk ILT . C：Schematic representation of the illustrated case.

cerebral arterial vasculature of an embryo/fetus at -mm At the -mm stage of the embryo, the anastomosis is crown-rump length. The consists of three components: completed, and the adult configuration of the OA becomes first is the peripheral nervous system , second is the identifiable. Until this stage, the primitive OA starts to central nervous system , and third are the assimilate the supraorbital branch of the stapedial artery. muscles and glands periorbital structures . The blood This branch not only supplies the intraorbital extraocular supplies to these components reflect their different contents, but also plays a role in the formation of the middle natures,,,, . meningeal artery MMA ,, . Vascularization of the optic cup is derived from two The origin of the OA from the ACA,, , the ICA branches of the primitive ICA, called the primitive ventral bifurcation , or double OAs originating from the same ICA ophthalmic VOA and the DOA. The VOA arises can be explained with relative ease by the stages before the from the future anterior cerebral artery ACA , and the formation of the primitive OA Fig. 2B . Similarly, the OA DOA arises from the carotid siphon, . Later, these arteries arising from the MMA, which is the most frequently reported anastomose near the optic nerve. The VOA makes an variation , the MMA arising from the OA , the OA arising additional anastomosis with the supracavernous portion of the from the basilar artery and the persistent loop of the ICA, ICA,,, . MMA, and OA can be explained by the role of the stapedial At the  mm stage, these two arteries supply the orbit. artery and the primitive trigeminal artery,, . The VOA from the ACA through the optic canal gives off the In normal development, the proximal part of the VOA and the nasal ciliary artery, and the disappears rapidly, and the vessel then arises from the ICA, other DOA from the ICA carotid siphon via the SOF gives as in the adult configuration. Finally, the DOA regresses and off the temporociliary artery Fig. 2 . become ILT at the SOF. Although the embryology of the OA This final configuration gives rise to the primitive is complex, it provides an insight into understanding the ophthalmic artery POA , . When the embryo reaches  variations of the OA. mm, the stapedial artery, which arises from the primitive hyoidal branch of the petrous ICA, gives rise to the maxillo- References ,, facial and supraorbital branches . When the embryo 㧛） Al-Qahtani S, Tampieri D, Brassard R: Coil Embolization reaches  mm, the supraorbital branch of the stapedial of an Aneurysm Associated with an Infraoptic Anterior artery forms an anastomosis with the primitive future Cerebral Artery in a Child. AJNR :, . permanent OA. 㧜） Hamada J, Kitamura I, Kurino M, et al: Abnormal origin of

40 JNET Vol.3 No.1 May 2009 Tanaka M.

bilateral ophthalmic arteries. J Neurosurg :, ） Nutik S, Dilenge D: Carotid-anterior cerebral artery . anastomosis: case report. J Neurosurg :, . 㧝） Hassler W, Zentner J, Voigt K: Abnormal origin of the ） Ogawa T, Miyauchi T, Kato T, et al: Internal carotid origin ophthalmic artery from the anterior cerebral artery: of double ophthalmic arteries. Neuroradiology :, neuroradiological and intraoperative fi ndings. Neuroradiology . :, . ） Padget DH: The development of the cranial arteries in the 㧞） Komiyama M: Functional Anatomy of the Brain and Spinal human embryo. Contrib Embryol :, . Vessels. Osaka, Medica Shuppan, , . ） Robinson LR: An unusual human anterior cerebral artery. 㧟） Lasjaunias P, Berenstein A, ter Brugge KG: Surgical J Anat :, . Neuroangiography , Clinical Vascular Anatomy and ） Sade B, Tampieri D, Mohr G: Ophthalmic Artery Variations, Springer-Verlag, nd ed, . Originating from Basilar Artery: A Rare Variant. AJNR 㧠） Lasjaunias P, Moret J, Mink J: The anatomy of the :, . inferolateral trunk ILT of the internal carotid artery. ） Spinnato S, Pasqualin A, Chioffi F, et al: Infraoptic course Neuroradiology :, . of the anterior cerebral artery associated with an anterior 㧡） Matsumura Y, Nagashima M: Anatomical variations in the communicating artery aneurysm: anatomic case report and origin of the human ophthalmic artery with special reference embryological considerations. Neurosurgery :, to the and surrounding meninges. Cells Tissues . Organs :, . ） Vignaud J, Hasso AN, Lasjaunias P, et al: Orbital vascular 㧢） Mayer PL, Kiev EL: The ontogenic and phylogenetic basis anatomy and embryology. Radiology :, . of cerebrovascular anomalies and variants. Apuzzo MLJ ） Willinsky R, Lasjaunias P, Berenstein A: Intracavernous ed, Brain Surgery. Vol . New York, Churchill Livingstone, branches of the internal carotid artery ICA : comprehensive , . review of their variations. Surg Radiol Anat :, 㧣）Newton TH, Potts DG: Radiology of the Skull and Brain. . St. Louis, Mosby, , .

JNET Vol.3 No.1 May 2009 41