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Ota T, Komiyama M. Vascular supply of the hindbrain: Basic longitudinal and axial angioarchitecture. Interv Neuroradiol 2022; 28:756-764. [PMID: 34935534 PMCID: PMC9706269 DOI: 10.1177/15910199211063011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 11/15/2022] Open
Abstract
The basic pattern of arterial vascularization is highly conserved across vertebrates and develops under neuromeric rules. The hindbrain has an angioarchitecture that is homologous to that of the spinal cord, and the hindbrain vascular system can be analyzed at the longitudinal and axial structures. During development, there are two main longitudinal arteries: the longitudinal neural artery and primitive lateral basilovertebral anastomosis. This review discusses the basic pattern of the blood supply of the hindbrain, the development of vascularization, and the anatomical variations, with a special reference to the embryological point of view of two main longitudinal anastomoses (longitudinal neural artery and primitive lateral basilovertebral anastomosis). The formation of commonly observed variations, such as fenestration and duplication of the vertebrobasilar artery, or primitive trigeminal artery variant, can be explained by the partial persistence of the primitive lateral basilovertebral anastomosis. Understanding the pattern and the development of the blood supply of the hindbrain provides useful information of the various anomalies of the vertebrobasilar junction and cerebellar arteries.
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Affiliation(s)
- Takahiro Ota
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo,
Japan
| | - Masaki Komiyama
- Department of Neurointervention, Osaka City General Hospital, Osaka,
Japan
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Deniz MA, Turmak M, Hattapoğlu S, Tekinhatun M. Persistent trigeminal artery detected on computed tomography angiography. Surg Radiol Anat 2022; 44:715-720. [DOI: 10.1007/s00276-022-02960-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/02/2022] [Indexed: 10/18/2022]
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Abdalla O, Ahmed R, Ewida A, Gould G. Rare PTA variant (Saltzman type IIIa) associated with multiple cerebral aneurysms. BMJ Case Rep 2021; 14:e241258. [PMID: 33653866 PMCID: PMC7929836 DOI: 10.1136/bcr-2020-241258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Odai Abdalla
- Neurology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Rashid Ahmed
- Neurology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Amr Ewida
- Neurology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Grahame Gould
- Neurosurgery, SUNY Upstate Medical University, Syracuse, New York, USA
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Suematsu Y, Watanabe T, Takeshima H. Posterior Petrous Meningioma Fed by a Branch of the Persistent Trigeminal Artery Terminating in the Anterior Inferior Cerebellar Artery. World Neurosurg 2021; 150:110-113. [PMID: 33640533 DOI: 10.1016/j.wneu.2021.02.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 11/30/2022]
Abstract
Persistent trigeminal artery (PTA) is the most common persistent carotid-basilar fetal anastomosis and terminates extremely rarely directly in the dominant hemispheric branch of the anterior inferior cerebellar artery (AICA). We present a case of a branch of this PTA variant (Saltzman type 3b) demonstrated as the feeding artery of a large posterior petrous meningioma, which was confirmed under direct vision during surgery through the extended retrosigmoid approach. Meticulous dissection from the tumor surface provided early identification of the feeding branch from the PTA and its bifurcation at the attachment of the posterior petrous surface adjacent to the jugular foramen enabled preservation of the terminal cortical branch of the cerebellar hemisphere. Meningioma in the posterior cranial fossa may recruit substantial supply from branches of the PTA terminating in the AICA. This PTA variant should be recognized during surgical resection of posterior fossa neoplasms to prevent ischemic complication of the AICA territory.
