Persistent Primitive Trigeminal Artery Research Articles

Trigeminal neuralgia caused by a persistent primitive trigeminal artery variant passing through Meckel’s cavity: a case report

BackgroundPersistent primitive trigeminal artery variant (PPTAv) is a rare remnant of the primitive intracranial embryonic anastomotic arteries, and its persistence has an unknown etiology. Trigeminal neuralgia attributed to a PPTAv passing through Meckel’s cavity is extremely uncommon.Case presentationA 73-year-old woman presented with right-sided facial pain for 10 years that had failed to respond to medication. Magnetic resonance angiography suggested the presence of a PPTAv compressing the trigeminal nerve, as the abnormal artery originated from the right internal carotid artery. During microvascular decompression (MVD), the offending vessel was inferred to be a PPTAv, as it continued to become the anterior inferior cerebellar artery after passing through Meckel’s cavity. Postoperative computed tomography angiography showed the PPTAv continuing posteriorly as the anterior inferior cerebellar artery and supplying the cerebellar hemisphere, which confirmed the intraoperative judgment. The pain resolved after MVD and has not recurred in 12 months of follow-up.ConclusionMVD is the best surgical choice for trigeminal neuralgia combined with a PPTAv. For patients with neurovascular conflicts, particularly those with suspected vascular variations, preoperative imaging examinations play a critical role in meticulously evaluating the anatomical locations of the nerves and blood vessels. Semilunar puncture (for radiofrequency ablation or percutaneous balloon compression) is contraindicated in patients with a PPTAv.

Trigeminal neuralgia caused by a persistent primitive trigeminal artery: preoperative three-dimensional multifusion imaging and computational fluid dynamics analysis. Illustrative case.

Trigeminal neuralgia (TN) is caused by trigeminal nerve compression by colliding vessels. Preoperative three-dimensional (3D) multifusion images are useful for surgical simulations. Moreover, computational fluid dynamics (CFD) analysis of colliding vessels may be useful for hemodynamic evaluation at the site of neurovascular contact (NVC). A 71-year-old woman had TN due to compression of the trigeminal nerve by the superior cerebellar artery (SCA) fused with the persistent primitive trigeminal artery (PTA). Preoperative 3D multifusion simulation images of silent magnetic resonance (MR) angiography and MR cisternography depicted the NVC, including the trigeminal nerve, SCA, and PTA. CFD analysis revealed the hemodynamic condition of the NVC, including the SCA and PTA. The wall shear stress magnitude (WSSm) at the NVC showed a local elevation due to flow confluence from the SCA and PTA. High WSSm was observed in the NVC. Preoperative simulation images of MR angiography and MR cisternography may depict the NVC. CFD analysis can provide the hemodynamic condition at the NVC.

Management paradigms of persistent primitive trigeminal artery aneurysms: A systematic review and analysis of techniques and complications from 1960s to 2022: From conservative to surgical to endovascular, how far along the right path are we?

Aneurysms of persistent primitive trigeminal artery (PPTAAs) are increasingly reported and commonly managed by endovascular (EN) techniques. There are no systematic reviews or meta-analyses which analyse outcomes and complications of treatment modalities for PPTAAs. We aim to highlight the change in trend of management of PPTAAs and to identify clinical and radiological parameters which may influence management paradigms. A systematic search of literature was done in PubMed, Embase, Google Scholar, Cochrane library and Medline using keywords 'persistent primitive trigeminal artery', 'aneurysms', 'embolization', 'surgical clipping', etc. Only cases reporting aneurysms of PPTA were included. Three subgroups, such as conservative, open surgical (OS) and EN interventional, were studied for outcome evaluation. In the EN subgroup, relation of clinical and radiological parameters with outcome (complete/partial occlusion) was analysed using Microsoft Excel Data Analysis ToolPak. Of the 101 articles found eligible for assessment, 54 were analysed quantitatively. Mortality in the conservative group was 12.5% and OS group was 9.09%. After EN treatment, complete angiographic occlusion was seen in 88.89% PPTAAs and 5.5% warranted retreatment. In the EN subgroup, location (p=0.17), shape (p=0.69), Saltzman circulation (p=0.26) or status of rupture (p=0.08) did not significantly impact angiographic occlusion outcome. Multivariate regression analysis showed 6.6% influence of independent variables, that is, age, gender, aneurysm location, side, shape (saccular/fusiform), rupture status and type of Saltzman circulation on aneurysm occlusion outcome [F(7,27) =1.34] (p=0.27). Total mortality reported in the EN group was 8.57%. Clinical or radiological parameters do not influence angiographic occlusion outcome. Although EN techniques are successful, meticulous reporting of outcomes and complications is important.

