Persistent Trigeminal Artery Review: Classic and Variant Pattern - Embriology, Anatomic and Radiological Characteristics

Abstract

Purpose: Persistent Primitive Trigeminal Artery (PPTA) is one of the four transient carotid-basilar anastomoses in embryologic development. It was first angiographically demonstrated by Sutton around 1950. PPTA variant patterns exist, and it is important to be recognized in the medical practical routine. Review the embryology, anatomic, and radiological characteristics of Persistent Trigeminal Artery, including the classic pattern and its variants according to the literature. Methods:We conducted online bibliographic research on websites such as PubMed using the keywords "persistent trigeminal artery," "carotid-basilar anastomosis," and "MR persistent trigeminal artery." The articles used for this paper were those written in English, Spanish, or Portuguese that included the previously described words. We also collected the information from the Beneficência Portuguesa Hospital Radiology Service in Sao Paulo, Brazil, for comparison. Results:In the series from the Radiology Service of the Beneficência Portuguesa Hospital in Sao Paulo, Brazil, we identified four PTA variants, which had an incidence of 0.13, consistent with the incidence reported in the literature. Conclusions:We discovered a very low incidence of this important anastomotic variant. However, despite the low incidence of this pathology, the clinical relevance in some surgeries when we encounter a PPTA is essential to avoid complications, like bleeding or infarction.