Persistent Trigeminal Artery: Neuroanatomic and Clinical Relevance

Autor: Dhaval Shukla, Nishanth Sadashiva, Bhagavatula Indira Devi, Gaurav Tyagi, Hanumanthapura R. Aravinda, Subhas Konar, Jitender Saini
Rok vydání: 2020
Předmět:
Adult
Male
medicine.medical_specialty
Adolescent
medicine.medical_treatment
Magnetic resonance angiography
Arteriovenous Malformations
Young Adult
03 medical and health sciences
0302 clinical medicine
Trigeminal neuralgia
medicine.artery
medicine
Humans
Child
Stroke
Aged
Retrospective Studies
Transsphenoidal surgery
medicine.diagnostic_test
business.industry
Angiography
Digital Subtraction
Intracranial Aneurysm
Digital subtraction angiography
Cerebral Arteries
Middle Aged
Trigeminal Neuralgia
Neurovascular bundle
medicine.disease
body regions
medicine.anatomical_structure
Trigeminal Ganglion
Child
Preschool
030220 oncology & carcinogenesis
Trigeminal artery
Female
Surgery
Neurology (clinical)
Radiology
Internal carotid artery
business
Magnetic Resonance Angiography
030217 neurology & neurosurgery
Zdroj: World Neurosurgery. 134:e214-e223
ISSN: 1878-8750
DOI: 10.1016/j.wneu.2019.10.025
Popis: Introduction Persistent trigeminal artery (PTA) is the most common remnant of primitive circulation communicating the developing carotid and vertebrobasilar junction. Although discovered incidentally, an altered hemodynamic may lead to an increased association of aneurysms, vascular malformations, and stroke. Neurosurgeons should be aware of the presence and significance of PTA when interpreting imaging and planning interventions. Methods We retrospectively reviewed all magnetic resonance angiography and cerebral digital subtraction angiography performed between 2012 and 2017 for the presence of PTA. The radiologic and anatomic details were noted and analyzed along with the clinical profiles. We categorized the radiologic findings with respect to the available classification systems. A review of the available literature was done comparing our results. Results We found 33 cases of incidentally detected PTA. The average age of the patients was 45.42 years. The lateral surface of the proximal cavernous internal carotid artery was the most common origin (n = 23). Only 3 cases had a medial/transsellar course. Most cases were Saltzman/Weon type I (19/33). Intracranial aneurysms were associated with 6 patients (18.18%). Trigeminal neuralgia (TN) was a presenting feature in 5 patients. None had a direct neurovascular conflict at the root entry zone. Conclusions Our study is one of the largest to describe the incidence of PTA. We emphasized the importance of PTA to the neurosurgeons; increased association of aneurysms, as a route for intervention in occlusive disease of the posterior fossa; risk of injury and bleeding during transsphenoidal surgery; and the association with TN. However, we found that only PTA variants are likely to be associated with TN because of their cisternal course causing NV conflict.
Databáze: OpenAIRE
Externí odkaz: