Arterial abnormalities and associated variations of the vertebrobasilar system on the brain base: apropos of a rare case / Anomalías arteriales y variaciones asociadas del sistema vertebrobasilar en la base del cerebro: un caso raro

SUMMARY: The presented case characterizes an association of primitive and definitive arteries with variations on the cadaveric brain base of a very old man. This case is found by the retrospective review of the data archive obtained during many years of cooperation of the author and co-authors. Fenestration of the (ectatic) basilar artery, partial and total duplication of some cerebellar arteries was associated with other variations of the vertebrobasilar and carotid systems. Although this is a case autopsied because of the myocardial infarction, the peculiarity of the case lies in the absence of the aneurysm based on the fenestration or dissection of one of the cerebral arteries.

RESUMEN: El caso presentado caracteriza una asociación de arterias primitivas y definitivas con variaciones sobre la base cerebral cadavérica de un anciano. Este caso se encuentra mediante la revisión retrospectiva de datos obtenidos durante muchos años de un trabajo de cooperación del autor y coautores. La fenestración de la arteria basilar (ectásica), la duplicación parcial y total de algunas arterias cerebelosas se asoció con otras variaciones de los sistemas vertebrobasilar y carotídeo. Si bien se trata de un caso de autopsia a causa de un infarto del miocardio, la peculiaridad del caso radica en la ausencia del aneurisma en base a la fenestración o disección de una de las arterias cerebrales.

Microvascular decompression in patients with intractable idiopathic trigeminal neuralgia

To evaluate etiology and implications of microvascular decompression [MVD] in patients with intractable idiopathic trigeminal neuralgia. Descriptive case series. Neurosurgery department of Hayatabad Medical Complex, Peshawar from January 2007 to December 2009. Patients with idiopathic trigeminal neuralgia [ITN] irrespective of age and sex, were included in the study. Patients responding to medical treatment were excluded. MRI brain was done for all patients to exclude secondary causes. Microvascular decompression was performed in all patients under general anesthesia. Patients were examined on seventh postoperative day and the clinical findings were documented. Outcome of surgery was declared as successful when there was a commensurate relief of neuralgia paroxysms and deep background pain along with total withdrawal of medications. Fifty two patients were operated for trigeminal neuralgia. There were 23 [44%] males and 29 [56%] females [M:F 1:1.26]. Age ranged between 20-70 years [Mean 56 years]. Right sided neuralgia was present in 34 [65%] cases. In 50 cases [96%] a neurovascular conflict was found. The superior cerebellar artery [SCA] was the cause of compression in 45 [86.53%] patients, anterior inferior cerebellar artery [AICA] in two patients, and one patient each, the vessel involved was posterior inferior cerebellar artery [PICA], basilar artery, and petrosal vein. In 2 patients trigeminal nerve was found encased by tight arachnid adhesions. Trigeminal nerve entry zone was the point of conflict in 38 cases [73.07%]. The mandibular division [V3] was involved in 30 cases [57.7%] followed by maxillary division [V2] in 18 cases [34.61%] and ophthalmic division [V1] in 4 cases [94.23%]. Cerebrospinal fluid [CSF] leakage occurred in 3 cases [5.76%]. One patient developed wound infection. One patient [1.92%] expired in the postoperative period due to mid brain stroke. The main etiological factor of trigeminal neuralgia was vascular compression, especially by SCA, of the 5[th] nerve roots at brain stem. Microvascular decompression is safe and effective therapy for all ages

Persistent trigeminal artery: angio-tomography and angio-magnetic resonance finding / Artéria trigeminal persistente: achado na angio-tomografia e angio-ressonância magnética

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.

Artéria trigeminal (AT) é a anastomose carótido-vertebrobasilar mais comum a persistir na vida adulta. Tipicamente estende-se da artéria carótida interna até a artéria basilar. Artérias primitivas persistentes são usualmente um achado incidental, mas freqüentemente estão associadas a malformações vasculares, aneurismas e, no caso da AT, a neuralgia do trigêmio. Apresentamos um paciente com AT como causa de neuralgia do trigêmio e em outros três como um achado incidental, em angiogramas por tomomografia computadorizada e ressonância magnética.

