Congenital absence or hypoplasia of the internal carotid artery is an extremely rare developmental abnormality. Usually these patients are asymptomatic because of functional compensation via the circle of Willis. A less frequent collateral circulation can occur by way of the primitive maxillary artery, an embrionic vessel originating from the controlateral carotid siphon and running through the sella turcica.
We describe a fortuitous finding of unilateral agenesis of the internal carotid artery with intercavernous anastomosis in a patient with a meningioma adhering to the lateral margin of the right anterior clinoid. The case was studied by CT, MRI, MR angiography and digital subtraction angiography
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