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Affiliation(s)
- Yuuki Suematsu
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
| | - Takashi Watanabe
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hideo Takeshima
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Ferreira A, Coelho PS, Cruz VT. Persistent trigeminal artery in a patient with posterior circulation stroke treated with rt-PA: case report. BMC Neurol 2019; 19:257. [PMID: 31656167 PMCID: PMC6816207 DOI: 10.1186/s12883-019-1492-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A persistent trigeminal artery (PTA) is a non-involuted embryonic vessel that connects the cavernous part of the internal carotid artery with the posterior circulation. In the adult it is associated with multiple pathological conditions including trigeminal neuralgia, ophthalmoplegia, hypopituitarism, intracavernous fistula, brain aneurysms and posterior circulation strokes. The latter may occur through steal phenomena or thrombosis in the anterior circulation. PTA associated vertebrobasilar hypoplasia has yet to be associated to TIA like events, however, in the reported case, that seems to be the case with reported vertigo being probably linked to vertebrobasilar insufficiency. CASE REPORT We present a case of an 82-year-old man with sudden onset neurological deficits, including left hemiparesis with crural predominance, vertical nystagmus, right internuclear ophthalmoplegia, dysarthria and dysmetria on the left arm. CT angiography disclosed basilar artery hypoplasia in the proximal two thirds and a persistent trigeminal artery. He was diagnosed with acute ischemic stroke. He was submitted to rt-PA with partial reversion of deficits. CONCLUSION The ischemic events related to PTA remain a rare cause of stroke with specific pathophysiological mechanisms and implications. They may occur through steal phenomena or thrombosis in the anterior circulation. Upon literature review, in the described case both mechanisms seem possible, however the transient episodes of vertigo could have been the first sign of vertebrobasilar insufficiency.
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Affiliation(s)
- Axel Ferreira
- Neurology Department, Hospital Pedro Hispano, ULS Matosinhos, Porto, Portugal.
| | - Paulo S Coelho
- Neurology Department, Hospital Pedro Hispano, ULS Matosinhos, Porto, Portugal
| | - Vítor Tedim Cruz
- Neurology Department, Hospital Pedro Hispano, ULS Matosinhos, Porto, Portugal.,EPIUnit, Institute of Public Health University of Porto, Porto, Portugal
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Brzegowy K, Pękala PA, Zarzecki MP, Pękala JR, Roy J, Aziz HM, Tubbs RS, Walocha JA, Tomaszewski KA, Mikos M. Prevalence and Clinical Implications of the Primitive Trigeminal Artery and its Variants: A Meta-Analysis. World Neurosurg 2019; 133:e401-e411. [PMID: 31536812 DOI: 10.1016/j.wneu.2019.09.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The primitive trigeminal artery (PTA) is the most common and the largest persistent carotid-basilar anastomosis. Primitive trigeminal artery variants (PTAVs) are anastomoses between the internal carotid artery and cerebellar arteries. These vessels pose a risk of hemorrhagic or ischemic complications during neurosurgical procedures in the parasellar and intrasellar regions. The aim of this study was to determine the prevalence of both PTA and PTAVs and their clinically important anatomic features. METHODS Major electronic databases were thoroughly searched for studies on PTA and PTAV. References in the included articles were also evaluated. Data regarding prevalence, laterality, origin, course patterns, and associated anomalies were extracted and pooled into a meta-analysis. RESULTS A total of 39 studies (110,866 patients) were included in the meta-analysis. The total pooled prevalence estimate of PTA and PTAVs combined was 0.4% (95% confidence interval [CI], 0.3-0.5). Individually, PTA was present in 0.3% of patients and PTAV in 0.2%. Both arteries most often originated from the C4 internal carotid artery and took a course lateral to the dorsum sellae. The anterior inferior cerebellar artery type was the predominant PTAV (72.1%). Basilar artery hypoplasia was found in 42.5% of patients with a PTA. CONCLUSIONS PTA and PTAVs are rare vessels, but they are clinically important because they can contribute to trigeminal neuralgia. Knowledge of the potential course of these arteries is essential in neuroradiology and neurosurgery, especially in minimally invasive procedures such as the endoscopic endonasal transsphenoidal approach to the pituitary gland and the percutaneous gasserian ganglion procedure.
