Trigeminal Artery Research Articles

Comprehensive Management of Intracranial Aneurysms in Rare and Variant Arterial Locations: A Detailed Case Report

AbstractAneurysms on variant arteries, especially involving the persistent trigeminal artery (PTA), azygos artery, and lenticulostriate arteries (LSAs), are rare. This report presents a case and subsequent management of a patient with multiple unruptured aneurysms arising from variant anatomical structures. A 48-year-old patient with a history of worsening headaches presented with three unruptured aneurysms at the PTA, azygos artery, and left LSA, confirmed via catheter angiography with three-dimensional reconstruction. Given the potential effects on conventional cerebrovascular structures, managing multiple aneurysms in rare and variant locations requires a tailored strategy. This case was successfully treated with an endovascular approach and a period of observation, emphasizing the need for individualized treatment planning.

Persistent trigeminal artery aneurysm rupture inducing a carotid-cavernous fistula: its presentation and management. Illustrative case.

A carotid-cavernous fistula (CCF) is a well-recognized entity resulting from an abnormal connection between the internal carotid artery (ICA) or external carotid artery and the cavernous sinus. Typical CCF symptomology includes proptosis, chemosis, orbital bruit, headache, facial pain, and cranial nerve (CN) palsies. While CCFs most often occur posttraumatically, they can also occur spontaneously, secondary to cavernous ICA aneurysm rupture. Very rarely, they can occur secondary to the rupture of an anomalous persistent trigeminal artery (PTA) aneurysm. Herein, the authors describe the case of a 54-year-old woman who presented with a CN VI palsy and headache due to a CCF secondary to a PTA aneurysm rupture. The CCF was ultimately treated via coil embolization of the aneurysm and the parent PTA vessel. Though such occurrences are rare, clinicians should be vigilant in assessing for the presence of a PTA in patients with a CCF, as a PTA-associated CCF requires unique treatment considerations. In some cases where the PTA plays a crucial role in the posterior circulation supply, preservation of the parent vessel PTA is crucial. However, in cases in which an adequate posterior circulation collateral supply exists, embolization of the aneurysm and the parent vessel PTA is a reasonable treatment option for fistula closure. https://thejns.org/doi/10.3171/CASE24287.

Hyperplastic Variant of Anterior Choroidal Artery with Saltzman IIIc Type Persistent Trigeminal Artery Variant

Hyperplastic Variant of Anterior Choroidal Artery with Saltzman IIIc Type Persistent Trigeminal Artery Variant

A Case of Cerebral Infarction due to Internal Carotid Artery Occlusion Accompanied by Persistent Primitive Trigeminal Artery.

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.

The Relationship between the Permanent Trigeminal Artery and Cerebrovascular Disease: A Meta-Analysis.

We aimed to analyze the variability of the permanent trigeminal artery (PTA) and its relationship with cerebrovascular disease. To analyze the variability of the PTA and its relationship with cerebrovascular disease by using the terms "primitive trigeminal artery", "persistent primitive trigeminal artery", " persistent trigeminal artery variant", "PPTA", "PTAV", "carotid- basilar anastomoses", "carotid-vertebrobasilar anastomoses", "persisting embryonic vessels" were used as keywords, and the English-language literature related to PTA and cerebrovascular diseases published in PubMed, EMBAS, and Web of Science databases from 2000 to 2022 were searched by using "subject terms + free words". A meta-analysis of the collected data was performed using stata14.0 statistical software to assess the relationship between the immortal trigeminal artery and cerebrovascular-related diseases. A total of 1908 relevant articles were initially retrieved for this study. Ten papers were initially screened according to the inclusion and exclusion criteria, while the literature was then read one by one to exclude duplicates, reviews, case reports, and conference abstracts, and six papers were finally included for meta-analysis. The six papers included in this paper were all cross-sectional studies with 39,355 subjects, of which 206 subjects had PTA, with a variation rate of approximately 0.52%, including 77 males and 129 females, 117 left-sided variants and 87 right-sided variants. In contrast, of the 206 subjects with a PTA, 52 had cerebrovascular disease, with an overall prevalence of approximately 25.24%. The PTA could influence the development of cerebrovascular disease.

