Persistent Trigeminal Artery: Neuroanatomic and Clinical Relevance

Area of Science:

• Neurology
• Vascular Anatomy
• Medical Imaging

Background:

• Persistent trigeminal artery (PTA) is the most common remnant of primitive circulation, connecting the carotid and vertebrobasilar systems.
• Altered hemodynamics associated with PTA may increase the risk of aneurysms, vascular malformations, and stroke.
• Neurosurgeons must recognize PTA's presence and implications for imaging interpretation and surgical planning.

Purpose of the Study:

• To investigate the incidence and characteristics of incidentally detected persistent trigeminal arteries (PTA).
• To analyze the association of PTA with cerebrovascular pathologies and neurological symptoms.
• To provide insights for neurosurgical management and understanding of PTA.

Main Methods:

• Retrospective review of magnetic resonance angiography and cerebral digital subtraction angiography from 2012-2017.
• Analysis of radiologic, anatomic, and clinical data from 33 incidentally detected PTA cases.
• Comparison of findings with existing literature and classification systems.

Main Results:

• 33 cases of incidentally detected PTA were identified, with a mean patient age of 45.42 years.
• The most common origin was the lateral cavernous internal carotid artery; most cases were Saltzman/Weon type I.
• Associated findings included intracranial aneurysms in 18.18% of patients and trigeminal neuralgia in 5 patients.

Conclusions:

• This study contributes significant data on PTA incidence and characteristics.
• PTA is clinically relevant due to its association with aneurysms, potential as an intervention route, surgical risks, and link to trigeminal neuralgia.
• Specific PTA variants with a cisternal course are more likely associated with trigeminal neuralgia due to neurovascular conflict.