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Wang Y, Yu J. Clinical Importance of the Persistent Primitive Trigeminal Artery in Vascular Lesions and Its Role in Endovascular Treatment. Front Neurol 2022; 13:928608. [PMID: 35899260 PMCID: PMC9309485 DOI: 10.3389/fneur.2022.928608] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
| | - Jinlu Yu
- *Correspondence: Jinlu Yu ; ; orcid.org/0000-0003-2329-7946
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Cho DY, Kim BS, Jang J, Choi HS, Jung SL, Ahn KJ, Shin YS. Cerebellar artery arising from the cavernous segment of the internal carotid artery and persistent trigeminal artery: a spectrum of incomplete longitudinal fusion. Acta Radiol 2020; 61:386-394. [PMID: 31342758 DOI: 10.1177/0284185119861310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The embryological relationship between cerebellar arteries originating directly from the cavernous segment of the internal carotid artery and persistent trigeminal artery is not well understood. Purpose To evaluate the incidence and pattern of cerebellar arteries originating from the internal carotid artery and persistent trigeminal artery, and to discuss their probable embryological relationship. Material and Methods We reviewed 5113 angiographic studies from 5093 patients at our institution over the last eight years, searching for patients with persistent trigeminal artery and cerebellar arteries originating from a cavernous segment of internal carotid artery (persistent trigeminal artery variant). Results Of the 5093 patients, 27 patients had persistent trigeminal artery or persistent trigeminal artery variant (0.53%). Twenty patients (6 men, 14 women; median age = 54 years) had persistent trigeminal artery (0.39%). Seven patients (2 men, 5 women, age range = 37–72 years; median age = 57 years) had a persistent trigeminal artery variant with persistent trigeminal artery terminating in a cerebellar artery without direct connection to the basilar artery (persistent trigeminal artery variant; 0.14%). The terminal branch of the persistent trigeminal artery variant was an anterior inferior carotid artery in five patients and a superior cerebellar artery in two patients. Of the seven patients having persistent trigeminal artery variant, four patients had another artery from the basilar artery to the anterior inferior carotid artery territory. In 6/20 patients with persistent trigeminal artery, there was an anterior inferior carotid artery arising from the persistent trigeminal artery. One of these patients showed another arterial branch from the basilar artery to the anterior inferior carotid artery territory. Conclusion Persistent trigeminal artery variant and cerebellar arteries originating from the persistent trigeminal artery are both believed to be a spectrum of incomplete fusion of the longitudinal neural arteries. Understanding the precise anatomy is important in diagnostic and therapeutic settings for related vascular disease.
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Affiliation(s)
- Dong Young Cho
- Department of Radiology, College of Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Republic of Korea
| | - Bum-Soo Kim
- Department of Radiology, College of Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Republic of Korea
| | - Jinhee Jang
- Department of Radiology, College of Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Republic of Korea
| | - Hyun Seok Choi
- Department of Radiology, College of Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Republic of Korea
| | - So Lyung Jung
- Department of Radiology, College of Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Republic of Korea
| | - Kook-Jin Ahn
- Department of Radiology, College of Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Republic of Korea
| | - Yong Sam Shin
- Department of Neurosurgery, College of Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Republic of Korea
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Wenz H, Wenz R, Förster A, Fontana J, Kerl HU, Groden C, Scharf J. Missing relationship of moyamoya and persistent primitive artery in Europeans. Another distinctive feature or artifact? Surg Radiol Anat 2015; 37:1079-85. [DOI: 10.1007/s00276-015-1457-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 03/03/2015] [Indexed: 11/30/2022]
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Uchino A, Saito N, Takahashi M, Kurita H, Ishihara S. Cerebral Arterial Variations Associated with Moyamoya Disease Diagnosed by MR Angiography. Neuroradiol J 2014; 27:697-701. [PMID: 25489893 DOI: 10.15274/nrj-2014-10093] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 08/15/2014] [Indexed: 11/12/2022] Open
Abstract
Moyamoya disease is a rare progressive cerebrovascular steno-occlusive disease associated with different variations of the cerebral arteries. We evaluated the types and prevalence of such variations among patients with moyamoya disease. In our institution during the past seven years, we diagnosed 72 patients (24 male, 48 female; aged 6 to 75 years, mean, 42 years) with moyamoya disease by magnetic resonance (MR) angiography using either a 3-Tesla or one of two 1.5-T imagers and a standard time-of-flight technique without contrast media. An experienced neuroradiologist retrospectively reviewed the images. There were 15 cerebral arterial variations in 13 of 72 patients with moyamoya disease (18.1%), including four basilar artery fenestrations, three ophthalmic arteries arising from the middle meningeal artery, two intracranial vertebral artery fenestrations, two persistent first cervical intersegmental arteries, two persistent trigeminal arteries, one extracranial origin of the posterior inferior cerebellar artery, and one persistent stapedial artery. Although our number of patients was small, moyamoya disease was frequently associated with variations of the cerebral arteries, especially fenestrations in the vertebrobasilar system and persistent trigeminal artery.