Persistent Primitive Arteries

Primitive anastomotic arteries temporarily exist between the future internal carotid and vertebrobasilar arteries during the early embryonic period(between 28 and 32 days of life). The primitive trigeminal, otic, hypoglossal, and proatlantal intersegmental arteries serve as major blood channels to the developing vertebrobasilar circulation at this stage. These arteries are replaced by the posterior communicating and vertebral arteries, and the primitive anastomotic arteries rapidly regress following the development of the definitive vertebrobasilar circulation. Occasionally, these primitive anastomoses persist and are incidentally discovered after birth. Physicians who treat cerebrovascular diseases should be familiar with the anatomy and functions of these vessels. In this review, we discuss the embryonic basis of the carotid-vertebrobasilar anastomoses and the clinical significance of their persistent forms in adults.

Disappearing Cerebral Communicating Vessels in Embryonic Development—With a Case of Carotid-Vertebrobasilar Artery Anastomosis

In early embryonic development, anastomoses between carotid and basilar arteries occur in the primitive trigeminal, primitive otic, primitive hypoglossal, and primitive proatlantal arteries, and these anastomoses gradually disappear as the embryo continues to develop. This article reported a case of vascular anastomosis occurring between the external carotid artery and vertebral artery.

Persistent trigeminal artery in a patient with moyamoya disease:a case report and literature review

BackgroundsPersistent trigeminal artery (PTA) is a rare anastomosis between internal carotid artery (ICA) and basilar artery. In rare conditions, the PTA could be combined with others cerebrovascular anomalies, moyamoya disease (MMD) is one of them.Case presentationHere, we reported one rare case of MMD associated with PTA, the patient admitted to our department for severe dizziness and headache, imaging examination suggested MMD combined with right PTA, which arising from the ipsilateral cavernous portion of ICA. The patient received phased bilaterral revascularization with no any complication. In the subsequent follow-up, the patient’s symptoms and intracranial vascular condition gradually improved. Moreover, we conducted a literature review of coexistence of PTA and MMD, the results of a web of science regarding such condition, and a deep discussion providing brief insight into the status of co-occurrence of PTA and MMD, including its manifestation, treatment and outcome.ConclusionsThe coexistence of PTA and MMD was rarely reported, the pathogenesis of such condition remains unknown. We found that the features of the coexistence of PTA and MMD were diverse, revascularization might be a feasible for such patient.

Two Rare Variations; Persistent Trigeminal Artery and Hypoplasia of the A1 Segment of the Anterior Cerebral Artery

The trigeminal artery, which is one of the major carotid-basilar anastomoses in the fetal period, regresses with the development of the posterior circulation in the prenatal period. In rare cases, when this regression does not occur but persists, it is called persistent trigeminal artery (PTA). Because of the association of the persistent trigeminal artery with many other cerebral vascular pathologies, it is of vital importance to identify it and know its imaging characteristics, especially in cases where vascular surgery or interventional procedures are planned. We report a case with PTA and hypoplasia of the A1 segment of the anterior cerebral artery (ACA) as an associated vascular anomaly. Magnetic resonance angiography (MRA) is a non-invasive method for the detection of PTA and other vascular anomalies.

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.

Persistent trigeminal artery variant and presumed ophthalmic artery simultaneously arising from the inferolateral trunk incidentally diagnosed by magnetic resonance angiography.

To describe a case of persistent trigeminal artery variant (PTAV) and presumed ophthalmic artery (OA) simultaneously arising from the inferolateral trunk (ILT). A 53-year-old woman with an initial episode of convulsion underwent cranial magnetic resonance imaging (MRI) and MR angiography (MRA) of the intracranial region for the evaluation of brain and vascular lesions. The MR machine was a 3-T scanner. MRI revealed no pathological brain lesions. On MRA, the left anterior inferior cerebellar artery (AICA) arose from the cavernous segment of the internal carotid artery (ICA), indicative of the PTAV. The arising point was more distal than the usual point, and the presumed OA also arose simultaneously from the short common trunk, which was considered the ILT. There are two types of PTA: lateral (usual) and medial (intrasellar) PTA. The lateral-type PTA and PTAV arise from the ICA of the distal precavernous-proximal cavernous segment and take a course similar to that of the posterior fossa. The medial type arises slightly more in the distal cavernous segment than in the lateral type. The OA rarely arises from the cavernous segment of the ICA and enters the orbit via the superior orbital fissure. The origin of this type of OA is considered to be the ILT. We herein report a case of a PTAV and presumed OA arising simultaneously from an ILT. No similar case has been reported in the relevant English language literature.