Aneurisma sacular a nivel del ápex de la arteria basilar / Sacular aneurysm in the apex of basilar artery

El aneurisma cerebral es una dilatación focal de una arteria por debilidad de su pared. Un aneurisma cerebral puede romperse provocando una hemorragia intracraneana que puede causar la muerte o serias complicaciones. El objetivo del presente artículo es mostrar los diferentes tipos de aneurismas y la evolución del paciente con respecto a la enfermedad. Se presenta el caso de un joven remitido al hospital Universitario de Santander por un cuadro clínico compatible con aneurisma sacular en el ápex de la arteria basilar. El paciente presentó síntomas que incluyen cefalea, nauseas, vómitos, entre otros. La panangiografía ayuda a establecer el diagnóstico, mostrando específicamente el vaso comprometido. La finalidad del tratamiento es reducir el riesgo de una hemorragia subaracnoidea.

Sacular aneurysm in the apex of basilar artery the cerebral aneurysm is a focal expansion of an artery for weakness of his wall. A cerebral aneurysm can break provoking a hemorrhage intracraneana that can cause the death or serious complications. The aim of the article is to show the different types of aneurysms and the evolution of the patient with regard to the disease. One presents the case of a young man sent to the University hospital of Santander for a clinical picture compatible n the ápex of the basilary artery. The patient present symptoms that include migraine, nauseas, vomits, between others. The panangiografia helps to establish the diagnosis, showing specifically the awkward glass. The purpose of the treatment is to reduce the risk of a hemorrhagesubaracnoidea.

Manifestaçöes otoneurológicas na dolicoectasia da artéria basilar e vertebral / Otoneurological manifestations in the vertebrobasilar dolichoectasy

Sao feitas consideraçoes a respeito do quadro clínico otoneurológico e da fisiopatologia na dolicoectasia vértebro-basilar. Os autores apresentam como ilustraçao um caso com manifestaçoes clínicas centrais e periféricas em um paciente com dolicoectasia da artéria basilar e vertebral.

Arteria trigeminal persistente asociada con aneurismas / Trigeminal artery associated with aneurysm

Enbriológicamente hay dos sistemas que irrigan el sistema nervioso central; la arteria carótida interna y el plexo neural longitudinal que es el primordio de la arteria basilar. Existen vasos anastomóticos por arterias persistentes durante el desarrollo embriológico entre estos dos sistemas; tres son intracraneales y una suboccipital. Rostrocaudalmente son: la arteria trigeminal persistente, la arteria ótica o también llamada arteria auditiva primitiva persistente, la arteria hipoglosa y la arteria proatlantal, la única occipital. Realizamos una breve revisión de las anatómosis carótidibasilares con el objeto de recordar la existemcia de estas variantes anatómicas que pueden ser visualizadas en un estudio de angiografía cerebral. Informándo la historia de una paciente de 42 años de edad con arteria trigeminal persistente asociada con un aneurisma.

Presentación de un caso de arteria trigeminal primitiva persistente / Persistent trigeminal artery: case report

Presentación de una paciente con hemorragia subaracnoidea espontánea causada por un aneurisma de la arteria comunicante anterior asociada a una arteria trigeminal primitiva persistente

Isquemia cerebral transitória associada a artéria trigeminal persistente: relato de caso / Transient cerebral ischemia associated to persistent trigeminal artery: report of case

Uma paciente com artéria trigeminal persistente apresentou vários episódios de isquemia cerebral transitória, associada a ateroesclerose difusa, na circulaçäo anterior. O autor enfatiza a investigaçäo desta anomalia arterial em pacientes jovens com quadros isquêmicos, fazendo uma revisäo da embriologia e quadros clínicos apresentados