Persistent primitive trigeminal artery: a review

Abstract

The trigeminal artery is the largest of the fetal carotid-basilar anastomotic arteries, and it persists for the longest embryonic period. The artery usually involutes after the development of the posterior communicating artery. The exact causes of persistence of this primitive vessel into adulthood are not completely clear. Angiographic and anatomical descriptions of the various persistent trigeminal artery (PTA) configurations and their relation to the remainder of the cerebrovascular tree and the other surrounding structures have been reported. Persistent trigeminal artery can be associated with many other vascular anomalies and disorders including aneurysms, arteriovenous malformations and carotidcavernous fistulae. A thorough understanding of the anatomical and angiographic features of this persistent embryonic arterial channel is of utmost importance when making therapeutic decisions and embarking on surgical or endovascular intervention for any pertinent pathological condition. We review the embryology, angiographic features, microsurgical anatomy and associated vascular anomalies and disorders of the persistent trigeminal artery.

Persistent trigeminal artery as a rare cause of ischaemic lesion and migraine-like headache

“…In patients undergoing vascular examinations, PTA and its variants are reported with a frequency of 0.1-1%, depending on the imaging modality used [3,17]. In early angiographic studies, the frequency of PTA in examined groups was approximately 0.2% [25]; however, in newer reports this number is significantly higher.…”

“…These anastomoses are made by the trigeminal, otic, hypoglossal and proatlantal intersegmental arteries [1,3]. Before the vertebral and posterior communicating arteries develop, the trigeminal artery temporarily supplies the hindbrain at about 28-35 days of gestation.…”

Intrasellar chordoma associated with a primitive persistent trigeminal artery.

“…Subsequently, relationships of skull base tumors to intracranial vessels, should be carefully evaluated preoperatively with an angiogram, particularly when those surgical approaches are used (3). The decision to occlude PPTA must take into account the particular anatomical variation, branches, and its association with other cerebrovascular variants and disorders, all of which determine the safety of such a procedure (3,4).…”

“…Subsequently, relationships of skull base tumors to intracranial vessels, should be carefully evaluated preoperatively with an angiogram, particularly when those surgical approaches are used (3). The decision to occlude PPTA must take into account the particular anatomical variation, branches, and its association with other cerebrovascular variants and disorders, all of which determine the safety of such a procedure (3,4). This paper provides new insight into the need of suitable preoperative management of primitive carotid-basilar anastomoses that persist into adulthood before attempting surgical removal of sellar tumors, in order to achieve extensive surgical resection avoiding intraoperative life-threatening vascular complications.…”

“…The trigeminal artery (TA) is an anastomosis between embryonic precursors of the vertebrobasilar and carotid systems, and may persist into adult life (3). It is the most common type of persistent primitive artery and is present in 0.1-0.6% of individuals (3,4).…”