Medial-type persistent trigeminal artery and ipsilateral posterior communicating artery supplying bilateral posterior cerebral arteries combined with an aberrant right subclavian artery and bicarotid trunk.

To describe a case of a medial-type persistent trigeminal artery (PTA) associated with multiple arterial variations. A 34-year-old woman with multiple sclerosis underwent cranial magnetic resonance (MR) angiography from the aortic arch to the neck region and intracranial region for the evaluation of an unruptured cerebral aneurysm that was previously detected on MR imaging. The MR machine was a 3-T scanner. There was an aberrant right subclavian artery and bicarotid trunk, medial-type left PTA and ipsilateral posterior communicating artery (PCoA) supplying bilateral posterior cerebral arteries (PCAs). The unruptured aneurysm was located at the paraclinoid segment of the left internal carotid artery and was treated successfully by coil embolization via a transfemoral approach. Only 10% of PTAs are classified as the medial type. The association with extremely large ipsilateral PCoA, which supplies the bilateral PCAs, has not been previously reported. Aberrant right subclavian arteries are common and are frequently associated with a bicarotid trunk. Before catheterization of the cerebral arteries, the aortic arch and its branches must be evaluated by MR angiography or computed tomography angiography to prevent catheterization failure via the right transradial approach.

Percutaneous balloon compression for trigeminal neuralgia due to the primitive trigeminal artery: A case report and review of the literature

Trigeminal neuralgia (TN) is often caused by vascular compression of the trigeminal nerve cisternal segment. TN due to the primitive trigeminal artery formed by developmental variants of cerebral vessels is rare. We report here a 59-year-old male with TN whose preoperative MRI showed a primitive trigeminal artery that compressed the trigeminal nerve, and microvascular decompression (MVD) was performed to separate the vessel from the trigeminal nerve cisternal segment. The pain was relieved after MVD, but it recurred two months later. MRI reexamination showed that although MVD relieved the vascular compression of the trigeminal nerve cisternal segment, the nerve in the Meckel’s cave was still compressed by PTA, which was thought to be the cause of TN recurrence. Due to the limitations of the surgical microscope view, completing the vascular decompression at the Meckel’s cave is challenging. So percutaneous balloon compression was performed. After the procedure, the TN subsided. The patient remained pain free at one year follow-up. To our knowledge, this is the first case of primitive trigeminal artery-associated TN treated by percutaneous balloon compression. This case suggests that percutaneous balloon compression may be considered for TN caused by compression of the primitive trigeminal artery when MVD is difficult to perform.

P.128 Recurrent subarachnoid hemorrhage secondary to Chiari 1 malformation

Background: We describe a patient with recurrent subarachnoid hemorrhage (SAH) secondary to Chiari 1 malformation. Methods: A retrospective review of the clinical chart was performed. Results: A previously healthy female in her 70’s presented with worst headache of life. CT demonstrated 4th ventricular hemorrhage with SAH extending into the bilateral cerebellomedullary fissures. CTA did not show a vascular etiology and patient was discharged home. Incidental note was made of a right persistent trigeminal artery. The patient then represented 2 weeks later with worst headache of life and decreased level of consciousness. CT demonstrated extensive SAH extending into the 3rd and 4th ventricles. CTA and diagnostic cerebral angiogram did not show a vascular etiology. MRI brain/C-spine revealed Chiari 1 malformation. An external ventricular drain was placed but could not be weaned. She underwent suboccipital craniectomy with C1 laminectomy. Intraoperatively, there was a prominent dorsal spinal vein that appeared under tension as it pierced the arachnoid membrane and subsequently entering the dura as a rudimentary occipital sinus. This vein was coagulated and divided. The patient recovered well and was at neurological baseline at 6 month follow-up. Conclusions: This is the first reported case of recurrent SAH secondary to Chiari 1 malformation.

An anatomical study of persistent trigeminal artery detected by computed tomography angiography and magnetic resonance angiography: proposal for a modified classification and a novel basilar artery grading system.

