{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T20:12:18Z","timestamp":1785442338667,"version":"3.56.0"},"reference-count":68,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100009367","name":"Mansoura University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100009367","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Acta Neurochir"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Persistent primitive hypoglossal artery (PPHA) is a rare embryological variant of the cerebral circulation in which the posterior circulation is supplied through a persistent embryonic carotid\u2013basilar anastomosis. While often discovered incidentally, PPHA may have important clinical consequences when associated with atherosclerotic disease, aneurysms, or other cerebrovascular abnormalities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To introduce a structured clinical classification system for PPHA that captures its anatomical spectrum, pathological associations, and\u00a0symptomatic presentations, with the aim of improving diagnostic precision and procedural planning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A six-category framework was developed to stratify PPHA according to its clinical and radiological features. This classification emphasizes anatomical distinctiveness and pathological relevance to facilitate risk stratification and therapeutic decision-making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The proposed classification defines six categories: (1) isolated asymptomatic PPHA, (2) PPHA with stenosis, (3) aneurysmal PPHA, (4) PPHA with carotid artery stenosis, (5) PPHA with cranial nerve compression, and (6) PPHA associated with other vascular anomalies. Organizing PPHA into these categories provides a practical system for clinical assessment and intervention planning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This novel classification addresses the current absence of a standardized clinical framework for PPHA. Its adoption may enhance physician awareness, improve patient safety during cerebrovascular interventions, and aid multidisciplinary decision-making in complex neurovascular cases. Validation in clinical practice is warranted to establish its utility.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00701-025-06654-w","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T04:55:41Z","timestamp":1761195341000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Persistent primitive hypoglossal artery: a classification-based approach to understanding and managing a rare vascular anomaly"],"prefix":"10.1007","volume":"167","author":[{"given":"Nshaat Abdrabou","family":"Elsayed","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Azhar","family":"Ali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,23]]},"reference":[{"issue":"6","key":"6654_CR1","doi-asserted-by":"publisher","first-page":"2464","DOI":"10.1016\/j.radcr.2024.02.089","volume":"19","author":"AA AlQarni","year":"2024","unstructured":"AlQarni AA, AlOtibi T, Mahnashi Y, Alawad A, Aldawsari WM (2024) Persistence of a hypoglossal artery: case report. Radiol Case Rep 19(6):2464\u20132466. https:\/\/doi.org\/10.1016\/j.radcr.2024.02.089","journal-title":"Radiol Case Rep"},{"key":"6654_CR2","doi-asserted-by":"publisher","DOI":"10.4076\/1757-1626-2-8571","volume":"2","author":"S Avcu","year":"2009","unstructured":"Avcu S, van der Schaaf I, Ozcan HN, Sengul I, Fransen H (2009) Persistent hypoglossal artery detected incidentally in a hypertensive patient with intracerebral hemorrhage: a case report and review of the literature. Cases J 2:8571. https:\/\/doi.org\/10.4076\/1757-1626-2-8571","journal-title":"Cases J"},{"issue":"3","key":"6654_CR3","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1016\/j.surneu.2006.10.053","volume":"68","author":"GM Baltsavias","year":"2007","unstructured":"Baltsavias GM, Chourmouzi D, Tasianas N, Drevelengas A, Damianovski D, Jovkovski S (2007) Ruptured aneurysm of a persistent primitive hypoglossal artery treated by endovascular approach\u2013case report and literature review. Surg Neurol 68(3):338\u2013343. https:\/\/doi.org\/10.1016\/j.surneu.2006.10.053","journal-title":"Surg Neurol"},{"issue":"3","key":"6654_CR4","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1007\/BF00588264","volume":"33","author":"T