open access
Persistent trigeminal artery as a rare cause of vertebrobasilar insufficiency
, 1, 2
Affiliations- Department of Neurology, Wroclaw Medical University, Wroclaw, Poland
- Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland
open access
Abstract
The persistent trigeminal artery (PTA) is the most common foetal carotid-basilar anastomosis which may persist into adult life. In the literature there are numerous papers referring to the anatomical characteristics of this anomalous vessel. In the majority of cases PTA is an incidental finding and its clinical significance has been debated. Some authors describe the coincidence of PTA with various clinical syndromes. However, there are few reports linking PTA with the symptoms of vertebrobasilar insufficiency. We present a patient with a 3-year history of recurrent dizziness and impaired vision, precipitated by physical activity, in whom neuroimaging techniques revealed a left PTA. In our case the occurrence of PTA might have been related to the clinical manifestation and the potential mechanism will be discussed.
Abstract
The persistent trigeminal artery (PTA) is the most common foetal carotid-basilar anastomosis which may persist into adult life. In the literature there are numerous papers referring to the anatomical characteristics of this anomalous vessel. In the majority of cases PTA is an incidental finding and its clinical significance has been debated. Some authors describe the coincidence of PTA with various clinical syndromes. However, there are few reports linking PTA with the symptoms of vertebrobasilar insufficiency. We present a patient with a 3-year history of recurrent dizziness and impaired vision, precipitated by physical activity, in whom neuroimaging techniques revealed a left PTA. In our case the occurrence of PTA might have been related to the clinical manifestation and the potential mechanism will be discussed.
Keywords
persistent trigeminal artery, computed tomography angiogram, stroke, magnetic resonance imaging, vertebrobasilar insufficiency
About this articleTitle
Persistent trigeminal artery as a rare cause of vertebrobasilar insufficiency
Journal
Issue
Article type
Case report
Pages
785-790
Published online
2021-06-29
Page views
4422
Article views/downloads
1885
DOI
Pubmed
Bibliographic record
Folia Morphol 2022;81(3):785-790.
Keywords
persistent trigeminal artery
computed tomography angiogram
stroke
magnetic resonance imaging
vertebrobasilar insufficiency
Authors
K. Sulima
J. Chojdak-Łukasiewicz
B. Paradowski
M. Guziński
References (36)- Agnoli AL. Vascular anomalies and subarachnoid haemorrhage associated with persisting embryonic vessels. Acta Neurochir (Wien). 1982; 60(3-4): 183–199.
- Ali S, Radaideh MM, Shaibani A, et al. Persistent trigeminal artery terminating in the posterior inferior cerebellar artery: case report. Neurosurgery. 2008; 62(3): E746–8; discussion E746.
- Alcalá-Cerra G, Tubbs RS, Niño-Hernández LM. Anatomical features and clinical relevance of a persistent trigeminal artery. Surg Neurol Int. 2012; 3: 111.
- Arráez-Aybar LA, Fuentes-Redondo T, Millán JM. Persistent trigeminal artery: a cross-sectional study based on over 3 years conventional angiography, CT angiography and MR angiography images. Surg Radiol Anat. 2016; 38(4): 445–453.
- 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(11): e578–e585.
- Battista RA, Kwartler JA, Martinez DM. Persistent trigeminal artery as a cause of dizziness. Ear Nose Throat J. 1997; 76(1): 43–45.
- Bechri H, Louraoui SM, Fikri M, et al. Persistence of a trigeminal artery associated with a posterior meningeal artery aneurysm: case report and literature review. J Surg Case Rep. 2020; 2020(2): rjz389.
- Behari S, Krishna H, Kumar MV, et al. Association between an aplastic basilar artery, unaccompanied by a primitive carotid-vertebrobasilar anastomosis, and multiple aneurysms on the dominant posterior communicating artery. J Neurosurg. 2004; 100(5): 946–949.
- Bosco D, Consoli D, Lanza PL, et al. Complete oculomotor palsy caused by persistent trigeminal artery. Neurol Sci. 2010; 31(5): 657–659.
- Boyko OB, Curnes JT, Blatter DD, et al. MRI of basilar artery hypoplasia associated with persistent primitive trigeminal artery. Neuroradiology. 1996; 38(1): 11–14.
- Brzegowy K, Pękala PA, Zarzecki MP, et al. Prevalence and clinical implications of the primitive trigeminal artery and its variants: a meta-analysis. World Neurosurg. 2020; 133: e401–e411.
