Trigeminal Neuralgia Associated With an Anomalous Artery Originating From the Persistent Primitive Trigeminal Artery

Abstract

Fig. 1 Magnetic resonance angiograms, axial view(A) and lateral view (B), revealing the primitive trigeminal artery (PTA) (arrow) originating from the posterolateral aspect of the left internal carotid artery and connecting with the basilar artery, and also an anomalous small artery (arrowhead) directly originating from the PTA. 194Neurol Med Chir (Tokyo) 46, 194¿197, 2006 AbstractA 31-year-old man presented with typical trigeminal neuralgia caused by an anomalous variant type of anterior inferior cerebellar artery (AICA) directly branching from the primitive trigeminal artery (PTA). Three-dimensional computed tomography angiography, magnetic resonance angiography, and magnetic resonance cisternography disclosed that this anomalous artery originated from the PTA and coursed to the AICA territory of the cerebellum. Microvascular decompression surgery disclosed the trigeminal nerve compressed by this AICA variant together with the superior cerebellar artery. These arteries were successfully transpositioned to decompress the nerve. Careful and thorough inspection around the trigeminal nerve verified that the PTA did not conflict with the nerve. This unusual case was caused by compression of the trigeminal nerve from the AICA directly originating from the PTA, without the more common involvement of the PTA.

Arterial relationships to the nerves and some rigid structures in the posterior cranial fossa

“…Because of intensive microsurgical investigation the artery-nerve relationships particularly of the anterior inferior, posterior inferior, and superior cerebellar artery at the nerve root entry zone have been well studied (Hardy and Rhoton, 1978;Hardy et al, 1980;Lister et al, 1982;Toole, 1990;Dubuisson, 1994;Loeser, 1994;Murai et al, 2006;Yamada et al, 2006). However, the artery-nerve relationships to the skull and dural structures, especially concerning the vertebral and basilar arteries are not sufficiently examined.…”

“…E-mail: niknet@mail.bg nerve compression. Investigations of this aspect began after Dandy's (1934) report concerning the compression of the trigeminal nerve by elongated tortuous arteries at the nerve root entry zone, and his suggestion that this may be the cause of trigeminal neuralgia (Jannetta, 1967(Jannetta, , 1976Hardy and Rhoton, 1978;de Oliveira, 1985;Rhoton, 1993;Murai et al, 2006;Yamada et al, 2006). Nonetheless, these microsurgical studies concern the artery-nerve relationships at the nerve root entry zone of the brain stem.…”

Классическая Невралгия Тройничного Нерва

“…К та-ким заболеваниям относятся: опухоли мосто-мозжескового угла [67,145,181,211,244,248,287,319,347,348], арахноидиты задней че-репной ямки [142,323], аневризмы и артерио-венозные мальфор-мации вертебробазилярного бассейна [150,240,254,265,309,361,352,425], аномалии Арнольда-Киари [218,405], платибазии [264,357]. Клинически этот вид НТН отличается от классической нарастающим сенсорным дефицитом, не характерным для клас-сической НТН.…”

Trigeminal Neuralgia Caused by an Anomalous Posterior Inferior Cerebellar Artery from the Primitive Trigeminal Artery: Case Report

“…Yamada and Kondo [5] reported one case of TN elicited by an anomalous AICA, branching from the PTA, which they identified as an "intermediate" type for it anomalous AICA. It is similar to our case.…”

“…Although the literature has mentioned this "intermediate type" PTA variant [5], no previous study has provided full, specific details about its angiographic anatomy and surgical importance during microvascular decompression (MVD).…”