Bharucha","year":"1991","unstructured":"Bharucha T, Mammen T (1991) Aneurysm of a persistent hypoglossal artery. Neuroradiology 33(3):265\u2013267. https:\/\/doi.org\/10.1007\/BF00588264","journal-title":"Neuroradiology"},{"issue":"2","key":"6654_CR5","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1177\/159101990901500206","volume":"15","author":"R De Blasi","year":"2009","unstructured":"De Blasi R, Medicamento N, Chiumarullo L, Salvati A, Maghenzani M, Dicuonzo F, Carella A (2009) A case of aneurysm on a persistent hypoglossal artery treated by endovascular coiling. Interv Neuroradiol 15(2):175\u2013178. https:\/\/doi.org\/10.1177\/159101990901500206","journal-title":"Interv Neuroradiol"},{"issue":"1","key":"6654_CR6","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1016\/j.jvs.2014.06.008","volume":"61","author":"K Brown","year":"2015","unstructured":"Brown K, Itum DS, Preiss J, Duwayri Y, Veeraswamy RK, Salam A, Dodson TF, Brewster LP (2015) Carotid artery stenting has an increased risk of external carotid artery occlusion compared with carotid endarterectomy. J Vasc Surg 61(1):119\u2013124. https:\/\/doi.org\/10.1016\/j.jvs.2014.06.008","journal-title":"J Vasc Surg"},{"issue":"4","key":"6654_CR7","doi-asserted-by":"publisher","first-page":"543","DOI":"10.1177\/1708538120966514","volume":"29","author":"M Burgard","year":"2021","unstructured":"Burgard M, Psathas E, Mordasini P, Medlin F, Menth M, Egger B, Oscar MD (2021) Symptomatic internal carotid artery stenosis in the presence of a persistent primary hypoglossal artery. Vascular 29(4):543\u2013549. https:\/\/doi.org\/10.1177\/1708538120966514","journal-title":"Vascular"},{"issue":"3","key":"6654_CR8","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1227\/01.NEU.0000136934.89138.6A","volume":"55","author":"MM Chow","year":"2004","unstructured":"Chow MM, Woo HH, Masaryk TJ, Rasmussen PA (2004) Persistent hypoglossal artery aneurysm presenting with subarachnoid hemorrhage: case report. Neurosurgery 55(3):722. https:\/\/doi.org\/10.1227\/01.NEU.0000136934.89138.6A","journal-title":"Neurosurgery"},{"key":"6654_CR9","unstructured":"Fujii Y, Arai H, Takeuchi S, Sasaki O, Kamada K, Ogawa H, Shimbo Y (1988) [An autopsy case of persistent primitive hypoglossal artery with multiple cerebral aneurysms]. No Shinkei Geka (4):421\u2013426. Japanese."},{"issue":"8","key":"6654_CR10","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1016\/j.ijom.2007.02.009","volume":"36","author":"RM Graham","year":"2007","unstructured":"Graham RM, Thomson EF, Baldwin AJ (2007) Isolated hypoglossal nerve palsy due to a vascular anomaly. Int J Oral Maxillofac Surg 36(8):759\u2013761. https:\/\/doi.org\/10.1016\/j.ijom.2007.02.009","journal-title":"Int J Oral Maxillofac Surg"},{"issue":"3","key":"6654_CR11","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1177\/159101990501100308","volume":"11","author":"M Grand","year":"2005","unstructured":"Grand M, Nepper-Rasmussen J (2005) Aneurysm of persistent primitive hypoglossal artery occluded with guglielmi detachable coils. Interv Neuroradiol 11(3):247\u2013250. https:\/\/doi.org\/10.1177\/159101990501100308","journal-title":"Interv Neuroradiol"},{"issue":"4","key":"6654_CR12","doi-asserted-by":"publisher","first-page":"258","DOI":"10.4103\/0971-3026.73534","volume":"20","author":"M Gupta","year":"2010","unstructured":"Gupta M, Gupta R, Seith A (2010) Persistent primitive hypoglossal artery associated with Chiari II malformation: diagnosis and clinical implications. Indian J Radiol Imaging 20(4):258\u2013260. https:\/\/doi.org\/10.4103\/0971-3026.73534","journal-title":"Indian J Radiol Imaging"},{"issue":"3","key":"6654_CR13","first-page":"134","volume":"88","author":"R Guzman","year":"2005","unstructured":"Guzman R, L\u00f6vblad KO, Barth A, Remonda L, Schroth G (2005) Persistent hypoglossal artery found incidentally. JBR-BTR 88(3):134\u2013135","journal-title":"JBR-BTR"},{"key":"6654_CR14","doi-asserted-by":"publisher","unstructured":"Hamzoian H, Harris B, Ditamo M, Chaudhary S (2023) Peculiar Neurological Examination Secondary to Persistent Primitive Hypoglossal Artery. Cureus 15(7):e42249. https:\/\/doi.org\/10.7759\/cureus.42249","DOI":"10.7759\/cureus.42249"},{"issue":"3","key":"6654_CR15","doi-asserted-by":"publisher","first-page":"383","DOI":"10.4103\/ijri.IJRI_429_19","volume":"30","author":"S