Persistent Primitive Trigeminal Artery – A Rare Vessel

Primitive carotido vertebral anastomosis is a well-recognized entity. During intrauterine development, craniovertebral blood circulation is characterized by temporary connections between the primitive internal carotid and dorsal longitudinal neural arteries. With normal development, they regress in the prenatal period. The most common of these is a persistent primitive trigeminal artery (PPTA) We report the case of a young male patient with intracranial bleed in the left capsuloganglionic region who was subsequently found to have a persistent primitive trigeminal artery on Magnetic Resonance Imaging Angiography.

Clinical Importance of the Persistent Primitive Trigeminal Artery in Vascular Lesions and Its Role in Endovascular Treatment.

The persistent primitive trigeminal artery (PPTA) extends from the internal carotid artery to the basilar artery between the origins of the anterior inferior cerebellar artery and superior cerebellar artery. PPTAs have complex anatomical characteristics. Salas and Saltzman classifications are most often used in PPTAs. The PPTA can play many roles in vascular lesions, including intracranial aneurysms, brain arteriovenous malformations, trigeminal artery-cavernous fistulas, Moyamoya disease, and large vessel occlusion. For these lesions, surgical treatment is difficult due to the deep location and complex anatomy of the PPTA, but endovascular treatment (EVT) has emerged as a good alternative. Currently, a complete review of the clinical importance of the PPTA in terms of its role in the development and EVT of vascular lesions is lacking. Therefore, we conducted a PubMed search, performed a review of the relevant extracted literature and cataloged our experience with PPTAs. By review, we found that a thorough understanding of the anatomical and angiographic features of this PPTA is of utmost importance when making therapeutic decisions for any of these pathological conditions.

Persistent primitive trigeminal artery played a role as a collateral pathway in spontaneous internal carotid artery dissection: a case report

Persistent primitive trigeminal artery played a role as a collateral pathway in spontaneous internal carotid artery dissection: a case report

Unilateral Carotid-Cavernous Fistula Associated With Primitive Persistent Trigeminal Artery Leading to Bilateral Ophthalmic Presentations.

Unilateral Carotid-Cavernous Fistula Associated With Primitive Persistent Trigeminal Artery Leading to Bilateral Ophthalmic Presentations.

Fenestration of the cavernous internal carotid artery associated with a persistent primitive trigeminal artery.

Fenestration of the cavernous segment of the internal carotid artery (ICA) is an extremely rare variant with unknown clinical significance. We present two cases of this variant, both of which were associated with a persistent primitive trigeminal artery (PPTA). Large dual channels of the ICA were seen extending from the part immediately distal to the origin of the PPTA to the C3 segment of the ICA. We speculate that coexistence of the two vascular anomalies might be due to failed regression or a remnant of the primitive arterial network during the same early gestation period in which development of the PTA takes place (3-5 mm crown-rump length stage).

Contralateral Ocular Manifestations of a Carotid Cavernous Fistula Associated With Primitive Persistent Trigeminal Artery.

Contralateral Ocular Manifestations of a Carotid Cavernous Fistula Associated With Primitive Persistent Trigeminal Artery.

