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Abe H, Mori K, Fukui I, Tamase A, Yamashita R, Takeda M, Nakano T, Nomura M, Yamamoto T. A Case of Cerebral Infarction due to Internal Carotid Artery Occlusion Accompanied by Persistent Primitive Trigeminal Artery. Asian J Neurosurg 2024; 19:174-178. [PMID: 38974450 PMCID: PMC11226249 DOI: 10.1055/s-0044-1787085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
An 85-year-old woman with a history of diabetes mellitus became aware of motor weakness of the left lower extremity. Magnetic resonance imaging showed multiple small cerebral infarctions in the right corona radiata. Angiography revealed persistent primitive trigeminal artery (PPTA) originating from the right internal carotid artery (ICA) and connecting to basilar artery, and the right ICA occluded distal to PPTA. Collateral blood circulation had developed, and sufficient collateral blood flow was expected. From these findings, the right ICA was considered to show stenosis due to atherosclerotic changes before occlusion. Conservative treatment was conducted with the transoral administration of rivaroxaban. It is important to correctly diagnose the anatomy and existence of an anomalous vessel in a stroke patient, not only when endovascular treatment is planned, but also for conservative medical treatment. Rapid and accurate radiological examinations facilitate safe and effective treatment.
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Affiliation(s)
- Hiroyuki Abe
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Kanagawa, Japan
- Department of Neurosurgery, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan
| | - Kentaro Mori
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Kanagawa, Japan
| | - Issei Fukui
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Kanagawa, Japan
| | - Akira Tamase
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Kanagawa, Japan
| | - Ryotaro Yamashita
- Department of Neurology, Yokohama Sakae Kyosai Hospital, Yokohama, Kanagawa, Japan
| | - Mutsuki Takeda
- Department of Neurology, Yokohama Sakae Kyosai Hospital, Yokohama, Kanagawa, Japan
| | - Tatsu Nakano
- Department of Neurology, Yokohama Sakae Kyosai Hospital, Yokohama, Kanagawa, Japan
| | - Motohiro Nomura
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Kanagawa, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan
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Sreenivasan SA, Agarwal N, Roychowdhury S, Khandelwal P, Nanda A, Gupta G. Sequential aneurysms with incidental persistent primitive trigeminal artery: Is this association purely coincidental? A case study and review of the literature in search for a pathobiological mechanism. Surg Neurol Int 2022; 13:508. [DOI: 10.25259/sni_828_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
Background:
The appearance of sequential bilateral aneurysms in patients with persistent primitive trigeminal artery (PTA) is not described in the literature. No clear guidelines on screening and follow-up of patients with incidental PTAs for the detection of associated lesions have been established.
Case Description:
A 55-year-old lady presented with occasional headaches. Detailed evaluation showed a left ophthalmic segment internal carotid artery (ICA) aneurysm measuring (11.2 × 5.5) mm. A bovine aortic arch configuration (type III) and a persistent left PTA were identified. A pipeline flex flow diverter was placed and aneurysm was coiled. Follow-up angiography after 6 months showed a completely occluded aneurysm with preserved PTA and a new aneurysm in the right ICA ophthalmic segment measuring 3.5 × 1.5 mm. It was followed up serially with angiography which revealed significant increase in 6 months. The base measured 5.4 mm and two blebs 3.1 mm and 2.5 mm had appeared on the dome. A SUPRASS flow diverter was placed across this aneurysm. Serial follow-up showed complete occlusion of the left aneurysm and significant reduction in filling of the right aneurysm. A review of the literature identified 34 cases of incidental PTAs associated with 50 aneurysms with increased prevalence of anterior circulation aneurysms in patients with incidental PTA.
Conclusion:
Sequential angiography of a patient with incidental PTA and an ICA aneurysm shows presence of a new aneurysm in contralateral circulation and its progression in size and morphology. Detailed large-scale studies are needed to assess the impact of incidental PTA on aneurysm development and management.