Haryu","year":"2020","unstructured":"Haryu S, Shida N, Tominaga T (2020) Unusual case of persistent primitive hypoglossal artery with anterior choroidal artery aneurysm in Chiari type I malformation. Indian J Radiol Imaging 30(3):383\u2013385. https:\/\/doi.org\/10.4103\/ijri.IJRI_429_19","journal-title":"Indian J Radiol Imaging"},{"issue":"5","key":"6654_CR16","doi-asserted-by":"publisher","first-page":"372","DOI":"10.2176\/nmc.39.372","volume":"39","author":"T Hatayama","year":"1999","unstructured":"Hatayama T, Yamane K, Shima T, Okada Y, Nishida M (1999) Persistent primitive hypoglossal artery associated with cerebral aneurysm and cervical internal carotid artery stenosis\u2013case report. Neurol Med Chir (Tokyo) 39(5):372\u2013375. https:\/\/doi.org\/10.2176\/nmc.39.372","journal-title":"Neurol Med Chir (Tokyo)"},{"issue":"32","key":"6654_CR17","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000026904","volume":"100","author":"S He","year":"2021","unstructured":"He S, Wei ML, Xie F, Richard SA (2021) A fenestrated persistent primitive hypoglossal artery harboring a ruptured aneurysm: a case report. Medicine (Baltimore) 100(32):e26904. https:\/\/doi.org\/10.1097\/MD.0000000000026904","journal-title":"Medicine (Baltimore)"},{"issue":"2","key":"6654_CR18","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2019.104459","volume":"29","author":"H Hikichi","year":"2020","unstructured":"Hikichi H, Ueno T, Iwamura M, Nishijima H, Arai A, Suzuki C, Midorikawa H, Nunomura JI, Tomiyama M (2020) Hypoglossal nerve palsy due to compression by a persistent primitive hypoglossal artery: case report. J Stroke Cerebrovasc Dis 29(2):104459. https:\/\/doi.org\/10.1016\/j.jstrokecerebrovasdis.2019.104459","journal-title":"J Stroke Cerebrovasc Dis"},{"issue":"2","key":"6654_CR19","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1055\/s-0035-1568879","volume":"26","author":"S Hopf-Jensen","year":"2017","unstructured":"Hopf-Jensen S, Marques L, Prei\u00df M, B\u00f6rm W, M\u00fcller-H\u00fclsbeck S (2017) Variation of a persistent primitive hypoglossal artery (PPHA) as incidental finding in the diagnostic clarification of cerebral vasculopathy associated with intracranial vasculitis. Int J Angiol 26(2):121\u2013124. https:\/\/doi.org\/10.1055\/s-0035-1568879","journal-title":"Int J Angiol"},{"key":"6654_CR20","doi-asserted-by":"publisher","unstructured":"Huang M, Moisi M, Zwillman ME, Volpi JJ, Diaz O, Klucznik R (2016) Transient Ischemic Attack in the Setting of Carotid Atheromatous Disease with a Persistent Primitive Hypoglossal Artery Successfully Treated with Stenting: A Case Report. Cureus 8(1):e464. https:\/\/doi.org\/10.7759\/cureus.464","DOI":"10.7759\/cureus.464"},{"issue":"3","key":"6654_CR21","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0b013e3182077d75","volume":"68","author":"FK Hui","year":"2011","unstructured":"Hui FK, Schuette AJ, Cawley CM (2011) Endovascular treatment of an aneurysm of a persistent primitive hypoglossal artery with complete resolution of brainstem compressive symptoms: case report. Neurosur 68(3):E854. https:\/\/doi.org\/10.1227\/NEU.0b013e3182077d75","journal-title":"Neurosur"},{"issue":"6","key":"6654_CR22","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1016\/j.surneu.2004.03.018","volume":"62","author":"P Huynh-Le","year":"2004","unstructured":"Huynh-Le P, Matsushima T, Muratani H, Hikita T, Hirokawa E (2004) Persistent primitive hypoglossal artery associated with proximal posterior inferior cerebellar artery aneurysm. Surg Neurol 62(6):546\u2013551. https:\/\/doi.org\/10.1016\/j.surneu.2004.03.018","journal-title":"Surg Neurol"},{"key":"6654_CR23","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2024.108179","volume":"238","author":"T Ishizuka","year":"2024","unstructured":"Ishizuka T, Endo H, Yamaguchi S, Hiratsuka Y, Noro S, Ishikawa K, Fuchizaki T, Tatsuta Y, Sakurai S, Shindo K, Yamaguchi Y, Ogino T, Kamiyama K, Osato T, Nakamura H (2024) Endovascular treatment of acute atherothrombotic internal carotid artery occlusion associated with persistent primitive hypoglossal artery. Clin Neurol Neurosurg 238:108179. https:\/\/doi.org\/10.1016\/j.clineuro.2024.108179","journal-title":"Clin Neurol