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Affiliation(s)
- Akira Uchino
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center; Hidaka, Saitama, Japan -
| | - Naoko Saito
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center; Hidaka, Saitama, Japan
| | - Masahiro Takahashi
- Department of Neurosurgery, Saitama Medical University International Medical Center; Saitama, Japan
| | - Hiroki Kurita
- Department of Neurosurgery, Saitama Medical University International Medical Center; Saitama, Japan
| | - Shoichiro Ishihara
- Department of Neurosurgery, Saitama Medical University International Medical Center; Saitama, Japan
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Meckel S, Spittau B, McAuliffe W. The persistent trigeminal artery: development, imaging anatomy, variants, and associated vascular pathologies. Neuroradiology 2011; 55:5-16. [PMID: 22170080 DOI: 10.1007/s00234-011-0995-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Accepted: 11/29/2011] [Indexed: 10/14/2022]
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Weon YC, Choi SH, Hwang JC, Shin SH, Kwon WJ, Kang BS. Classification of persistent primitive trigeminal artery (PPTA): a reconsideration based on MRA. Acta Radiol 2011; 52:1043-51. [PMID: 21969699 DOI: 10.1258/ar.2011.110191] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Persistent primitive trigeminal artery (PPTA) is the most common permanent carotid-basilar anastomosis. Magnetic resonance angiography (MRA) has become the primary non-invasive imaging technique for evaluation of cerebral vascular anatomy and can provide detailed 3D imaging of intracranial vessels. PURPOSE To evaluate the usefulness of MRA for the detection of PPTA and to re-classify its variations based on the embryologic types of PcomA and its relationship with the basilar artery and its branches. MATERIAL AND METHODS Of the total 7329 patients who underwent MRA at our institution from March 2008 through November 2010, we retrospectively analyzed the MRAs of 24 patients with a PPTA. Special attention was given to defining the relationship of the PPTA and the basilar artery with PcomA and to determine the site of origin, size, and course of the PPTA. The PPTA classification included five types based on their anatomic relationship to the neighboring arteries. Clinical features and associated vascular anomalies are also described. RESULTS Twenty-four (17 women and seven men, 34 ~ 81 years of age, mean age 59.67 years) of the 7329 patients had a PPTA (0.33 %). Eleven cases (45.8%) were classified as type 1, three (12.5%) as type 2, five (20.8%) as type 3, one (4.2%) as type 4, and four (16.7%) as type 5b. Fifteen PPTAs (62.5%) were located on the left side and nine were located (37.5%) on the right side. The basilar artery proximal to the insertion of the PPTA showed severe to moderate hypoplasia in 13 cases (54%). Nine intracranial artery aneurysms were detected in seven (29%) of the 24 study patients. CONCLUSION This study revealed five types of PPTA and necessitates an adjustment of the previous classification of PPTA on the basis of our MRA examinations. A PPTA should be considered by both the clinician and the radiologist who interpret MR angiography.