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Affiliation(s)
- Sanjeev A. Sreenivasan
- Department of Neurological Surgery, Rutgers - Robert Wood Johnson Medical School, New Jersey, United States
| | - Neha Agarwal
- Fetal Centre, Department of Obstetrics and Gynecology, University of Texas McGovern Medical School, Houston, Texas, United States
| | - Sudipta Roychowdhury
- Department of Neurological Surgery, Rutgers - Robert Wood Johnson Medical School, New Jersey, United States
| | - Priyank Khandelwal
- Department of Neurological Surgery, New Jersey Medical School, RUTGERS, Newark, New Jersey, United States
| | - Anil Nanda
- Department of Neurological Surgery, Rutgers - Robert Wood Johnson Medical School, New Jersey, United States
| | - Gaurav Gupta
- Department of Neurological Surgery, Rutgers - Robert Wood Johnson Medical School, New Jersey, United States
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Tyagi G, Sadashiva N, Konar S, Aravinda HR, Saini J, Shukla D, Devi BI. Persistent Trigeminal Artery: Neuroanatomic and Clinical Relevance. World Neurosurg 2019; 134:e214-e223. [PMID: 31627002 DOI: 10.1016/j.wneu.2019.10.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Persistent trigeminal artery (PTA) is the most common remnant of primitive circulation communicating the developing carotid and vertebrobasilar junction. Although discovered incidentally, an altered hemodynamic may lead to an increased association of aneurysms, vascular malformations, and stroke. Neurosurgeons should be aware of the presence and significance of PTA when interpreting imaging and planning interventions. METHODS We retrospectively reviewed all magnetic resonance angiography and cerebral digital subtraction angiography performed between 2012 and 2017 for the presence of PTA. The radiologic and anatomic details were noted and analyzed along with the clinical profiles. We categorized the radiologic findings with respect to the available classification systems. A review of the available literature was done comparing our results. RESULTS We found 33 cases of incidentally detected PTA. The average age of the patients was 45.42 years. The lateral surface of the proximal cavernous internal carotid artery was the most common origin (n = 23). Only 3 cases had a medial/transsellar course. Most cases were Saltzman/Weon type I (19/33). Intracranial aneurysms were associated with 6 patients (18.18%). Trigeminal neuralgia (TN) was a presenting feature in 5 patients. None had a direct neurovascular conflict at the root entry zone. CONCLUSIONS Our study is one of the largest to describe the incidence of PTA. We emphasized the importance of PTA to the neurosurgeons; increased association of aneurysms, as a route for intervention in occlusive disease of the posterior fossa; risk of injury and bleeding during transsphenoidal surgery; and the association with TN. However, we found that only PTA variants are likely to be associated with TN because of their cisternal course causing NV conflict.
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Affiliation(s)
- Gaurav Tyagi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Nishanth Sadashiva
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India.
| | - Subhas Konar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Jitender Saini
- Department of Neuroradiology and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Bhagavatula Indira Devi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
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Diana F, Mangiafico S, Valente V, Wlderk A, Grillea G, Colonnese C, Bartolo M. Persistent trigeminal artery aneurysms: case report and systematic review. J Neurointerv Surg 2019; 11:1261-1265. [DOI: 10.1136/neurintsurg-2019-015046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/30/2019] [Accepted: 06/02/2019] [Indexed: 11/04/2022]
Abstract
BackgroundThe persistent trigeminal artery (PTA) is an adult carotid-basilar anastomosis with debated pathologic aspects, such as its association with brain aneurysms. True trigeminal artery aneurysms are rare vascular anomalies, reported in a few case reports.ObjectiveTo report our experience with a ruptured trigeminal artery aneurysm and to provide a systematic review of the literature in order to analyse potential links between the anatomic configuration of the PTA and PTA aneurysm (PTAA) type, and implications of each PTAA type for the diagnostic and therapeutic approach.MethodsWe reviewed the medical literature on trigeminal artery aneurysms according to the PRISMA guidelines. Population characteristics, aneurysms features, and PTA type and side were assessed.Results40 previously published cases of PTAAs were included in the analysis. The mean age of subjects was 55 years, with a strong female predominance (77%). Four PTAAs were accidentally discovered, while 16 caused compressive symptoms and 20 were ruptured. Successful endovascular treatment was performed in 62% of cases.ConclusionsPTAAs are rare vascular anomalies, underdiagnosed in the presence of a trigemino-cavernous fistula. Parent vessel occlusion seems to be the best therapeutic option for ruptured or symptomatic unruptured PTAAs in Saltzman type II and III PTAs. Patency of the parent vessel is the main target in Saltzman type I PTA.