Neurosurg"},{"issue":"17","key":"6654_CR24","doi-asserted-by":"publisher","DOI":"10.3171\/CASE23427","volume":"6","author":"K Iwaki","year":"2023","unstructured":"Iwaki K, Arimura K, Fukuda S, Takagishi S, Kurogi R, Nakamura K, Nakamizo A, Yoshimoto K (2023) Percutaneous transluminal angioplasty for persistent primitive hypoglossal artery stenosis: illustrative case. J Neurosurg Case Lessons 6(17):CASE23427. https:\/\/doi.org\/10.3171\/CASE23427","journal-title":"J Neurosurg Case Lessons"},{"key":"6654_CR25","doi-asserted-by":"publisher","unstructured":"Kabila B, Boumeriem K, Mesbah O, Kettani NEE, Fikri M, Jiddane M, Firdaous T (2025) Persistence of the hypoglossal artery: A rare case report. Radiol Case Rep 20(6):2657\u20132661. https:\/\/doi.org\/10.1016\/j.radcr.2025.02.046","DOI":"10.1016\/j.radcr.2025.02.046"},{"key":"6654_CR26","doi-asserted-by":"publisher","unstructured":"Kadooka K, Pamatmat R, Ueda K, Tsuboki S, Mitsutake T, Tanaka M (2025) Symptomatic Common Carotid Artery Stenosis With a Persistent Primitive Hypoglossal Artery Presenting With Posterior Circulation Symptoms and Technical Challenges in Stenting. Cureus 17(4):e81562. https:\/\/doi.org\/10.7759\/cureus.81562","DOI":"10.7759\/cureus.81562"},{"issue":"1","key":"6654_CR27","doi-asserted-by":"publisher","first-page":"71","DOI":"10.4103\/2152-7806.156633","volume":"6","author":"H Kageyama","year":"2015","unstructured":"Kageyama H, Toyooka T, Osada H, Tsuzuki N (2015) Infratentorial arteriovenous malformation associated with persistent primitive hypoglossal artery. Surg Neurol Int 6(1):71. https:\/\/doi.org\/10.4103\/2152-7806.156633","journal-title":"Surg Neurol Int"},{"issue":"5","key":"6654_CR28","first-page":"794","volume":"30","author":"H Kanai","year":"1992","unstructured":"Kanai H, Nagai H, Wakabayashi S, Hashimoto N (1992) A large aneurysm of the persistent primitive hypoglossal artery. Neurosurgery 30(5):794\u2013797","journal-title":"Neurosurgery"},{"issue":"5","key":"6654_CR29","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1055\/s-0028-1082299","volume":"51","author":"R Kanazawa","year":"2008","unstructured":"Kanazawa R, Ishihara S, Okawara M, Ishihara H, Kohyama S, Yamane F (2008) A successful treatment with carotid arterial stenting for symptomatic internal carotid artery severe stenosis with ipsilateral persistent primitive hypoglossal artery: case report and review of the literature. Minim Invasive Neurosurg 51(5):298\u2013302. https:\/\/doi.org\/10.1055\/s-0028-1082299","journal-title":"Minim Invasive Neurosurg"},{"issue":"3","key":"6654_CR30","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1016\/s0090-3019(98)00053-6","volume":"51","author":"M Katoh","year":"1999","unstructured":"Katoh M, Kamiyama H, Kobayashi N, Makino K, Takano K, Tokumitsu N, Takamura H (1999) Severe stenosis of the internal carotid artery presenting as loss of consciousness due to the presence of a primitive hypoglossal artery: a case report. Surg Neurol 51(3):310\u2013312. https:\/\/doi.org\/10.1016\/s0090-3019(98)00053-6","journal-title":"Surg Neurol"},{"key":"6654_CR31","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1055\/s-0029-1243243","volume":"52","author":"M Kawabori","year":"2009","unstructured":"Kawabori M, Kuroda S, Yasuda H, Hokari M, Nakayama N, Saito H, Iwasaki Y (2009) Carotid endarterectomy for internal carotid artery stenosis associated with persistent primitive hypoglossal artery: efficacy of intraoperative multi-modality monitoring. Minim Invasive Neurosurg 52:263\u2013266. https:\/\/doi.org\/10.1055\/s-0029-1243243","journal-title":"Minim Invasive Neurosurg"},{"issue":"11","key":"6654_CR32","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2021.106099","volume":"30","author":"K Kawamura","year":"2021","unstructured":"Kawamura K, Tokugawa J, Watanabe M, Fujita N, Teramoto S, Kimura T, Ito Y, Nakao Y, Yamamoto T (2021) Persistent primitive hypoglossal artery with ipsilateral symptomatic carotid artery stenosis and cerebral aneurysm. J Stroke Cerebrovasc Dis 30(11):106099. https:\/\/doi.org\/10.1016\/j.jstrokecerebrovasdis.2021.106099","journal-title":"J Stroke Cerebrovasc Dis"},{"issue":"2","key":"6654_CR33","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1007\/s00276-014-1285-7","volume":"37","author":"D Kimball","year":"2015","unstructured":"Kimball