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Affiliation(s)
- Young Cheol Weon
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Seong Hoon Choi
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jae Cheol Hwang
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Shang Hun Shin
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Woon-Jung Kwon
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Byeong Seong Kang
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Uchino A, Saito N, Okada Y, Kozawa E, Mizukoshi W, Inoue K, Takahashi M. Persistent trigeminal artery and its variants on MR angiography. Surg Radiol Anat 2011; 34:271-6. [DOI: 10.1007/s00276-011-0848-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 06/24/2011] [Indexed: 11/29/2022]
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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; 52:1111-9. [PMID: 20309534 DOI: 10.1007/s00234-010-0669-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Accepted: 02/24/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The primitive persistent trigeminal artery (PTA) is the most common carotid-basilar anastomosis, but because of its extremely low incidence, it is poorly understood. The purpose of this study is to clarify the features of PTA and its variants (PTAV) based on a large magnetic resonance angiography (MRA) series. METHODS MRA was performed on continuous 16,415 patients (8,610 males and 7,805 females) between October 2005 and September 2008 using two 1.5-T systems and one 1.0-T system. These all MRAs were evaluated by neuroradiologists. RESULTS The incidence of both PTA and PTAV was 0.68% (48 cases of PTA, 50 cases of PTAV, and five unclassified). Among them, 65 cases originated from the left internal carotid artery and 38 from the right. There were 44 cases of lateral type PTA and four cases of medial type. Hypoplasia of the basilar artery proximal to the union of PTA was recognized as follows: no hypoplasia in 12 cases, moderate hypoplasia in 22 cases, and severe hypoplasia in 13 cases. Distance from SCA and the union was an average of 6.7 mm. Four cases of pre- and postoperative cerebral aneurysms were recognized in 103 cases (3.9%). CONCLUSION We have identified details of both PTA/PTAV. The incidence of PTA was similar to previous studies, and the co-existence of cerebral aneurysm was also similar when compared to patients in the general population without PTA or PTAV.
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Affiliation(s)
- Eri O'uchi
- Department of Radiology, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan.
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Yang Z, Liu J, Zhao W, Xu Y, Hong B, Huang Q, He S. A fusiform aneurysm of a persistent trigeminal artery variant: case report and literature review. Surg Radiol Anat 2009; 32:401-3. [PMID: 19690795 DOI: 10.1007/s00276-009-0537-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 07/25/2009] [Indexed: 11/30/2022]
Abstract
A 48-year-old man suffered from spontaneous subarachnoid hemorrhage. Emergent right internal carotid angiography showed the presence of a persistent trigeminal artery (PTA) variant with a fusiform aneurysm on its proximal segment where it branched from the internal carotid artery. This artery supplied the territory of the anterior inferior cerebellar artery. After consideration of the adequacy of the cerebellar circulation without this anomalous artery, intraluminal occlusion of the aneurysm together with the PTA variant was performed using detachable coils. The patient recovered uneventfully without any neurologic deficits.
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Affiliation(s)
- Zhigang Yang
- Department of Neurosurgery, Changhai Hospital, Shanghai, China
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Arakawa T, Koizumi M, Terashima T, Honma S, Kawai K, Kodama K, Miki A. Two anatomical autopsy cases of direct communication between a persistent primitive trigeminal artery and an anterior inferior cerebellar artery. Ann Anat 2007; 189:489-98. [PMID: 17910403 DOI: 10.1016/j.aanat.2006.11.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The persistent primitive trigeminal artery (PPTA) is the most common persistent carotid-basilar anastomosis. However, morphological findings of the PPTA based on the anatomical autopsy are very scarce. To understand the reason why such a variant artery develops, it is essential to examine the detailed morphology of the PPTA and developmental process of this artery. Here, we present two anatomical autopsy instances of the PPTA (cases 1 and 2). In the first case (78-year-old female; right side), the anterior inferior cerebellar artery (AICA) arose from the internal carotid artery passing medial to the abducens nerve. This artery gave off a small branch communicating to the basilar artery, passed lateral to the trigeminal nerve root, and continued backward to the dorsal surface of the cerebellum. Thus, in this case, the AICA is considered to be branched from the PPTA. In the second case (75-year-old female, left side), the PPTA branched from the internal carotid artery, and passed lateral to the abducens nerve, giving off an artery connecting with the AICA. These communicating arteries between the basilar artery and the AICA, recognized in cases 1 and 2, are considered to be the persistence of the primitive lateral basilovertebral anastomosis during the early embryological period. We propose that the primitive lateral basilovertebral anastomosis forms the arterial network around the trigeminal nerve root, and the AICA develops through this anastomosis.
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Affiliation(s)
- Takamitsu Arakawa
- Department of Physical Therapy, Faculty of Health Science, Kobe University Graduate School of Medicine, 7-10-2 Tomogaoka, Suma-Ku, Kobe 654-0142, Japan.
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