Successful mechanical thrombectomy using a combined technique for internal carotid artery occlusion with persistent primitive trigeminal artery

Background: The prevalence of persistent primitive trigeminal artery (PPTA) has been reported to be 0.1–0.6%. We report the successful recanalization of internal carotid artery (ICA) without embolization to new vascular territory (ENT) using a combined technique in a case of ICA occlusion with PPTA.Case Description: A 65-year-old female presented with sudden consciousness disorder. The Glasgow Coma Scale score was 7 (E1, V1, M5) and National Institutes of Health Stroke Scale score was 28. Magnetic resonance diffusion-weighted imaging showed areas of high signal intensity in the left frontal lobe, parietal lobe, insular cortex, and corona radiata. Magnetic resonance angiography showed occlusion of the left ICA distal to a PPTA. We performed mechanical thrombectomy (MT) using a combined technique with a balloon guide catheter (BGC), aspiration catheter, and stent retriever and achieved complete recanalization without ENT. The patient experienced a good postoperative recovery course. At 6 months, her Modified Rankin Scale score was 2.Conclusion: MT using a combined technique with BGC would be useful to prevent embolization to the posterior circulation through the PPTA in cases of ICA occlusion with PPTA.

Is a trident or a bident? Appearance of a primitive trigeminal artery on sagittal views

•Recognition of a persistent primitive trigeminal artery (PPTA) is of clinical significance due to its association with aneurysms and several vascular variants in addition to preoperative planning.•Characteristic appearance of PPTA on MR sagittal images of the brain resembles the Greek letter tau (two prongs) and was linked to Neptune’s trident (three prongs).•Use of a bident sign as a more visually and mythologically precise description of the appearance of PPTA. A 50 year old male with an incidental finding on the MRI brain (Fig. 1).Fig. 2A) Lateral digitally subtracted catheter angiogram of a selected internal carotid artery (arrow) injection demonstrating the persistent trigeminal artery (arrowhead) passing posteriorly to join the basilar artery (open arrow). B) Cropped view of the painting “Concilio degli dei” by Raffaello Sanzio da Urbino depicting Hades holding a bident (left), next to his brother Poseidon holding a trident (middle) [10]. Zeus (right) is also pictured, without a spear.View Large Image Figure ViewerDownload Hi-res image Download (PPT) A.fetal posterior cerebral arteryB.persistent trigeminal arteryC.persistent hypoglossal arteryD.persistent otic arteryE.persistent proatlantal artery Answer on page 240 Is a trident or a bident? Appearance of a primitive trigeminal artery on sagittal viewsJournal of Clinical NeuroscienceVol. 75PreviewA persistent primitive trigeminal artery (PPTA) is the remnant of the embryonic arterial circulation in adults and is the most common type of the persistent carotid-vertebrobasilar anastomoses (with frequency 0.1–0.6%); followed by persistent hypoglossal artery (0.02–0.1%), persistent proatlantal artery and otic artery, which existence, however, remains controversial [6,7]. A PPTA arises from the proximal cavernous part of the ICA and courses posteriorly to join the basilar artery. Recognition of a PPTA is of clinical significance due to its association with aneurysms and several vascular variants [1,4]. Full-Text PDF Erratum to “Is a trident or a bident? Appearance of a primitive trigeminal artery on sagittal views – Question and Is a trident or a bident? Appearance of a primitive trigeminal artery on sagittal views – Answer” [J. Clin. Neurosci. 75C (2020) 204–205 and 240–241]Journal of Clinical NeuroscienceVol. 78PreviewThe publisher regrets to inform readers that there was an error in the article title for both the question and answer articles. The correct title is ‘Is it a trident or a bident? Appearance of a persistent primitive trigeminal artery on sagittal views – Question’ and ‘Is it a trident or a bident? Appearance of a persistent primitive trigeminal artery on sagittal views – Answer’ respectively. Full-Text PDF

A unique temporary collateral pathway between carotid-vertebrobasilar arteries in a carotid dissection patient