The purpose of this study is to investigate the anatomical characteristics of persistent trigeminal artery (PTA) detected by computed tomography angiography (CTA) and magnetic resonance angiography (MRA), propose a modified classification and a novel grading system for basilar artery (BA). Patients who underwent head CTA or MRA in our hospital between August 2014 and August 2022 were reviewed retrospectively. The prevalence, sex, and course of PTA were evaluated. PTA types were modified based on Weon's classification. Type I to IV were similar to those in Weon's classification except the presence of intermed fetal-type posterior cerebral artery (IF-PCA). Type V was the same as that in Weon's classification. Type VI included subtypes of VIa (concomitant IF-PCA based on type I to IV) and VIb (other variants). BA was assessed based on a scale of 0 to 5 compared with PTA's caliber (0, BA aplasia; 1 and 2, BA non-dominant; 3, equilibrium; 4 and 5, BA dominant). A total of 57 patients (0.06%) with PTA, including 36 females and 21 males, were detected in 94,487 patients. Six patients (10.5%) were medial type and 51 patients (89.5%) were lateral type. Thirty-seven patients (64.9%) were type I, 1 (1.8%) as type II, 13 (22.8%) as type III, 3 (5.3%) as type IV, 1 (1.8%) as type V, and 2 (3.5%) as type VI. For BA grading, 4 (7.0%), 21 (36.8%), 17 (29.8%), 6 (10.5%), 6 (10.5%), and 3 (5.3%) of the patients were grade 0, 1, 2, 3, 4, and 5, respectively. Fifteen patients (26.3%) had intracranial aneurysms. One cases (1.8%) had a fenestration of the PTA. The prevalence of PTA in our study was lower than that in most previous reports. The modified PTA classification and BA grading system can be used to better understand the vascular structure of PTA patients.

Persistent Trigeminal Artery: A Little Known Cause of Trigeminal Neuralgia- MR Imaging

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 usually found incidentally but can be often associated with vascular malformation, cerebral aneurysm trigeminal neuralgia and even posterior circulation strokes. We report here a case of persistant trigeminal artery as a cause of trigeminal neuralgia and its aspects found in MR imaging.

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.

Development of the basilar artery system in the human embryonic period

The doctrine of the origin and development of cerebral arteries in the embryonic period of man in the XIX – XXI centuries was formed by I. Tandler (1899, 1902), H. Evans (1911), G.L. Streeter (1908, 1918), G.D. Aronovich (1939), D.N. Padget (1947 – 1972), N.V. Popova-Latkina (1954 – 1975), Y.N. Shapovalov (1963), A.G. Knorre (1967), I. Stanek (1977), B. Carlson (1983), A.V. Gorbunov (1998 – 2022), etc. To date, we have shown that basilar arteries are detected in embryos at 7 weeks of intrauterine development, posterior cerebral arteries with plexiform branching – at 8 weeks of intrauterine life, and persistent trigeminal arteries continue to be detected in prenatal embryos at 8-9 weeks of human prenatal ontogenesis. In prenatal embryos 7-8-9 weeks of prenatal ontogenesis, the basilar artery system provides the needs of the human intrauterine brain.

Interventions and imaging in patients with anatomic variations of cerebral circulation: a pictorial review.

The cerebral arterial system shows a wide spectrum of variations. Minor degrees of anatomic differences can be seen in almost all patients. Recognition of these anatomic variants is essential for the following: evaluating collateral circulation; some anatomic variants may mimic pathology; increased risk for aneurysm formation with some variants (e.g. fenestration, persistent trigeminal artery); dealing with pathologies that can arise with these variations; and for preoperative planning. The anterior and posterior groups of intracranial circulation show numerous anastomoses that play a major role in maintaining adequate blood supply to the cerebral parenchyma. This review focuses on the imaging features of these variants as seen on computed tomography and magnetic resonance imaging with relevant digital subtraction angiography imaging. We also present some case illustrations where understanding of these variants contributed to providing appropriate management.

An unusual anatomical variant: A transclival artery supplying the vertebrobasilar circulation.

The persistent carotid-vertebrobasilar anastomoses are arterial communications between the anterior and posterior circulations due to the persistence of embryological connections. We here present an extremely rare instance of a transclival persistent carotid-vertebrobasilar anastomosis in a 10-month-old infant, which does not fit into any of the traditionally described categories, such as the trigeminal artery, hypoglossal artery, or proatlantal artery.