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Affiliation(s)
- Karolina Brzegowy
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland; International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - Przemysław A Pękala
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland; International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - Michał P Zarzecki
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland; International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - Jakub R Pękala
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland; International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - Joyeeta Roy
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Hasina M Aziz
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland; International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington, USA
| | - Jerzy A Walocha
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland; International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - Krzysztof A Tomaszewski
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland; International Evidence-Based Anatomy Working Group, Krakow, Poland; Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland.
| | - Marcin Mikos
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
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Alonso-Vanegas MA, Quintero-López E, Moreira-Holguín JC, Martínez-Albarrán AA, Corona-Cedillo R, Gómez-Amador JL. Communicating Segment Aneurysm of Internal Carotid Artery Associated with Saltzman's Type III Persistent Trigeminal Artery: A Case Report. Ann Vasc Surg 2016; 38:316.e7-316.e12. [PMID: 27522982 DOI: 10.1016/j.avsg.2016.05.095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/05/2016] [Accepted: 05/06/2016] [Indexed: 11/19/2022]
Abstract
Persistent trigeminal artery (PTA), also called primitive trigeminal artery, represents the most common embryonic remnant of fetal circulation in adulthood, (only after fetal pattern of posterior communicating artery [PComA]) with an estimated incidence of between 0.1% and 0.76%. The permanence of this fetal pattern constitutes an incidental finding in most cases, however, may be associated with aneurysms, arteriovenous malformations, trigeminal neuralgia, and other types of fetal circulation persistency. A patient with giant aneurysm in the communicating segment of the right internal carotid artery, associated with the presence of PTA and fetal pattern of PComA, also on the right side is reported.
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Affiliation(s)
- Mario A Alonso-Vanegas
- Epilepsy Priority Program, Department of Neurosurgery, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico; Hospital HMG Coyoacán, Mexico City, Mexico; Hospital ABC, Mexico City, Mexico
| | | | - Juan C Moreira-Holguín
- National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
| | - Adrián Axallacan Martínez-Albarrán
- National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico; Epilepsy Priority Program, National Autonomous University of Mexico, Mexico City, Mexico.
| | | | - Juan L Gómez-Amador
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
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Variant PTA Terminating in Cerebellar Artery, Associated with Multiple Aneurysms. Case Rep Radiol 2016; 2016:4594326. [PMID: 27446623 PMCID: PMC4944022 DOI: 10.1155/2016/4594326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 05/04/2016] [Accepted: 06/09/2016] [Indexed: 11/18/2022] Open
Abstract
Persistent trigeminal artery (PTA) is one of the remnant fetal anastomoses between the carotid artery and basilar artery. PTAs are classified according to angiographic appearance and various connection. Among them, those directly terminating in the cerebellar arteries are rare subtype. In addition, aneurysms of the PTA are unusual in the literature and have not previously accompanied this subtype of PTA connecting cerebellar artery. We present the first case of an aneurysm of the PTA which is directly terminating in the cerebellar arteries and combined with multiple aneurysms.
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Takigawa T, Suzuki K, Sugiura Y, Suzuki R, Takano I, Shimizu N, Tanaka Y, Hyodo A. Double-balloon remodeling for coil embolization of a primitive trigeminal artery variant aneurysm. A case report. Interv Neuroradiol 2014; 20:295-300. [PMID: 24976091 DOI: 10.15274/inr-2014-10053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 11/23/2013] [Indexed: 11/12/2022] Open
Abstract
Here we describe the case of a patient with a wide-necked unruptured aneurysm arising at origin of a persistent primitive trigeminal artery (PTA) variant from the right internal carotid artery (ICA), supplying the territory of the right superior cerebellar artery and the anterior inferior cerebellar artery. To preserve the ICA and the PTA variant, coil embolization of the aneurysm was performed using a double-balloon remodeling technique (HyperForm™ and HyperGlide™ Occlusion Balloon Systems; ev3 Endovascular Inc., Irvine, CA, USA). The association of a PTA variant with an aneurysm is very rare. To our knowledge, this is the first description of the use of coil embolization using double-balloon remodeling to treat a PTA variant aneurysm. This technique permits complete embolization and reduces the risk of cerebral and cerebellar ischemia.