BackgroundIn adults, the anastomosis between carotid and vertebrobasilar arteries is usually the posterior communicating artery, sometimes the primitive trigeminal artery. In this case, the basilar artery fed the internal carotid artery through the pontine-to-tentorial artery anastomosis after severe stenosis from traumatic carotid dissection.Case presentationA 32-year-old female was diagnosed with ischemic stroke caused by traumatic carotid artery dissection. Aspirin (100 mg/day) and clopidogrel (75 mg/day) were prescribed. Digital subtraction angiography performed 6 days after stroke onset showed a dissection in the cervical segment of left internal carotid artery with severe local stenosis, and a collateral pathway from BA to the cavernous segment of internal carotid artery through the lateral pontine and tentorial artery. Without interventional therapy, clinical symptoms improved significantly within 10 days after onset. At 3-month follow-up, left common carotid artery angiography showed the stenosis had been significantly improved with a residual aneurysm. There was no collateral pathway between carotid-vertebrobasilar arteries, and a residual small artery originated from the posterior vertical segment of cavernous internal carotid artery. The small artery was clearly visualized by 3-dimensional rotational angiography and identified the tentorial artery.ConclusionTo the author’s knowledge, this is the first report of a collateral pathway between carotid vertebrobasilar arteries through the pontine-to-tentorial artery anastomosis. Meanwhile, tentorial artery origination directly from the cavernous segment of internal carotid artery is rare and easily mistaken for persistent primitive trigeminal artery. 3-dimensional rotational angiography can provide sensitive and accurate diagnostic assessment of the small artery, and may be a useful tool for screening of abnormal small arteries.

Anterior Transpetrosal Approach for Trigeminal Schwannoma with Persistent Primitive Trigeminal Artery: 2-Dimensional Operative Video.

The surgical management of trigeminal schwannomas often requires complicated skull base approaches based on detailed anatomical understanding because of the involvement of multiple compartments of the trigeminal nerve from its root to the peripheral branches. When there is vital anatomical anomaly around the tumor, this can make the surgical management and anatomical understanding more difficult.1,2 This video demonstrates the microsurgical removal of a dumbbell-shaped trigeminal schwannoma via the anterior transpetrosal transtentorial approach in a patient with a persistent primitive trigeminal artery, the most common persistent embryonic carotid-vertebrobasilar anastomosis. A 32-yr-old woman presented with progressive facial sensory impairment, dizziness, and slight diplopia because of right abducens palsy. Neuroimaging revealed a right Meckel's cave tumor extending to both the middle and posterior cranial fossae and displacing the abducens nerve inferomedially. The persistent primitive trigeminal artery, which is an anomalous communication between the cavernous carotid and basilar arteries, was identified ventral to the tumor. While preserving most of the noninvaded trigeminal nerve, gross-total resection was achieved under direct visualization of the abducens nerve and persistent primitive trigeminal artery, piercing the dura of the posterior cavernous sinus and coursing medially along the clivus. The patient's facial sensory impairment and diplopia almost disappeared without new neurological deficits or tumor recurrence during the follow-up period of 1 yr. Three-dimensional reconstructed images demonstrated the anatomical relationship of the tumor, the persistent primitive trigeminal artery, and the extent of osseous drilling of the petrosectomy. Informed consent was obtained from the patient.

The conundrum of a resolving cavernous sinus syndrome

A middle-aged lady who presented with headaches and sudden onset of left cavernous sinus syndrome was found to have a left persistent primitive trigeminal artery (PPTA) on scans. The syndrome uniquely resolved spontaneously after a few days. Vascular variations in the region of the cavernous sinus should be actively sought in cross-sectional imaging performed for cavernous sinus syndrome.

P.103 Persistent primitive hypoglossal artery with an associated posterior circulation aneurysm

Background: Persistent fetal carotid-vertebrobasilar anastomoses are rare, with an incidence of <1%. The most common anomaly seen in this group is a persistent primitive trigeminal artery; others such as a persistent hypoglossal artery account for less than 15% of all persistent fetal anastomoses, making this finding exceedingly rare. Methods: We present the case of a 32-year-old-female with Poland syndrome (right-sided), who presented with thunderclap headache and reduced level of consciousness secondary to diffuse subarachnoid hemorrhage and hydrocephalus. CT and catheter angiography demonstrated an aneurysm of the V4 segment of the right vertebral artery arising from a persistent right hypoglossal artery, with an absent ipsilateral vertebral artery proximal to the anomaly. Results: Hydrocephalus was treated with an EVD, followed by a successful embolization of the V4 aneurysm with Axium coils. Subsequent MR studies demonstrated minimal recanalization of the aneurysm, and small foci of possible infarcts in the hippocampi. Four months later, the patient has some persistent short term memory difficulties but is otherwise neurologically intact. Conclusions: We present a rare finding of a persistent fetal hypoglossal artery with an associated vertebral aneurysm. The aneurysm was successfully treated endovascularly through coil embolization with minimal residual -neurological deficit. This vascular anomaly was ipsilateral to her Poland Syndrome defects.

