Treatment of Large or Giant Cavernous Aneurysm Associated with Persistent Trigeminal Artery: Case Report and Review of Literature

Ishikawa, Tatsuya; Yamaguchi, Koji; Anami, Hidenori; Sumi, Masatake; Ishikawa, Takeshi; Kawamata, Takakazu

doi:10.1016/j.wneu.2017.09.033

Cited by 13 publications

(10 citation statements)

References 18 publications

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“…[13] Despite these associations, several studies have debated the need of increased surveillance in these patients with incidental PTAs. [6,8] We believe that the presence of PTA might alter the flow dynamics of circle of Willis, predisposing to aneurysm formation. Other pathogenic mechanisms of aneurysm formation include hypertension and hemodynamic stress.…”

Section: Discussionmentioning

confidence: 99%

Sequential aneurysms with incidental persistent primitive trigeminal artery: Is this association purely coincidental? A case study and review of the literature in search for a pathobiological mechanism

Sreenivasan

Agarwal

Roychowdhury

et al. 2022

Surgical Neurology International

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Background: The appearance of sequential bilateral aneurysms in patients with persistent primitive trigeminal artery (PTA) is not described in the literature. No clear guidelines on screening and follow-up of patients with incidental PTAs for the detection of associated lesions have been established. Case Description: A 55-year-old lady presented with occasional headaches. Detailed evaluation showed a left ophthalmic segment internal carotid artery (ICA) aneurysm measuring (11.2 × 5.5) mm. A bovine aortic arch configuration (type III) and a persistent left PTA were identified. A pipeline flex flow diverter was placed and aneurysm was coiled. Follow-up angiography after 6 months showed a completely occluded aneurysm with preserved PTA and a new aneurysm in the right ICA ophthalmic segment measuring 3.5 × 1.5 mm. It was followed up serially with angiography which revealed significant increase in 6 months. The base measured 5.4 mm and two blebs 3.1 mm and 2.5 mm had appeared on the dome. A SUPRASS flow diverter was placed across this aneurysm. Serial follow-up showed complete occlusion of the left aneurysm and significant reduction in filling of the right aneurysm. A review of the literature identified 34 cases of incidental PTAs associated with 50 aneurysms with increased prevalence of anterior circulation aneurysms in patients with incidental PTA. Conclusion: Sequential angiography of a patient with incidental PTA and an ICA aneurysm shows presence of a new aneurysm in contralateral circulation and its progression in size and morphology. Detailed large-scale studies are needed to assess the impact of incidental PTA on aneurysm development and management.

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Section: Discussionmentioning

confidence: 99%

Sequential aneurysms with incidental persistent primitive trigeminal artery: Is this association purely coincidental? A case study and review of the literature in search for a pathobiological mechanism

Sreenivasan

Agarwal

Roychowdhury

et al. 2022

Surgical Neurology International

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“…Interestingly, these reports suggest that such specific aneurysms on an arterial anomaly are found in patients of a relatively younger age. 18,19 Some reports have demonstrated cases in patients under 30 years old. 19,20 Chalouhi et al 10 pointed out a high frequency of multiple aneurysms in patients with paraclinoid aneurysms, and it may support the congenital fragility of the arterial wall.…”

Section: Discussionmentioning

confidence: 99%

“…18,19 Some reports have demonstrated cases in patients under 30 years old. 19,20 Chalouhi et al 10 pointed out a high frequency of multiple aneurysms in patients with paraclinoid aneurysms, and it may support the congenital fragility of the arterial wall. Tanaka 21 reported a case of a paraclinoid aneurysm at a primitive dorsal ophthalmic artery.…”