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Abstract
The primitive carotid-vertebrobasilar anastomoses are primitive embryonic cerebral vessels that temporarily provide arterial supply from the internal carotid artery to the longitudinal neural artery, the future vertebrobasilar artery in the hindbrain. Four types known are the trigeminal, otic, hypoglossal, and proatlantal intersegmental arteries. The arteries are accompanied by their corresponding nerves and resemble an intersegmental pattern. These vessels exist in the very early period of cerebral arterial development and rapidly involute within a week. Occasionally, persistence of the carotid to vertebrobasilar anastomosis is discovered in the adult period, and is considered as the vestige of the corresponding primitive embryonic vessel. The embryonic development and the segmental property of the primitive carotid-vertebrobasilar anastomoses are discussed. This is followed by a brief description of the persisting anastomoses in adults.
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Affiliation(s)
- Katsunari Namba
- Center for Endovascular Therapy, Division of Neuroendovascular Surgery, Jichi Medical University
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Alcalá-Cerra G, Tubbs RS, Niño-Hernández LM. Anatomical features and clinical relevance of a persistent trigeminal artery. Surg Neurol Int 2012; 3:111. [PMID: 23087827 PMCID: PMC3475875 DOI: 10.4103/2152-7806.101798] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 08/15/2012] [Indexed: 11/29/2022] Open
Abstract
Background: Although persistent trigeminal artery (PTA) is uncommonly identified, knowledge of this structure is essential for clinicians who interpret cranial imaging, perform invasive studies of the cerebral vasculature, and operate this region. Methods: A review of the medical literature using standard search engines was performed to locate articles regarding the PTA, with special attention with anatomical descriptions. Results: Although anatomical reports of PTA anatomy are very scarce, those were analyzed to describe in detail the current knowledge about its anatomical relationships and variants. Additionally, the embryology, classification, clinical implications, and imaging modalities of this vessel are extensively discussed. Conclusions: Through a comprehensive review of isolated reports of the PTA, the clinician can better understand and treat patients with such an anatomical derailment.
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Affiliation(s)
- Gabriel Alcalá-Cerra
- Department of Neurosurgery, Hospital Universitario del Caribe, Universidad de Cartagena. Cartagena de Indias, Colombia
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Complex anomalies of type 1 proatlantal intersegmental artery and aortic arch variations. Surg Radiol Anat 2012; 35:177-80. [PMID: 22971758 DOI: 10.1007/s00276-012-1017-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 08/28/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE We report a case of type 1 proatlantal intersegmental artery (PIA) associated with multiple anomalies of the aortic arch, and discuss the possible embryonic mechanism and clinical importance of the multiple cerebrovascular variants in this patient. METHODS A 65-year-old woman with dizziness underwent cerebral magnetic resonance (MR) imaging and head and neck MR angiography using a 3-tesla scanner and computed tomography (CT) angiography using a 64-slice multidetector CT scanner. RESULTS MR and CT angiography demonstrated an aneurysm of the distal end of the azygos anterior cerebral arteries and hypoplasia of the proximal right vertebral artery (VA) with an anastomotic artery, between the right internal carotid artery (ICA) and distal right VA that passed through the foramen magnum, indicating a type 1 PIA. She also demonstrated an aberrant right subclavian artery (ARSA) with hypoplasia of the right VA, and the left VA arose directly from the aortic arch. CONCLUSION To our knowledge, this is the first report of a type 1 PIA associated with multiple vascular anomalies of the aortic arch, such as ARSA and origin of the left VA from the arch. In cases of persistent anastomoses between the carotid and vertebrobasilar arteries, such as PIAs, imaging examination should include the aortic arch to identify associated vascular variations.
