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jtL\’, 1973



LTHOUGH there have been numerous with 8 mm. by 6 mm. measurements of the
reported cases of persistence of the right canal. Ihle rim was smooth and sclerotic.

primitive hs’poglossal artery,7 there is little A reversed Stenvers series obtained during

information to be found in the literature arteriography showed tue primitive ii vpoglossal

artery coursing through the elllarged hypo-
concerning alterations of the hypoglossal
glossal canal (Fig. 6, A and B).
canal in this anomaly.2 Recently, we have
had tile opportunity to examine the roent-
genographic features of the hvpoglossal
canal in 2 patients with a hs’poglossal The persistent hs’poglossal artery is a
artery found incidentally at carotid arte- large branch arising from the internal
riography. carotid artery opposite the first to third
The purposes of this paper are to docu- cervical vertebral bodies. It is somewhat
ment tile roentgenographic changes in the tortuous and lies anterior to the course of
hypoglossal canal through which this the normal vertebral artery. The vessel
anomalous artery courses and to discuss the passes through the hs’poglossal canal into

differential diagnosis of hypoglossal canal the posterior fossa and joins tile basilar
artery.7 The il\poglossal or anterior con-
ds’loid canal courses an terolaterally and
REPORT OF CASES slightly cephalad through the occipital
CASE 1. A 69 year old female was admitted to condyles. In addition to the hs’poglossal
this hospital following an automobile accident. nerve, the canal transmits a meningeal
Because of right hemiparesis she underwent left branch of the ascending phars’ngeal artery
carotid arteriography to rule out subdural and a plexus of emissary veins.5 When per-
hematoma. The study was normal and an sistent, the hvpoglossal artery also passes
incidental finding was a persistent primitive through this canal.
hypoglossal artery (Fig. i, A and B). Subse-
quently, modified reversed Stenvers views of DISCUSSION
the skull5 (Fig. 2, A and B) and linear coronal
tomograms (Fig. 3) were obtained to demon- Gerlach et al.3 and Krayenbiihl and
strate the hypoglossal canals. These studies re- Yasargil6 mentioned that if tile primitive

vealed enlargement of the left hypoglossal hvpoglossal artery is present, tile hypO-

canal (13 mm. by 10mm.) as compared with the glossal canal on that side is enlarged.
right canal (6 mm. by 7 mm.). The enlarged Krayenb#{252}hl and Yasargil6 did not illustrate
canal retained a smooth sclerotic rim. this finding. Gerlach et al.3 demonstrated
the hs’poglossal artery passing through the
(ASE II. An 84 year 01(1 female was admitted
canal in an oblique projection at arteriog-
to this hospital for evaluation of headaches and
raphs’. However, they included no com-
right hemiparesis. left carotid arteriograplly
parati ye roen tgenograms or measurements
demonstrated a Iron tal con vexity men ingioma,
of the hypoglossal canals. In 1964, Con-
together with the incidental finding of a per-
sistent hypoglossal artery. Reversed Stenvers stans et al.2 utilized tomography to demon-
views (Fig. 4, ii aiud B and tomograms (Fig. strate an enlarged hs’poglossal canal sec-
c, 4-C) revealed an enlarged left hypoglossal ondary to a persistent hypoglossal artery.
canal measuring i8 mm. by 9 mm. as compared This is the only case we have been able to

From the Department of Radiology, Duke University Medical Center, Durham, North Carolina.

VoL. ii8, No. 3 The Hvpoglossal Artery and Hvpoglossal Canal 529

JIG. 1. Case 1. Percutaneous leftcommon carotid anteriograms. (A) Lateral view shows the prinlitive hvpo-
glossal artery arising fnonl the internal carotid artery (open arrow) and coursing through the hiypoglossal
canal (opposing arrows) to join the basilar artery. (B) Anteroposterior view shows simultaneous filling
of the anterior and posterior circulation.

FIG. 2. Case Modified reversed Stenvers view. (A) The

1. normal right canal (arrows) measures 7 mm. by
6 mm. (B) The enlarged left canal (arrows) measures 33 mm. by 30 mm. The contour is smooth with a
thin sclerotic rim.
G. A. Wardwell, J. A. Goree and J. P. Jinuenez JULY, 1973