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Affiliation(s)
- Tomoji Takigawa
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital; Koshigaya, Saitama, Japan -
| | - Kensuke Suzuki
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital; Koshigaya, Saitama, Japan
| | - Yoshiki Sugiura
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital; Koshigaya, Saitama, Japan
| | - Ryotaro Suzuki
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital; Koshigaya, Saitama, Japan
| | - Issei Takano
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital; Koshigaya, Saitama, Japan
| | - Nobuyuki Shimizu
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital; Koshigaya, Saitama, Japan
| | - Yoshihiro Tanaka
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital; Koshigaya, Saitama, Japan
| | - Akio Hyodo
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital; Koshigaya, Saitama, Japan
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Bai M, Guo Q, Li S. Persistent trigeminal artery/persistent trigeminal artery variant and coexisting variants of the head and neck vessels diagnosed using 3 T MRA. Clin Radiol 2013; 68:e578-85. [DOI: 10.1016/j.crad.2013.05.099] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 05/09/2013] [Accepted: 05/29/2013] [Indexed: 10/26/2022]
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Uchino A. Bilateral persistent trigeminal artery variants diagnosed by MR angiography. THE CEREBELLUM 2012; 10:745-7. [PMID: 21544587 DOI: 10.1007/s12311-011-0284-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A persistent trigeminal artery (PTA) is the most common anastomosis between the carotid and vertebrobasilar system. A PTA variant (PTAV) is a rare anomaly in which the cerebellar artery arises from the internal carotid artery (ICA) without connection with the basilar artery (BA). I present what I believe is the first report of bilateral PTAVs diagnosed using magnetic resonance (MR) angiography and briefly discuss the embryology of this rare anomaly. An 81-year-old woman with small infarctions underwent cerebral MR imaging and MR angiography with a 1.5-tesla imager for the evaluation of brain lesions. An MR angiography was obtained using the standard noncontrast three-dimensional time-of-flight technique. The MR angiographic demonstration of bilateral anterior inferior cerebellar arteries arising from the precavernous segment of the ICA without anastomosis to the BA indicated bilateral PTAVs. This is the first report of bilateral PTAVs diagnosed by MR angiography. The literature review indicates that an estimated prevalence of bilateral PTAVs is about 0.0012%.
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Affiliation(s)
- Akira Uchino
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, Japan.
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Conforti R, Parlato RS, De Paulis D, Cirillo M, Marrone V, Cirillo S, Moraci A, Parlato C. Trigeminal neuralgia and persistent trigeminal artery. Neurol Sci 2012; 33:1455-8. [PMID: 22246457 PMCID: PMC3506834 DOI: 10.1007/s10072-012-0942-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 01/06/2012] [Indexed: 11/29/2022]
Abstract
We report a case of trigeminal neuralgia caused by persistent trigeminal artery (PTA) associated with asymptomatic left temporal cavernoma. Our patient presented unstable blood hypertension and the pain of typical trigeminal neuralgia over the second and third divisions of the nerve in the right side of the face. The attacks were often precipitated during physical exertion. MRI and Angio-MRI revealed the persistent carotid basilar anastomosis and occasionally left parietal cavernoma. After drug treatment of blood hypertension, spontaneous recovery of neuralgia was observed and we planned surgical treatment of left temporal cavernoma.
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Affiliation(s)
- Renata Conforti
- Department of Neurological Sciences (Neurosurgery), Second University of Naples, Viale Colli Aminei, 21, 80131, Naples, Italy
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Nakamagoe K, Mamada N, Shiigai M, Shimizu K, Koganezawa T, Tamaoka A. Recurrent isolated abducens nerve paresis associated with persistent trigeminal artery variant. Intern Med 2012; 51:2213-6. [PMID: 22892506 DOI: 10.2169/internalmedicine.51.7862] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a 74-year-old woman who presented with recurrent isolated abducens nerve paresis. Cranial magnetic resonance imaging revealed that the right abducens nerve was sandwiched between the right internal carotid artery and a persistent trigeminal artery (PTA) variant, which might have led to neurovascular compression of the abducens nerve, resulting in abducens nerve damage. Normal variants of PTA, which are cerebellar arteries originating from a precavernous portion of the internal carotid artery, must be carefully observed as such variants can potentially cause a neurovascular compression of the abducens nerve.
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Affiliation(s)
- Kiyotaka Nakamagoe
- Department of Neurology, Institute of Clinical Medicine, University of Tsukuba, Japan.