Spontaneous direct carotid-cavernous sinus fistula secondary to a persistent primitive trigeminal artery treated by trans-venous coil embolisation.

A healthy 51-year-old female presented with a spontaneous direct carotid-cavernous sinus fistula associated with a persistent primitive trigeminal artery. She had no history of connective tissue or cerebrovascular disorders or significant head trauma. This is a rare lesion with only 18 previously reported cases. It had similar clinical presentation and imaging appearance to a high-flow direct carotid-cavernous fistula and was uncovered after successful trans-venous coil embolisation of the fistula. It therefore needs to be considered in cases of direct carotid-cavernous fistula without history of trauma. Knowledge of types of persistent primitive trigeminal artery is also important for their critical treatment implications.

Co-existence of persistent primitive trigeminal artery and another primitive carotid-basilar anastomosis associated with segmental agenesis of the ipsilateral internal carotid artery: a case report

BackgroundEmbryologically, the internal carotid artery (ICA) is comprised of seven segments, any of which may be absent. We presented a very rare case of a well-preserved persistent primitive trigeminal artery (PTA), serving as a collateral pathway to the distal internal carotid artery territory, associated with segmental agenesis of the ipsilateral internal carotid artery.ResultsA 47-year-old woman with no relevant previous medical history came to our hospital for a brain checkup. Magnetic resonance angiography revealed focal agenesis of the right ICA involving the cervical, ascending, and horizontal intrapetrous segments. The enlarged ipsilateral PTA mainly supplied the distal segments of the ICA. There was also the possibility of the co-existence of another primitive carotid-basilar anastomosis; however, we could not pursue a detailed evaluation.ConclusionsWe report a rare case of a well-preserved PTA serving as a collateral pathway to the distal ICA territory associated with segmental agenesis of the ipsilateral ICA. Clinical and radiological follow-up are needed.

Arteria trigemina primitiva - radiological report of three cases and review of literature.

The main aim of this paper is to present 3 cases of persistent (patent) primitive trigeminal artery incidentally revealed during various radiological examinations. The presence and function of these vessels in extrauterine life is sometimes associated with other vascular abnormalities, e.g. aneurysms, haemangiomas, moyamoya disease, but frequently found incidentally without any negative signs or symptoms. The presented cases of patients with primitive trigeminal artery clearly show that the reported ailments, which had made the diagnostic imagining necessary, were not associated with the patency of this artery.

Carotid-cavernous fistula caused by persistent primitive trigeminal artery trunk:a case report

Carotid-cavernous fistula caused by persistent primitive trigeminal artery trunk:a case report

Functional Vascular Anatomy of the Brain

Functional vascular anatomy is the study of anatomy in its relation to the function that figures out the normal and pathological vascularization of the brain and spinal cord. The mechanism of anatomical variations (e.g. fenestration of the basilar artery, persistent primitive trigeminal artery, and aberrant subclavian artery) can be explained according to the embryological development of the cardiovascular system. The most developmental process is common among the species of the vertebrates from the fish to the mammalian in the early phase of embryo. Thus, it is possible to deduce the reasons of vascular variants in terms of phylogeny. Such an embryological parallelism like the comparative anatomy provides the new insights into the nature of our vascular system. In addition, learning more about the hemodynamic consequence may help to realize the underlying physiopathology of cerebral arterial remodeling and stroke in patients with these vascular variants. This perception may facilitate better understanding of the vascular pathologies and lead to the appropriate decision making not only in the diagnostic work, but also in the interventional procedures. The aim of this study is to introduce the meanings of functional anatomy in the clinical application of vascular diseases and anomalous of the central nervous system.