D, Ples H, Miclaus GD, Matusz P, Loukas M (2015) Persistent hypoglossal artery aneurysm located in the hypoglossal canal with associated subarachnoid hemorrhage. Surg Radiol Anat 37(2):205\u2013209. https:\/\/doi.org\/10.1007\/s00276-014-1285-7","journal-title":"Surg Radiol Anat"},{"issue":"6","key":"6654_CR34","doi-asserted-by":"publisher","first-page":"259","DOI":"10.2176\/nmc.48.259","volume":"48","author":"M Kobayashi","year":"2008","unstructured":"Kobayashi M, Akaji K, Tanizaki Y, Mihara B, Ohira T, Kawase T (2008) Posterior inferior cerebellar artery aneurysm associated with persistent primitive hypoglossal artery. Neurol Med Chir (Tokyo) 48(6):259\u2013261. https:\/\/doi.org\/10.2176\/nmc.48.259","journal-title":"Neurol Med Chir (Tokyo)"},{"issue":"1","key":"6654_CR35","doi-asserted-by":"publisher","first-page":"55","DOI":"10.2176\/nmc.51.55","volume":"51","author":"K Konno","year":"2011","unstructured":"Konno K, Matsuo Y, Watanabe T, Ishihara S, Yoshino Y (2011) Carotid endarterectomy in a patient with persistent hypoglossal artery: a case report. Neurol Med Chir (Tokyo) 51(1):55\u201358. https:\/\/doi.org\/10.2176\/nmc.51.55","journal-title":"Neurol Med Chir (Tokyo)"},{"key":"6654_CR36","doi-asserted-by":"publisher","unstructured":"Lee EJ, Chang HW, Cho CH, Kim E, Lee SK, Kwon JH (2010) Rare variant of persistent primitive hypoglossal artery in magnetic resonance angiography. Surg Radiol Anat 32(8):801\u2013804. https:\/\/doi.org\/10.1007\/s00276-010-0664-y","DOI":"10.1007\/s00276-010-0664-y"},{"key":"6654_CR37","doi-asserted-by":"publisher","unstructured":"Leonard SD, Sadri L, Nguyen H, Saqib N, Heck M, Martin G (2024) Carotid endarterectomy in the setting of persistent hypoglossal artery. J Vasc Surg Cases Innov Tech 11(1):101648. https:\/\/doi.org\/10.1016\/j.jvscit.2024.101648","DOI":"10.1016\/j.jvscit.2024.101648"},{"issue":"7","key":"6654_CR38","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1177\/1538574419859102","volume":"53","author":"NJ Madden","year":"2019","unstructured":"Madden NJ, Calligaro KD, Dougherty MJ, Maloni K, Troutman DA (2019) Persistent hypoglossal artery: challenges associated with carotid revascularization. Vasc Endovasc Surg 53(7):589\u2013592. https:\/\/doi.org\/10.1177\/1538574419859102","journal-title":"Vasc Endovasc Surg"},{"issue":"3","key":"6654_CR39","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1016\/0090-3019(85)90029-1","volume":"24","author":"M Matsumura","year":"1985","unstructured":"Matsumura M, Nojiri K, Yumoto Y (1985) Persistent primitive hypoglossal artery associated with Arnold-Chiari type I malformation. Surg Neurol 24(3):241\u2013244. https:\/\/doi.org\/10.1016\/0090-3019(85)90029-1","journal-title":"Surg Neurol"},{"issue":"3","key":"6654_CR40","doi-asserted-by":"publisher","first-page":"669","DOI":"10.1097\/00006123-199709000-00032","volume":"41","author":"JF Megyesi","year":"1997","unstructured":"Megyesi JF, Findlay JM, Sherlock RA (1997) Carotid endarterectomy in the presence of a persistent hypoglossal artery: case report. Neurosurgery 41(3):669\u2013672. https:\/\/doi.org\/10.1097\/00006123-199709000-00032","journal-title":"Neurosurgery"},{"issue":"1\u20132","key":"6654_CR41","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1016\/j.jns.2012.08.018","volume":"323","author":"D Meila","year":"2012","unstructured":"Meila D, Wetter A, Brassel F, Nacimiento W (2012) Intermittent hypoglossal nerve palsy caused by a calcified persistent hypoglossal artery: an uncommon neurovascular compression syndrome. J Neurol Sci 323(1\u20132):248\u2013249. https:\/\/doi.org\/10.1016\/j.jns.2012.08.018","journal-title":"J Neurol Sci"},{"issue":"2","key":"6654_CR42","doi-asserted-by":"publisher","first-page":"144","DOI":"10.5853\/jos.2015.17.2.144","volume":"17","author":"K Menshawi","year":"2015","unstructured":"Menshawi K, Mohr JP, Gutierrez J (2015) A functional perspective on the embryology and anatomy of the cerebral blood supply. J Stroke 17(2):144\u2013158. https:\/\/doi.org\/10.5853\/jos.2015.17.2.144","journal-title":"J Stroke"},{"issue":"6","key":"6654_CR43","doi-asserted-by":"publisher","first-page":"e98","DOI":"10.1016\/j.jstrokecerebrovasdis.2016.03.026","volume":"25","author":"S Murai","year":"2016","unstructured":"Murai S, Kusaka N, Umakoshi M, Itami H, Otsuka