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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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Perot G, Clarençon F, Di Maria F, Sourour N, Biondi A, Cornu P, Chiras J. Persistent trigeminal artery feeding a hemispheric branch of the posterior inferior cerebellar artery: A rare anatomic variant. J Neuroradiol 2011; 38:251-4. [DOI: 10.1016/j.neurad.2011.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 02/13/2011] [Accepted: 02/28/2011] [Indexed: 11/16/2022]
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Uchino A, Saito N, Okada Y, Kozawa E, Mizukoshi W, Inoue K, Takahashi M. Persistent trigeminal artery and its variants on MR angiography. Surg Radiol Anat 2011; 34:271-6. [DOI: 10.1007/s00276-011-0848-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 06/24/2011] [Indexed: 11/29/2022]
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Turkoglu E, Arat A, Patel N, Kertmen H, Başkaya MK. Anterior communicating artery aneurysm associated with an infraoptic course of anterior cerebral artery and rare variant of the persistent trigeminal artery: A case report and literature review. Clin Neurol Neurosurg 2011; 113:335-40. [DOI: 10.1016/j.clineuro.2010.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2010] [Revised: 12/13/2010] [Accepted: 12/19/2010] [Indexed: 10/18/2022]
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18
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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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Soens J, Vrabec M, Demaerel P, Wilms G. Persistent Trigeminal Artery Variant: MR Angiographic Demonstration. A Report of Two Cases. Neuroradiol J 2010; 23:696-9. [PMID: 24148723 DOI: 10.1177/197140091002300608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 10/07/2010] [Indexed: 11/17/2022] Open
Abstract
A variant (PTAV) is the persistence after birth of the fetal carotid-basilar anastomosis between the internal carotid artery and a cerebellar artery. We describe two cases of a PTAV demonstrated on MR angiography. A comparison with a persistant trigeminal artery is made and an explanation of the extended Saltzman classification is given. These variants have only little clinical significance, but their recognition is crucial before surgical or interventional procedures or to understand paradoxical cerebellar lesions. MRA appears inferior to selective angiography in diagnosing these variants.
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Affiliation(s)
- J Soens
- Radiology Department, UZ Leuven; Leuven, Belgium -
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Bokkers R, van Laar P, van der Zwan A, Mali W, Hendrikse J. Mixed perfusion: A combined blood supply to the brain tissue by multiple arteries. J Neuroradiol 2010; 37:201-10. [DOI: 10.1016/j.neurad.2010.01.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 01/27/2010] [Accepted: 01/28/2010] [Indexed: 11/27/2022]
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O'uchi E, O'uchi T. Persistent primitive trigeminal arteries (PTA) and its variant (PTAV): analysis of 103 cases detected in 16,415 cases of MRA over 3 years. Neuroradiology 2010; 52:1111-9. [PMID: 20309534 DOI: 10.1007/s00234-010-0669-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Accepted: 02/24/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The primitive persistent trigeminal artery (PTA) is the most common carotid-basilar anastomosis, but because of its extremely low incidence, it is poorly understood. The purpose of this study is to clarify the features of PTA and its variants (PTAV) based on a large magnetic resonance angiography (MRA) series. METHODS MRA was performed on continuous 16,415 patients (8,610 males and 7,805 females) between October 2005 and September 2008 using two 1.5-T systems and one 1.0-T system. These all MRAs were evaluated by neuroradiologists. RESULTS The incidence of both PTA and PTAV was 0.68% (48 cases of PTA, 50 cases of PTAV, and five unclassified). Among them, 65 cases originated from the left internal carotid artery and 38 from the right. There were 44 cases of lateral type PTA and four cases of medial type. Hypoplasia of the basilar artery proximal to the union of PTA was recognized as follows: no hypoplasia in 12 cases, moderate hypoplasia in 22 cases, and severe hypoplasia in 13 cases. Distance from SCA and the union was an average of 6.7 mm. Four cases of pre- and postoperative cerebral aneurysms were recognized in 103 cases (3.9%). CONCLUSION We have identified details of both PTA/PTAV. The incidence of PTA was similar to previous studies, and the co-existence of cerebral aneurysm was also similar when compared to patients in the general population without PTA or PTAV.