Section: Discussionmentioning

confidence: 99%

Unruptured Paraclinoid Carotid Aneurysms Occur More Frequently in Younger Ages

et al. 2021

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Purpose: We investigated the age distribution of cerebral saccular aneurysms in various locations to clarify the differences by location and discuss the mechanism of formation.Materials and Methods: We retrospectively assessed clinical material obtained from 1,252 unruptured aneurysms treated with endovascular embolization between 2004 and 2019. Age, sex, laterality, and size were investigated by the location of aneurysms, classified as cavernous internal carotid artery (ICA), paraclinoid ICA, supraclinoid ICA, anterior communicating artery, anterior cerebral artery, middle cerebral artery, basilar artery complex, and posterior inferior cerebellar artery. Paraclinoid aneurysms were subclassified into 3 patterns according to their projecting direction: S-type, with superior protrusion; M-type, with medial protrusion; and P-type, with posteroinferior protrusion.Results: There was no significant difference by location for sex, laterality, and size. The mean age of patients with paraclinoid aneurysms (56.5 years old) was significantly lower than that of other aneurysm patients (64.3 years old). Notably, 40% of the patients with M-type aneurysms were <50 years old. This percentage was significantly higher than that of aneurysms at other locations (P<0.05).Conclusion: We found a young female predominance for patients with paraclinoid carotid aneurysms. This study may suggest that congenital factors contribute to paraclinoid aneurysm formation as well acquired factors, such as hemodynamic stress, atherosclerotic wall damage, and local inflammation.

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“…In lateraltype PPTAs, the artery projects along the dorsum sellae after passing between the trigeminal and abducens nerves, which may cause nerve compression resulting in trigeminal neuralgia or ocular motility disorder. 10,11) Cases of PPTA can also be anatomically classified according to Saltzman types. 2,12) In type 1, the Pcom and the proximal BA are usually hypoplastic, and the PPTA connects to the BA between the anterior inferior cerebellar artery and the SCA orifice.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Aneurysms in Persistent Primitive Trigeminal Arteries with Stent-Assisted Coil Embolization

Sakaï

Ando

Chihara

et al. 2021

JNET

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Persistent primitive trigeminal artery (PPTA) is a rare condition in which a fetal carotid-basilar anastomosis persists into adulthood. PPTA aneurysms often necessitate endovascular treatment and adjunctive techniques, such as stent-or balloon-assisted techniques, are sometimes selected. This case report describes two women in their sixties with unruptured right PPTA aneurysms who underwent stent-assisted coil embolization procedures, with consideration of the anatomical features in each case.Case Presentations: One patient presented with an aneurysm at the bifurcation of the PPTA and the basilar artery (BA), which was classified as Saltzman type 1 with a hypoplastic vertebral artery (VA)-BA system. A stent was deployed from the BA to the PPTA to cover the neck of the aneurysm and coil embolization was performed. The second patient presented with an aneurysm at the bifurcation of the PPTA and the internal carotid artery (ICA), which was classified as Saltzman type 2 with a hypoplastic VA-BA system. A stent was deployed from the PPTA to the petrous segment of the ICA covering the neck of the aneurysm and coil embolization was performed. In both patients, the 1-year follow-up digital subtraction angiography (DSA) showed that the aneurysms had not recurred. Conclusion:The PPTA aneurysms were successfully treated with stent-assisted coil embolization. The treatment strategy should be devised in accordance with both the lesion site and the PPTA variant. Keywords▶ persistent primitive trigeminal artery, aneurysm, stent, coil embolization This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.

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Treatment of Large or Giant Cavernous Aneurysm Associated with Persistent Trigeminal Artery: Case Report and Review of Literature

Cited by 13 publications

References 18 publications

Sequential aneurysms with incidental persistent primitive trigeminal artery: Is this association purely coincidental? A case study and review of the literature in search for a pathobiological mechanism

Sequential aneurysms with incidental persistent primitive trigeminal artery: Is this association purely coincidental? A case study and review of the literature in search for a pathobiological mechanism

Unruptured Paraclinoid Carotid Aneurysms Occur More Frequently in Younger Ages

Treatment of Aneurysms in Persistent Primitive Trigeminal Arteries with Stent-Assisted Coil Embolization

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