S, Nishiura T, Ogihara K (2016) Stenting for internal carotid artery stenosis associated with persistent primitive hypoglossal artery using proximal flow blockade and distal protection system: a technical case report and literature review. J Stroke Cerebrovasc Dis 25(6):e98\u2013e102. https:\/\/doi.org\/10.1016\/j.jstrokecerebrovasdis.2016.03.026","journal-title":"J Stroke Cerebrovasc Dis"},{"issue":"5","key":"6654_CR44","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1016\/0090-3019(85)90263-0","volume":"24","author":"Y Murayama","year":"1985","unstructured":"Murayama Y, Fujimoto N, Matsumoto K (1985) Bilateral persistent primitive hypoglossal arteries associated with a large ruptured aneurysm on one side. Surg Neurol 24(5):498\u2013502. https:\/\/doi.org\/10.1016\/0090-3019(85)90263-0","journal-title":"Surg Neurol"},{"issue":"3","key":"6654_CR45","doi-asserted-by":"publisher","first-page":"627","DOI":"10.4103\/ni.ni_127_22","volume":"73","author":"K Nagarajan","year":"2025","unstructured":"Nagarajan K, Amuthabharathi M, Adithan S, Gowtham MS (2025) Report of three cases of persistent hypoglossal artery with associated anomalies and a review of literature. Neurol India 73(3):627\u2013630. https:\/\/doi.org\/10.4103\/ni.ni_127_22","journal-title":"Neurol India"},{"issue":"2","key":"6654_CR46","first-page":"143","volume":"66","author":"GK Paraskevas","year":"2007","unstructured":"Paraskevas GK, Tsitsopoulos PP, Papaziogas B, Spanidou S (2007) Persistent primitive hypoglossal artery: an incidental autopsy finding and its significance in clinical practice. Folia Morphol (Warsz) 66(2):143\u2013147","journal-title":"Folia Morphol (Warsz)"},{"issue":"6","key":"6654_CR47","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1016\/s1130-1473(09)70137-x","volume":"20","author":"L Pasaoglu","year":"2009","unstructured":"Pasaoglu L, Hatipoglu HG, Vural M, Ziraman I, Ozcan HN, Koparal S (2009) Persistent primitive hypoglossal artery and fenestration of posterior cerebral artery: CT and MR angiography. Neurocirugia (Astur) 20(6):563\u2013566. https:\/\/doi.org\/10.1016\/s1130-1473(09)70137-x","journal-title":"Neurocirugia (Astur)"},{"issue":"3","key":"6654_CR48","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1097\/00006123-200003000-00031","volume":"46","author":"VC Prabhu","year":"2000","unstructured":"Prabhu VC, Bailes JE (2000) Persistent hypoglossal artery: case report and literature review. Neurosurgery 46(3):671\u2013674. https:\/\/doi.org\/10.1097\/00006123-200003000-00031","journal-title":"Neurosurgery"},{"issue":"2","key":"6654_CR49","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1016\/j.jvscit.2020.01.016","volume":"6","author":"LB Pride","year":"2020","unstructured":"Pride LB, Lagergren ER, Hafner DH, Chervu AA (2020) Critical carotid artery stenosis involving a persistent primitive hypoglossal artery. J Vasc Surg Cases Innov Tech 6(2):177\u2013180. https:\/\/doi.org\/10.1016\/j.jvscit.2020.01.016","journal-title":"J Vasc Surg Cases Innov Tech"},{"issue":"2","key":"6654_CR50","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1177\/1971400915626427","volume":"29","author":"B Ryu","year":"2016","unstructured":"Ryu B, Ishikawa T, Hashimoto K, Shimizu M, Yagi S, Shimizu T, Kawamata T (2016) Internal carotid artery stenosis with persistent primitive hypoglossal artery treated with carotid artery stenting: a case report and literature review. Neuroradiol J 29(2):115\u2013121. https:\/\/doi.org\/10.1177\/1971400915626427","journal-title":"Neuroradiol J"},{"issue":"8","key":"6654_CR51","doi-asserted-by":"publisher","DOI":"10.1093\/jscr\/rjab362","volume":"2021","author":"T Sanada","year":"2021","unstructured":"Sanada T, Shirai W, Yamamoto S, Kinoshita M, Tokumitsu N (2021) A case of carotid endarterectomy assisted with a three-way junction shunting tube for the internal carotid artery stenosis involving a persistent primitive hypoglossal artery. J Surg Case Rep 2021(8):rjab362. https:\/\/doi.org\/10.1093\/jscr\/rjab362","journal-title":"J Surg Case Rep"},{"issue":"5","key":"6654_CR52","doi-asserted-by":"publisher","first-page":"254","DOI":"10.2176\/jns-nmc.2021-0360","volume":"62","author":"M Segawa","year":"2022","unstructured":"Segawa M, Inoue T, Tsunoda S, Noda R, Akabane A (2022) Carotid endarterectomy for vertebrobasilar