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Affiliation(s)
- Eri O'uchi
- Department of Radiology, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan.
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Pereira LP, Nepomuceno LA, Coimbra PP, Oliveira Neto SRD, Natal MRC. Persistent trigeminal artery: angio-tomography and angio-magnetic resonance finding. ARQUIVOS DE NEURO-PSIQUIATRIA 2009; 67:882-5. [DOI: 10.1590/s0004-282x2009000500019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 07/22/2009] [Indexed: 11/22/2022]
Abstract
The trigeminal artery (TA) is the most common embryonic carotid-vertebrobasilar anastomosis to persist into adulthood. It typically extends from the internal carotid artery to the basilar artery. Persistent primitive arteries are usually found incidentally, but are often associated with vascular malformation, cerebral aneurysm and, in case of TA, with trigeminal neuralgia. We present one patient with TA as a cause of trigeminal neuralgia and in other three as an incidental finding, on TC and MR angiograms.
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Yang Z, Liu J, Zhao W, Xu Y, Hong B, Huang Q, He S. A fusiform aneurysm of a persistent trigeminal artery variant: case report and literature review. Surg Radiol Anat 2009; 32:401-3. [PMID: 19690795 DOI: 10.1007/s00276-009-0537-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 07/25/2009] [Indexed: 11/30/2022]
Abstract
A 48-year-old man suffered from spontaneous subarachnoid hemorrhage. Emergent right internal carotid angiography showed the presence of a persistent trigeminal artery (PTA) variant with a fusiform aneurysm on its proximal segment where it branched from the internal carotid artery. This artery supplied the territory of the anterior inferior cerebellar artery. After consideration of the adequacy of the cerebellar circulation without this anomalous artery, intraluminal occlusion of the aneurysm together with the PTA variant was performed using detachable coils. The patient recovered uneventfully without any neurologic deficits.
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Affiliation(s)
- Zhigang Yang
- Department of Neurosurgery, Changhai Hospital, Shanghai, China
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Dimmick SJ, Faulder KC. Normal Variants of the Cerebral Circulation at Multidetector CT Angiography. Radiographics 2009; 29:1027-43. [DOI: 10.1148/rg.294085730] [Citation(s) in RCA: 175] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Arakawa T, Koizumi M, Terashima T, Honma S, Kawai K, Kodama K, Miki A. Two anatomical autopsy cases of direct communication between a persistent primitive trigeminal artery and an anterior inferior cerebellar artery. Ann Anat 2007; 189:489-98. [PMID: 17910403 DOI: 10.1016/j.aanat.2006.11.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The persistent primitive trigeminal artery (PPTA) is the most common persistent carotid-basilar anastomosis. However, morphological findings of the PPTA based on the anatomical autopsy are very scarce. To understand the reason why such a variant artery develops, it is essential to examine the detailed morphology of the PPTA and developmental process of this artery. Here, we present two anatomical autopsy instances of the PPTA (cases 1 and 2). In the first case (78-year-old female; right side), the anterior inferior cerebellar artery (AICA) arose from the internal carotid artery passing medial to the abducens nerve. This artery gave off a small branch communicating to the basilar artery, passed lateral to the trigeminal nerve root, and continued backward to the dorsal surface of the cerebellum. Thus, in this case, the AICA is considered to be branched from the PPTA. In the second case (75-year-old female, left side), the PPTA branched from the internal carotid artery, and passed lateral to the abducens nerve, giving off an artery connecting with the AICA. These communicating arteries between the basilar artery and the AICA, recognized in cases 1 and 2, are considered to be the persistence of the primitive lateral basilovertebral anastomosis during the early embryological period. We propose that the primitive lateral basilovertebral anastomosis forms the arterial network around the trigeminal nerve root, and the AICA develops through this anastomosis.
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Affiliation(s)
- Takamitsu Arakawa
- Department of Physical Therapy, Faculty of Health Science, Kobe University Graduate School of Medicine, 7-10-2 Tomogaoka, Suma-Ku, Kobe 654-0142, Japan.