- Chen YC, Li MH, Chen SW, et al. Incidental findings of persistent primitive trigeminal artery on 3-dimensional time-of-flight magnetic resonance angiography at 3.0 T: an analysis of 25 cases. J Neuroimaging. 2011; 21(2): 152–158.
- Cloft HJ, Razack N, Kallmes DF. Prevalence of cerebral aneurysms in patients with persistent primitive trigeminal artery. J Neurosurg. 1999; 90(5): 865–867.
- Engelhardt J, El Hage G, Bojanowski MW. Persistent trigeminal artery as collateral circulation in ischemic stroke. World Neurosurg. 2021; 148: 67–69.
- Enomoto T, Sato A, Maki Y. Carotid-cavernous sinus fistula caused by rupture of a primitive trigeminal artery aneurysm. Case report. J Neurosurg. 1977; 46(3): 373–376.
- 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(1): 257.
- Fields WS. The significance of persistent trigeminal artery. Carotid-Basilar anastomosis. Radiology. 1968; 91(6): 1095–1101.
- George AE, Lin JP, Morantz RA. Intracranial aneurysm on a persistent primitive trigeminal artery. Case report. J Neurosurg. 1971; 35(5): 601–604.
- Heyer GL, Dowling MM, Licht DJ, et al. The cerebral vasculopathy of PHACES syndrome. Stroke. 2008; 39(2): 308–316.
- Hirschberg M, Hofferberth B. Calcium antagonists in an animal model of vertebrobasilar insufficiency. Acta Otolaryngol Suppl. 1988; 460: 61–65.
- Iancu D, Anxionnat R, Bracard S. Brainstem infarction in a patient with internal carotid dissection and persistent trigeminal artery: a case report. BMC Med Imaging. 2010; 10: 14.
- Kim MJ, Kim MS. Persistent primitive trigeminal artery: analysis of anatomical characteristics and clinical significances. Surg Radiol Anat. 2015; 37(1): 69–74.
- Khodadad G. Trigeminal artery and occlusive cerebrovascular disease. Stroke. 1977; 8(2): 177–181.
- Komiyama M. Persistent trigeminal artery and its variants. Interv Neuroradiol. 2019; 25(6): 635–637.
- Lam JJ, Shah MT, Chung SLi, et al. Persistent primitive trigeminal artery associated with a cavernous carotid aneurysm. Case report and literature review. J Radiol Case Rep. 2018; 12(11): 1–11.
- Lewis VL, Cail WS. Persistent trigeminal artery with internal carotid artery occlusion. Neurosurgery. 1983; 13(3): 314–315.
- Lima Neto AC, Bittar R, Gattas GS, et al. Pathophysiology and diagnosis of vertebrobasilar insufficiency: a review of the literature. Int Arch Otorhinolaryngol. 2017; 21(3): 302–307.
- Maeshima S, Tereda T, Masuo O, et al. Multiple cerebral aneurysms with persistent primitive trigeminal artery. J Clin Neurosci. 1999; 6(1): 52–54.
- Meckel S, Spittau B, McAuliffe W. The persistent trigeminal artery: development, imaging anatomy, variants, and associated vascular pathologies. Neuroradiology. 2013; 55(1): 5–16.
- Momma F, Ohara S, Ohyama T. Persistent trigeminal artery associated with brainstem infarct--case report. Neurol Med Chir (Tokyo). 1992; 32(5): 289–291.
- 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(12): 1111–1119.
- Padget DH. The development of the cranial arteries in the human embryo. Contribution to embryology. Carnegie Institution. 1948: 205–261.
- Salas E, Ziyal IM, Sekhar LN, et al. Persistent trigeminal artery: an anatomic study. Neurosurgery. 1998; 43(3): 557–61; discussion 561.
- Tubbs RS, Verma K, Riech S, et al. Persistent fetal intracranial arteries: a comprehensive review of anatomical and clinical significance. J Neurosurg. 2011; 114(4): 1127–1134.
- Tyagi G, Sadashiva N, Konar S, et al. Persistent Trigeminal Artery: Neuroanatomic and Clinical Relevance. World Neurosurg. 2020; 134: e214–e223.
- Uchino A, Saito N, Okada Y, et al. Persistent trigeminal artery and its variants on MR angiography. Surg Radiol Anat. 2012; 34(3): 271–276.