insufficiency caused by severe stenosis of primitive hypoglossal artery: a technical case report and literature review. Neurol Med Chir (Tokyo) 62(5):254\u2013259. https:\/\/doi.org\/10.2176\/jns-nmc.2021-0360","journal-title":"Neurol Med Chir (Tokyo)"},{"issue":"2","key":"6654_CR53","doi-asserted-by":"publisher","first-page":"159","DOI":"10.33529\/ANGIO2021220","volume":"27","author":"IN Shchanitsyn","year":"2021","unstructured":"Shchanitsyn IN, Larin IV, Titova II, Sazonova NV, Sumin DI, Ionova TA, Bazhanov SP, Lobkov DV (2021) Surgical treatment in symptomatic stenosis of the carotid artery and persistent primitive hypoglossal artery. Angiol Sosud Khir 27(2):159\u2013168. https:\/\/doi.org\/10.33529\/ANGIO2021220","journal-title":"Angiol Sosud Khir"},{"issue":"1","key":"6654_CR54","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/S0022-510X(00)00316-1","volume":"173","author":"A Shintani","year":"2000","unstructured":"Shintani A, Shiigai T, Ueno Y (2000) Isolated persistent hypoglossal artery found incidentally by MR angiography. J Neurol Sci 173(1):89\u201391. https:\/\/doi.org\/10.1016\/S0022-510X(00)00316-1","journal-title":"J Neurol Sci"},{"key":"6654_CR55","doi-asserted-by":"publisher","unstructured":"Srinivas MR, Vedaraju KS, Manjappa BH, Nagaraj BR (2016) Persistent Primitive Hypoglossal Artery (PPHA) - A Rare Anomaly with Literature Review. J Clin Diagn Res 10(1):TD13\u20134. https:\/\/doi.org\/10.7860\/JCDR\/2016\/15556.7116.","DOI":"10.7860\/JCDR\/2016\/15556.7116"},{"issue":"2","key":"6654_CR56","doi-asserted-by":"publisher","first-page":"104","DOI":"10.2176\/nmc.31.104","volume":"31","author":"I Sunada","year":"1991","unstructured":"Sunada I, Yamamoto S, Matsuoka Y, Nishimura S (1991) Endarterectomy for persistent primitive hypoglossal artery\u2013case report. Neurol Med Chir (Tokyo) 31(2):104\u2013108. https:\/\/doi.org\/10.2176\/nmc.31.104","journal-title":"Neurol Med Chir (Tokyo)"},{"issue":"4","key":"6654_CR57","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1007\/BF00588725","volume":"32","author":"S Takahashi","year":"1990","unstructured":"Takahashi S, Sato M, Sato N et al (1990) Persistent hypoglossal artery associated with other cerebrovascular anomalies: report of three cases. Neuroradiology 32(4):360\u2013363. https:\/\/doi.org\/10.1007\/BF00588725","journal-title":"Neuroradiology"},{"key":"6654_CR58","doi-asserted-by":"publisher","DOI":"10.12659\/AJCR.939450","volume":"24","author":"S Telianidis","year":"2023","unstructured":"Telianidis S, Westcott MJ, Ironfield CM, Sanders LM (2023) Case of amaurosis fugax in the setting of a persistent primitive hypoglossal artery requiring carotid endarterectomy with regional anesthesia. Am J Case Rep 24:e939450. https:\/\/doi.org\/10.12659\/AJCR.939450","journal-title":"Am J Case Rep"},{"issue":"6","key":"6654_CR59","doi-asserted-by":"publisher","first-page":"371","DOI":"10.2176\/nmc.34.371","volume":"34","author":"H Touho","year":"1994","unstructured":"Touho H, Ohnishi H, Seno M, Furuoka N, Komatsu T, Karasawa J (1994) Percutaneous transluminal angioplasty of stenotic primitive hypoglossal artery\u2013case report. Neurol Med Chir (Tokyo) 34(6):371\u2013374. https:\/\/doi.org\/10.2176\/nmc.34.371","journal-title":"Neurol Med Chir (Tokyo)"},{"issue":"2","key":"6654_CR60","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1177\/1591019918809087","volume":"25","author":"GH Tse","year":"2019","unstructured":"Tse GH, Martin A, Dyde RA, Coley SC (2019) Persistent hypoglossal artery aneurysm: case report and qualitative systematic review. Interv Neuroradiol 25(2):164\u2013171. https:\/\/doi.org\/10.1177\/1591019918809087","journal-title":"Interv Neuroradiol"},{"issue":"6","key":"6654_CR61","doi-asserted-by":"publisher","first-page":"543","DOI":"10.1007\/s00276-010-0769-3","volume":"33","author":"A Uchino","year":"2011","unstructured":"Uchino A, Saito N (2011) Persistent hypoglossal artery arising from the external carotid artery diagnosed by MR angiography. Surg Radiol Anat 33(6):543\u2013545. https:\/\/doi.org\/10.1007\/s00276-010-0769-3","journal-title":"Surg Radiol Anat"},{"key":"6654_CR62","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1016\/j.wneu.2018.06.119","volume":"117","author":"I Varvari","year":"2018","unstructured":"Varvari I, Bos EM, Dinkelaar W et