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26
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Scazzeri F, Picchietti S, Lonzi S, Ferrito G, Prosetti D, Paoli C. Persistent primitive trigeminal artery in monochorial twins. A case report. Neuroradiol J 2007; 20:186-9. [PMID: 24299641 DOI: 10.1177/197140090702000209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2007] [Accepted: 03/19/2007] [Indexed: 11/17/2022] Open
Abstract
The trigeminal artery is one of the arterial structures that constitute anastomosis between the carotid and the posterior circulation during fetal life and usually regress. However these arterial structures may persist in adult life and the trigeminal artery is the one that most frequently show such behaviour. We describe the case of two monochorial female twins with a persistent primitive trigeminal artery revealed by magnetic resonance angiography.
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Affiliation(s)
- F Scazzeri
- Neuroradiology Unit, Spedali Riuniti; Livorno, Italy -
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27
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de Bondt BJ, Stokroos R, Casselman J. Persistent trigeminal artery associated with trigeminal neuralgia: hypothesis of neurovascular compression. Neuroradiology 2006; 49:23-6. [PMID: 17089114 DOI: 10.1007/s00234-006-0150-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2006] [Accepted: 08/08/2006] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The aim of this study was to determine the prevalence of persistent trigeminal artery (PTA) associated with trigeminal neuralgia (TN). METHODS From January 1998 to January 2004, 288 MRI scans of patients examined for trigeminal deficits were retrospectively evaluated. MRI was performed at 1.5 T. Scan protocols included cerebral TSE T2-weighted imaging, contrast enhanced SE T1-weighted imaging and thin-section 3D T2-weighted imaging of the temporal bones, 3D TOF pre- and postcontrast MR angiography. TN was defined as episodes of intense stabbing, electric shock-like pain in areas of the face supplied by the trigeminal branches. Neurovascular compression (NVC) was assumed to be present if the patient showed clinical features of TN, if there was contact between an artery and the trigeminal nerve on the affected side, and if other pathology had been excluded. The prevalence and confidence intervals were calculated (95% CI of the prevalence was based on the exact binomial distribution). RESULTS Of 288 patients, 136 matched the criteria for TN. In this series a PTA was detected in three patients, which in all patients was on the same side as the TN. The prevalence of a PTA in patients presenting with TN was 2.2% (CI 0.005-0.06). CONCLUSION Previous studies have shown PTA as an incidental finding in 0.1-0.6% of cerebral angiograms. The prevalence of a PTA in patients with TN was 2.2%. With respect to the clinical significance, a PTA has to be considered in TN and the diagnosis of a PTA can easily be made using MR imaging/angiography.
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Affiliation(s)
- Bert-Jan de Bondt
- Department of Radiology, University Hospital Maastricht, P. Debeyelaan 25, 6202 AZ Maastricht, The Netherlands.
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Parmar H, Sitoh YY, Hui F. Normal variants of the intracranial circulation demonstrated by MR angiography at 3T. Eur J Radiol 2005; 56:220-8. [PMID: 15950421 DOI: 10.1016/j.ejrad.2005.05.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2005] [Revised: 05/09/2005] [Accepted: 05/11/2005] [Indexed: 10/25/2022]
Abstract
Magnetic resonance angiography (MRA) at 3T offers increased signal to noise ratio with better background suppression, leading to exquisite depiction of the intracranial circulation. We present a pictorial review of the normal variations and anomalies of the intracranial circulation detected on MRA performed on a high field 3T clinical scanner using parallel imaging techniques. The salient imaging features of these anomalies and normal variations are discussed with relevance to clinical practice.
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Affiliation(s)
- H Parmar
- National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.
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Compressive effect of large persistent trigeminal artery upon pituitary gland: importance of MRI and MRA. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/j.ejrex.2004.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Uchino A, Sawada A, Takase Y, Kudo S. MR Angiography of Anomalous Branches of the Internal Carotid Artery. AJR Am J Roentgenol 2003; 181:1409-14. [PMID: 14573446 DOI: 10.2214/ajr.181.5.1811409] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Akira Uchino
- Department of Radiology, Saga Medical School, 5-1-1 Nabeshima, Saga 849-8501, Japan.
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