The persistent trigeminal artery: development, imaging anatomy, variants, and associated vascular pathologies

Area of Science:

• Neurology
• Vascular Biology
• Embryology

Background:

• The persistent trigeminal artery (PTA) is the most common persistent embryological connection between the carotid and vertebrobasilar systems.
• It is frequently identified as an incidental finding in neuroimaging studies.

Purpose of the Study:

• To review the embryology, anatomy, and imaging findings of the PTA and its variants.
• To present associated arterial anomalies and pathologies, including aneurysms, fistulas, and nerve compression.
• To discuss the management of PTA-associated pathologies, emphasizing endovascular and surgical options.

Main Methods:

• Review of embryology and anatomy of the persistent trigeminal artery.
• Analysis of angiographic imaging findings and variants.
• Summary of associated pathologies and their clinical presentations.
• Discussion of management strategies, including endovascular and surgical interventions.

Main Results:

• The reported incidence of PTA and its variants ranges from 0.1% to 0.76%.
• Associated pathologies include aneurysms, trigeminal cavernous fistulas, and trigeminal nerve compression.
• Endovascular treatment is often preferred for aneurysms and fistulas; microvascular decompression for nerve compression.

Conclusions:

• Understanding PTA variants is crucial for accurate diagnosis and effective treatment planning.
• A multidisciplinary approach is recommended for managing patients with PTA-associated vascular pathologies.
• This review provides a comprehensive guide for clinicians dealing with this common cerebrovascular anomaly.