al (2018) Fatal subarachnoid hemorrhage from an aneurysm of a persistent primitive hypoglossal artery: case series and literature overview. World Neurosurg 117:285\u2013291. https:\/\/doi.org\/10.1016\/j.wneu.2018.06.119","journal-title":"World Neurosurg"},{"key":"6654_CR63","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2022.1053704","volume":"13","author":"Z Wan","year":"2022","unstructured":"Wan Z, Liu T, Xu N, Liu Q, Yu X, Wang H (2022) Concurrence of multiple aneurysms, extreme coiling of the extracranial internal carotid artery and ipsilateral persistent primitive hypoglossal artery: a case report and literature review. Front Neurol 13:1053704. https:\/\/doi.org\/10.3389\/fneur.2022.1053704","journal-title":"Front Neurol"},{"issue":"4","key":"6654_CR64","doi-asserted-by":"publisher","first-page":"199","DOI":"10.2176\/nmc.31.199","volume":"31","author":"S Yamamoto","year":"1991","unstructured":"Yamamoto S, Sunada I, Matsuoka Y, Hakuba A, Nishimura S (1991) Persistent primitive hypoglossal artery aneurysms\u2013report of two cases. Neurol Med Chir (Tokyo) 31(4):199\u2013202. https:\/\/doi.org\/10.2176\/nmc.31.199","journal-title":"Neurol Med Chir (Tokyo)"},{"key":"6654_CR65","doi-asserted-by":"publisher","DOI":"10.25259\/SNI_567_2023","volume":"14","author":"S Yoshida","year":"2023","unstructured":"Yoshida S, Kamatani K, Takigawa K, Tashiro N, Hashiguchi Y, Yasaka M, Aikawa H, Go Y, Kazekawa K (2023) Strategy of cerebral endovascular treatment for cervical internal carotid artery stenosis with a persistent primitive hypoglossal artery. Surg Neurol Int 14:308. https:\/\/doi.org\/10.25259\/SNI_567_2023","journal-title":"Surg Neurol Int"},{"key":"6654_CR66","unstructured":"Yuasa H, Mitake S, Oguri T, Miura T, Torii T, Kato D (2005) [A case of transient blindness due to severe stenosis of the internal carotid artery with persistent primitive hypoglossal artery (PPHA)]. Rinsho Shinkeigaku. 45(8):579\u201382. Japanese"},{"key":"6654_CR67","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2021.621610","volume":"12","author":"L Zhang","year":"2021","unstructured":"Zhang L, Chen X, Jia L, Dong L, Wang J, Liu P, Lv M (2021) Case report: persistent primitive hypoglossal artery accompanied by a basilar bifurcation aneurysm treated by Y-stent-assisted coil embolization. Front Neurol 12:621610. https:\/\/doi.org\/10.3389\/fneur.2021.621610","journal-title":"Front Neurol"},{"issue":"1","key":"6654_CR68","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1016\/j.jvs.2014.04.066","volume":"63","author":"L Zhang","year":"2016","unstructured":"Zhang L, Song G, Chen L, Jiao L, Chen Y, Wang Y (2016) Concomitant asymptomatic internal carotid artery and persistent primitive hypoglossal artery stenosis treated by endovascular stenting with proximal embolic protection. J Vasc Surg 63(1):237\u2013240. https:\/\/doi.org\/10.1016\/j.jvs.2014.04.066","journal-title":"J Vasc Surg"}],"container-title":["Acta Neurochirurgica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00701-025-06654-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00701-025-06654-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00701-025-06654-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T04:55:42Z","timestamp":1761195342000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00701-025-06654-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,23]]},"references-count":68,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["6654"],"URL":"https:\/\/doi.org\/10.1007\/s00701-025-06654-w","relation":{},"ISSN":["0942-0940"],"issn-type":[{"value":"0942-0940","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,23]]},"assertion":[{"value":"10 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The local institutional review board (IRB) approved the current review study (R.25.05.3183\u20132025\/05\/14).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Additional information"}},{"value":"Figures 2\u20137 are reused from previously published articles under appropriate Creative Commons licenses or with explicit publisher permission. Full attribution and licensing details are provided in the figure captions.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Image Permissions."}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interest"}}],"article-number":"279"}}