the hypoglossal canal was described by

Kirdani.5 In his series of 68 canals, using
dried skulls and patient material, he found
that the mid portion of the canal tended to
be round with a 6 fllflu. average diameter.
The largest dianueter was 11 mm. and the
smallest 4 num. A variation of as much as
3 mnu. was found when conuparing opposite
sides of tile sanue skull in the reversed
Stenvers position. Ihe inner and outer
openings of the hs’poglossal canal tended
JIG. ;. (ase i. Antenopostenior linear coronal tomo-
gram at the level of the foranien magnum. lile to 1)e oval witil the long axis horizontal.
night canal (left arrow) is seen niistinctl y. Ille The greatest diameter of ci tiuer opeiu ing was
left canal (night arrow) is enlarged when compared I 2 flum. ‘iie absolute and comparative
to the nigilt.
measurenuents in both our cases exceed the
upper limits of nornlal according to Kirdani.
find ill tile literature with comparative The left hs’poglossal canal in Case i (i,

roentgenographic documentation. Coiu- muu. b s’ 10 Dl Ill.) 5 6 nu Ill. Iarger t 11an tile

stalls et i/.- gave no llleasurenuents. nornual right canal (6 iuum. by 7 mm.)

‘Ille nornual roetu tgenographic anatonu 5’ of when tile greatest dianueters are conupared

11G. 4. Case ii. Modified reversed Stenvens view. (A) i’he nornlal right canal (arrowheads) measures 8 mm.
by 6 111111. (B) The enlarged left canal (arrows) is iS nlm. by 9 mm. The canal has a “kidney bean” con-
tour with a thin sclerotic rim.
\‘oi. ill, No. 3 Tile Hvpoglossai Artery and Hvpoglossal Canal 53’

The long axis is vertical in the abnormal diameter than the normal right canal (8
canal. In Case II, the left canal (i8 mnu. by mm. by 6 mm.). The long axis is again
9 mm.) is 10 mm. larger in its greatest vertical in the abnormal canal. In the case

‘ ‘


FIG. . Case ii. (A) Linear tomogram in the modified reversed Stenvers projection shows the normal right
canal (arrowheads). (B) The large left canal (arrows) indicates the “kidney bean” contour more cleanly
than on the plain roentgenogram. (C) Anteroposterior linear coronal tomogram at the level of the occipital
condyles shows the large left canal (arrowheads) as compared with the normal right canal (arrows).
2 0. A. Wardwell, J. A. Goree and J. P. jimenez JULY, i9”3

4 ‘

JIG. h. (ase II. Percutaneous left carotid anteniognams. A) faniv arterial phase. ihe Persistent hvpoglossal
artery (arrows) arises from the ill tennal carotid artery (open arrow) and pursues a tortuous course through
tile ii V poglossa I ca nit 1. (/3) 1.a te venous phase. Ihe ii vpoglossal ca nt I (arrows) is seen wi tilou t c( )n tras
material in tile anomalous artery. file contour is identical to the canal in ligune 4B.

reported bs’ Constans ci al.2 the greatest cases had gross destruction, not onls of the
dianueter of tile abnormal canal was oblique margins of tile hvpoglossal canal, but also
l)ut more nearls’ horizontal tilall vertical. of the jugular canal and otiler surrounding
ilis patient was 27 sears of age, wilereas structures. Two of these 10 cases were
our patients were 69 and $4. lilis suggests hs’poglossal neurinomas. l’heir onls case of
sinlplv that tile more vertical axis in our an isolated elllargefluelu t of tiue ii s’poglossal
cases results fronu atherosclerotic elonga- canal showed a smooth sclerotic rinu with-
tion and ectasia superinuposed 011 tile out destruction and was considered to con-
iornu all v tortuous hvpoglossal artery. tam an unproven neurinonua.
Valvassori and Kirdani’#{176} reported ii A review of published cases of hypo_
cases of enlargement of tile hs’poglossal glossal neurinoma include . additional
canal. Ille various etiologies included cases with abnornlal skull roentgenogranis.
hypoglossal neurinom a, fllellillgioma (alone In I case,1 tile roentgenograms were taken
and ill association with neurotibromatosis), postoperativels and, togetiler witil a similar
prinlars’ choiesteatoma, chordoma, glomus report,’ showed bone destruction involving
jugulare tumor and osteoms’elitis. Tile tile base of the skull as well as tile Ilypo-
roen tgenograph ic di I’Ieren ti at ion between glossal canal. A third case’ was a patient
benign (in tracan al i cu Iar) and destructive with generalized neurofibronuatosis and ilad
and extensive canal enlargement was Ilot roentgenographic documentation of an en-
nuade. A review of their roentgenograms larged hvpoglossal canal with a thin scle-
and descriptions revealed that 10 of the II rotic rim. Bernasconi et al.1 stated that this
\OL. ii8, No. 3 The Hypoglossal Artery and Hypoglossal Canal 533

is the only certain sign of of the

neurinoma REFERENCES

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et al.2 retain sclerotic margins and extend
the differential diagnosis of benign enlarge-
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