Radiographic features and clinical value of persistent trigeminal artery with vascular disease / 实用放射学杂志

Objective To explore CTA and MRA characteristics of persistent trigeminal artery (PTA)with vascular disease. Methods 54 patients diagnosed as PTA by CTA and MRA were collected retrospectively,whose classification,variation and associated vascular disease were analyzed.Results There were more females than males in 54 patients,whose average age was 59.72±16.32,and the incidence of left ones were higher than that of the right ones.Type Ⅰ of Weon classification was 16 cases (29.63%),type Ⅱ 7 cases (12.96%),typeⅢ 16 cases (29.63%),type Ⅳ 1 1 cases (20.37%),type Ⅴ 4 cases (7.41%).The lateral type of Salas classification was significantly higher than that in the middle type.There were 16 cases (29.63%)with aneurysm,in which 3 cases (18.75%)were rupture.3 cases were with moyamoya disease (5.56%).39 cases (72.22%)were with basilar artery dysplasia.There were 33 cases (61.11%)with the postembryonic cerebral artery.There were 29 cases with cerebral infarction (53.7%),4 cases with cerebral hemorrhage (7.4%),3 cases with subarachnoid hemorrhage (5.5 6%).Cerebral arteriosclerosis with different degrees of stenosis was showed in 1 7 cases (31.48%). 2 cases were accompanied with trigeminal neuralgia (3.7%),and only 1 case was with ocular nerve palsy (1.85%).Conclusion CTA and MRA could be used to display the anatomical features and radiographic classification of PTA ,and also clearly display and evaluate PTA associated with vascular disease.

Dual Stent-Assisted Coil Embolization for Fusiform Aneurysm Arising From Persistent Trigeminal Artery / 신경중재치료의학

Aneurysms of the persistent trigeminal artery (PTA) trunk are exceptionally rare and have a high risk for rupture. Dual stent placement through each internal carotid and basilar artery for endovascular coil embolization of a fusiform aneurysm arising from the PTA has not been described in the literature. A 44-year-old female with a history of chronic headache was identified to have a fusiform aneurysm arising from medially coursing adult type, Saltzman type 3 PTA trunk. Sacrifice of the PTA trunk inclusive of the aneurysm was performed with dual stent placement through each basilar and internal carotid artery across their respective junctions with the PTA. Six-month follow-up angiography showed complete occlusion of the PTA and the aneurysm. The patient's symptoms resolved. Our case demonstrated that the sacrifice of an adult type, Saltzman type 3 PTA inclusive of an associated fusiform aneurysm is feasible with dual stent-assisted coil embolization.

The appearance and clinical significance of persistent carotid-basilar artery anastomoses diagnosed by CT and MR angiography / 实用放射学杂志

Objective To explore the appearance of CT angiography(CTA)and magnetic resonance angiography (MRA)in persis-tent carotid-basilar artery anastomoses,and discuss its clinical significance.Methods 1 7 patients of persistent carotid-basilar artery anastomoses diagnosed by CT and MR angiography were retrospectively reviewed.10 patients were examined by craniocervical CTA, 7 patients were examined by cranial and cervical MRA,and 3 patients were examined by CTA and MRA.Results 10 patients had persistent trigeminal arteries (PTA).Based on Saltzman type:6 cases were Saltzman type Ⅰ,2 cases were Saltzman typeⅡ,and 2 cases were Saltzman type Ⅲ.1 case of 3 persistent hypoglossal arteries(PHA)originated from the right carotid artery,and 2 cases originated from the left external carotid artery.2 cases of 4 proatlantal intersegmental artery(PIA)were right ipsilateral,and 2 cases were left ipsilateral.1 case of PTA and 1 case of PHA associated with an aneurysm.6 cases of PTA,2 cases of PHA and 1 case of PIA complicated with ipsilateral vertebral arteries artopied or hypoplasia of the contralateral vertebral artery.Conclusion CTA and MRA can demonstrate clearly the course of persistent carotid-basilar artery anastomoses and its complicating intracranial coexisting abnormalities.Diagnosis of this anatomic variation may be helpful for providing reliable data to the guidance of surgery and interven-tional treatment.

