Bilateral Persistent Primitive Trigeminal Arteries Associated with Trigeminal Neuralgia

Abstract

Persistent carotid-vertebrobasilar anastomoses (PCVBA) include the primitive trigeminal artery (PTA), the primitive otic artery (POA), the primitive hypoglossal artery and proatlantal arteries (ProAs). The PTA is the most commonly seen of these accounting for approximately 80-85% of PCVBAs. The PTA which connects the internal carotid artery (ICA) to the basilar artery (BA) may occasionally connect to the superior or posterior inferior cerebellar arteries without interposition to the BA. It is then referred to as a persistent trigeminal artery variant (PTAV), an anomalous carotid-cerebellar anastomosis. Bilateral occurrence of PTA is extremely rare. During vertebral artery (VA) development the anterior radicular artery of segment C1 from the proatlantal artery of Padget evolves into the intradural component of the VA (V4 segment) plus a short extradural segment (distal V3 segment). Agenesis of a single anterior radicular artery of ProA results in the absence of one distal VA associated with an unremarkable contralateral VA and the BA. Absence or hypoplasia of the terminal portion of one VA is a commonly observed anatomic variant. However, absence of the terminal portions of both VAs is exceptional. A rare case of bilateral PTAs is presented with unilateral PTA and a contralateral PTAV causing trigeminal neuralgia. Furthermore, the bilateral PTAs were associated with the absence of the proximal portion of the BA in addition to the bilateral lack of a distal VA. This finding comes as a logical consequence of the developmental anatomy of the vertebrobasilar junction and is consistent with the assumed congenital nature of the anatomic variant.

Bilateral Persistent Trigeminal Arteries with Unilateral Trigeminal Artery to Cavernous Sinus Fistula

“…among these, four had a classic Pta with a contralateral Ptav. one case with bilateral Ptavs was also reported 6 . It is possible that the arterial branch supplying the left trigeminal-cavernous sinus fistula in our patient was a left Ptav that connected to the cerebellar artery.…”

“…Bilateral Ptas are an extremely rare condition. the eight cases reported in the English language literature (table 1) [3][4][5][6][22][23][24][25][26] were associated with intracranial aneurysm 4,25,26 , Moyamoya disease 24 , bilateral vertebral arteries agenesis, or hypoplasia 5,23 . among these, four had a classic Pta with a contralateral Ptav.…”

“…one of the most common persisting embryological carotid-basilar anastomoses (cBas), the incidence of unilateral persistent trigeminal artery (Pta) has been reported to be from 0.1% to 0.6% based on studies using large-scale magnetic resonance angiography (Mra) and digital subtraction angiography (dSa) imaging 1,2 , and bilateral Ptas are relatively rare [3][4][5][6] . trigeminal-cavernous sinus fistulas are uncommon lesions in which abnormal shunts between a Pta and an ipsilateral cavernous sinus develop spontaneously or secondary to trauma [7][8][9][10] .…”

Persistent trigeminal artery supply to an intrinsic trigeminal nerve arteriovenous malformation: A rare cause of trigeminal neuralgia

“…The artery serves as an embryological structure connecting the precavernous carotid artery and basilar artery until the seventh week of gestation. It typically regresses but remains postnatally in 0.1-0.6% of the population [5]. The PTA usually originates separate from and proximal to the meningohypophyseal trunk.…”