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Vasović L, Jovanović I, Ugrenović S, Vlajković S, Jovanović P, Stojanović V. Trigeminal artery: a review of normal and pathological features. Childs Nerv Syst 2012; 28:33-46. [PMID: 22071960 DOI: 10.1007/s00381-011-1622-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 10/18/2011] [Indexed: 12/28/2022]
Abstract
OBJECTS Carotid-vertebrobasilar anastomoses-the trigeminal, otic, hypoglossal, and proatlantal intersegmental arteries-serve as transitory channels between primitive internal carotid arteries and bilateral longitudinal neural arterial plexus, which is the precursor of future basilar artery, when the human embryo reaches about 4-mm length. MATERIAL AND METHODS Normal and/or abnormal morphofunctional aspects of the prenatal and postnatal forms of the trigeminal artery are described according to personal and literature data. Many arteries of similar origin and course are also noted in the differential diagnosis of the trigeminal artery. CONCLUSIONS The persistent primitive trigeminal artery, as the most commonly carotid-vertebrobasilar anastomosis, has a reported incidence of 0.03-2.2% in the literature. There is female sex predilection, and it may be discovered in patients of any age, on either side, and in association with many vascular variants. Although the significance of persistent primitive trigeminal artery regarding the development of an aneurysm or association with another pathological condition may not be clear, its (ab)normal morphology is the inspiration for anatomists, especially for neurosurgeons, before planning diagnostic and therapeutic procedures.
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Affiliation(s)
- Ljiljana Vasović
- Department of Anatomy, Faculty of Medicine, University of Niš, Blvd. Dr Zoran Đinđić 81, 18000 Niš, Serbia.
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Meckel S, Spittau B, McAuliffe W. The persistent trigeminal artery: development, imaging anatomy, variants, and associated vascular pathologies. Neuroradiology 2011; 55:5-16. [PMID: 22170080 DOI: 10.1007/s00234-011-0995-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Accepted: 11/29/2011] [Indexed: 10/14/2022]
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Normal and abnormal embryology and development of the intracranial vascular system. Neurosurg Clin N Am 2011; 21:399-426. [PMID: 20561492 DOI: 10.1016/j.nec.2010.03.011] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The brain vascular system develops in such a way that it continuously adapts the supply of oxygen and other nutrients to the needs of the parenchyma. To accompany the developing brain vesicles, it evolves in several steps: superficial meningeal network first; intraventricular choroid plexuses which determine the arterial pattern; penetrating capillaries from the surface to the ventricular germinal matrix forming simple transcerebral arteriovenous loops; cortical capillaries last, mainly in the last trimester. The venous return becomes connected to both the surface and to the choroidal veins, so forming distinct meningeal and subependymal venous drainage systems, while the arteries are on the surface only. While the arterial system was determined early (week 8), the venous system is continuously remodeled by the morphological changes of the base of the skull and the expansion of the brain vesicles. Until late in gestation, the vascular system is made of simple endothelial channels in which the arterial or venous fate is determined primarily by the direction of flow.
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Tubbs RS, Verma K, Riech S, Mortazavi MM, Shoja MM, Loukas M, Curé JK, Zurada A, Cohen-Gadol AA. Persistent fetal intracranial arteries: a comprehensive review of anatomical and clinical significance. J Neurosurg 2011; 114:1127-34. [PMID: 21235309 DOI: 10.3171/2010.11.jns101527] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
As fetal intracranial vessels may persist into adulthood, knowledge of their anatomy and potential clinical and surgical complications should be borne in mind by the surgeon. A comprehensive review of these vessels, however, is not easily identified in the literature. Therefore, the present analysis was undertaken so that such information is available to the clinician and morphologist.
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Affiliation(s)
- R Shane Tubbs
- Section of Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama 35233, USA.
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Tuccar E, Sen T, Esmer AF. Anatomy and clinical significance of the trigeminocerebellar artery. J Clin Neurosci 2009; 16:679-82. [DOI: 10.1016/j.jocn.2008.06.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Revised: 05/27/2008] [Accepted: 06/01/2008] [Indexed: 10/21/2022]
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