RE: Giant Cavernous Aneurysm Associated with a Persistent Trigeminal Artery and Persistent Otic Artery

No abstract available.

Persistent Trigeminal Artery with a Cerebellar Branch and Trigeminal-Cavernous Fistula from Ruptured Aneurysm: Transarterial Coil Embolization / 신경중재치료의학

We report a case of persistent trigeminal artery (PTA) with a cerebellar branch supplying the posterior inferior cerebellar arterial territory, combined with a trigeminal-cavernous fistula resulting from rupture of an aneurysm at proximal trunk of the PTA. The fistula was successfully treated by transarterial coil embolization with preservation of PTA.

Diagnosis of persistent trigeminal artery with 64-slice spiral CT angiography / 中国脑血管病杂志

Objective: To observe the application values of 64-slice spiral CT angiography (CTA) in diagnosing persistent trigeminal artery in an effort to improve the understanding of this vascular variation. Methods: The imaging data of 5 patients with persistent trigeminal artery in 2734 patients who performed 64-slice CTA of craniocervical arteries were analyzed retrospectively. The incidence, origin, running, and blood supply from posterior circulation of persistent trigeminal artery, and its complicating other vascular malformations were analyzed. Results: Circled digit oneThe incidence of persistent trigeminal artery was 0.18% (5/2734). Three of them were on the right side and 2 were on the left side. Circled digit twoAll the trigeminal arteries originated from the cavernous segment of internal carotid artery. Four patients were lateral type running and one (20%) was internal type running. According to Saltzman's classification about the blood supply in posterior circulation: one patient was Saltzman type I , one was type II, and three were type III. Circled digit threeThree patients had basilar artery and bilateral vertebral artery hypoplasia at the point of proximal anastomosis, one had complete atrophy of basilar artery at the point of proximal anastomosis, one complicated with aneurysm of the persistent trigeminal artery, and one complicated with fenestrated middle cerebral artery on the contralateral side. Conclusions: 64-slice CTA can clearly, rapidly, noninvasively, and accurately display the persistent trigeminal artery and its running. Understanding of this abnormal vessel in the sellar or suprasellar regions before surgery and interventional treatment will help develop a reasonable surgical and interventional regimen to avoid the risks caused by improper management.

Giant Cavernous Aneurysm Associated with a Persistent Trigeminal Artery and Persistent Otic Artery

Primitive trigeminal artery (PTA) and primitive otic artery (POA) is a very rare entity in adult life. We present a case of PTA and POA associated with a giant unruptured cavernous aneurysm in a 54-year-old woman. The PTA and the POA arose from the sac of the aneurysm directly, which greatly complicated endovascular therapy management.

A Case of Persistent Trigeminal Artery Presenting as Vertebrobasilar Insufficiency

The persistent trigeminal artery(PTA) is the most common type of persistent carotid-basilar anastomosis, usually diagnosed by cerebral angiography or autopsy. PTA is usually associated with hypoplasia or atresia of the vertebrobasilar artery and may result in symptoms of vertebrobasilar insufficiency caused by decreased perfusion of the brainstem. We report a patient with PTA who presented with symptoms of vertebrobasilar insufficiency. An 80-year-old woman with a history of hypertension, hyperlipidemia, and unstable angina pectoris presented with recurrent dizziness, dysarthria, and a tendency to fall to the left side. PTA was identified with hypoplasia of the vertebrobasilar system and mild stenosis of the bilateral proximal internal carotid arteries on brain MR angiography and cerebral angiography.

