Coil Embolization of an Aneurysm Located at the Trunk of the Persistent Primitive Trigeminal Artery -Case Report-

Abstract

A 71-year-old woman presented with an aneurysm at the trunk of the persistent primitive trigeminal artery (PPTA) manifesting as subarachnoid hemorrhage. Angiography and three-dimensional computed tomography revealed a wide-necked saccular aneurysm at the trunk of the left PPTA. Coil embolization with the balloon-assist technique was successful and PPTA patency was preserved. Preoperative conventional angiography should be performed to check for cross-filling of the PPTA. This case demonstrates that an aneurysm of the trunk of the PPTA can be successfully treated by coil embolization using the balloon-assist technique.

Resolution of Migraine-Like Headache by Coil Embolization of a Primitive Trigeminal Artery Aneurysm

“…The reported incidence of persistent PTA is about 0.2–0.6% in all cerebral angiograms [1,6]. Aneurysms of the PTA are exceptionally rare, and only around 40 cases of PTA‐associated aneurysms have been reported in the literature [1–3]. Fenestration refers to segmental duplication of a vessel into two distinct endothelium‐lined channels, which may or may not share adventitial covering, with continuity at the proximal and distal ends.…”

“…Most unruptured PTAs are asymptomatic; thus, aneurysms originating from the unruptured PTA are extremely rare. There are only about 40 previous reports of PTA‐associated aneurysms in the medical literature [1–3]. The PTA courses alongside and is anatomically in proximity to the trigeminal nerve.…”

Resolution of trigeminal neuralgia by coil embolization of a persistent primitive trigeminal artery aneurysm

“…Approximately 15% of cases of PTA have an associated aneurysm, with the most common location being the bifurcation of the cavernous segment of the ICA and the PTA 6. Abducens palsy is the most common neurological deficit, which is explained by the proximity of ICA-PTA bifurcation aneurysms to the abducens nerve.…”

“…Curiously, despite the close anatomical proximity between the PTA and the trigeminal nerve, there are no reported cases of trigeminal neuralgia secondary to PTA aneurysms. To date, there are only around 40 previous reports of such an aneurysm in the world literature, with the most common presenting symptoms being abducens palsy and headache 6. We report the first account of the resolution of trigeminal neuralgia following coil embolization of a PTA aneurysm.…”

Anatomical features and clinical relevance of a persistent trigeminal artery

“…[122485861] Ruptures of such aneurysms have presented as spontaneous PTA to cavernous sinus fistula and have been treated with an endovascular approach. [391920505962] Therapeutically, the PTA could provide an alternative endovascular approach to the posterior circulation, especially in some cases where the vertebral or basilar arteries are hypoplastic or compressed and do not permit catheter advancement.…”