Endovascular Treatment for a Persistent Trigeminal Artery Aneurysm Presenting as Isolated Sixth Nerve Palsy / 신경중재치료의학

The trigeminal artery is the most common persistent carotid-basilar anastomotic channel observed in adult life, and its occurrence probably represents a defect in cerebrovascular development. It can be associated with other congenital abnormalities such as cerebral aneurysms, but only rarely do aneurysms of the persistent trigeminal artery itself arise. Endovascular treatment of these aneurysms has not been attempted so much. We report a case of endovascular treatment for a persistent trigeminal artery aneurysm causing isolated sixth nerve palsy.

Persistent Trigeminal Artery Variant Detected by Conventional Angiography and Magnetic Resonance Angiography: Incidence and Clinical Significance

OBJECTIVE: Persistent trigeminal artery variant (PTAV) is an anastomosis between the internal carotid artery (ICA) and the cerebellar artery without any interposing basilar artery segment. We discuss its probable embryological origin and emphasize clinical implications. METHODS: Retrospectively 1250 conventional cerebral angiograms and 2947 cranial magnetic resonance angiographies (MRAs) were evaluated for the patients with PTAV. RESULTS: Five patients (four men and one woman, 23 to 76 years of age, median age 65 years) had a PTAV. Three patients who underwent MRA had a PTAV (3/2947=0.1%). Four of the patients who underwent cerebral angiography had a PTAV (4/1250=0.32%). Two of 143 patients who underwent both conventional angiography and cranial MRA showed PTAV. The PTAV was an incidental finding in all five patients. The PTAV originated from the cavernous segment of the left ICA in four patients and from the cavernous segment of the right ICA in one patient. The terminal branch of the PTAV was the anterior inferior cerebellar artery (AICA) and superior cerebellar artery (SCA) in two patients and the AICA only in the other three patients. CONCLUSION: Neurosurgeons should be aware of possible presence of PTAV. Manipulation of this vessel during a surgical approach to the parasellar region and percutaneous gasserian ganglion procedure may result in hemorrhage or ischemia.

A Case of Persistent Trigeminal Artery with Basilar Artery Hypoplasia: MRI, MRA and TCD findings

No abstract available.

Persistent Trigeminal Artery : An Unusual Cause of Cerebral Infarction / 대한뇌혈관외과학회지

Persistent trigeminal artery (PTA) can be associated with hypoplasia of the proximal basilar and ipsilatereal vertebral artery. This can predispose adults to posterior circulation ischemia by a low flow state. A 40 year-old male presented with diplopia, dizziness and motor weakness in all extremities. He had no conventional risk factors of ischemic stroke. In brain Magnetic Resonance Imaging (MRI), acute infarction was observed in medulla, pons and cerebellum. PTA was also discovered with hypoplasia of vertebrobasilar system in brain Magnetic Resonance Angiography (MRA).

Persistent Trigeminal Artery Aneurysm Treated with Guglielmi Detachable Coils

A persistent trigeminal artery(PTA) is a rare embryonic channel between internal carotid artery and basilar artery. It can be frequently associated with intracranial aneurysms. But an aneurysm arising from the junction of PTA and internal carotid artery(ICA) is extremely rare. The authors report a case of unruptured right ICA-PTA aneurysm treated with Guglielmi detachable coils successfully. Pathogenesis for the aneurysm formation at the junction of ICA and PTA is discussed.

Ruptured Persistent Trigeminal Artery Aneurysm Associated with Moyamoya Disease

Moyamoya disease is defined as the development of collateral pathways, associated with bilateral chronic progressive stenosis of the carotid fork. Persistent trigeminal artery is the vessel most frequently observed to persist into adult life among persistent carotid-basilar and carotid-vertebral anastomotic vessels. The authors present a man who had a sudden, severe headache and brain CT showed subarachnoid hemorrhage in left interpeduncular and prepontine cistern. Four-vessel angiogram revealed moyamoya disease associated with aneurysm arising from the junction of persistent trigeminal artery aneurysm and basilar artery. As a treatment, coil embolization was tried but it was failed because of anatomical difficulty of aneurysm. The aneurysm was successfully treated with clipping surgery 10 days later. To our knowledge, this is the first case being reported.