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A persistent trigeminal artery demonstrates cerebrovascular embryologic development.

Richard Bram1, Jason L Choi1, Alfred P See2

  • 1Department of Neurosurgery, University of Illinois at Chicago, Chicago, United States.

Surgical Neurology International
|March 10, 2023
PubMed
Summary
This summary is machine-generated.

A rare persistent primitive trigeminal artery (PPTA) variant was identified in a patient with a subarachnoid hemorrhage. This unique cerebrovascular anatomy highlights PPTA

Keywords:
Carotid-basilar anastomosisFetal intracranial arteryPersistent trigeminal arteryTrigeminalTrigeminal artery

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Area of Science:

  • Neuroscience
  • Vascular Anatomy
  • Embryology

Background:

  • Cerebrovascular development involves transient carotid-vertebrobasilar anastomoses.
  • The persistent primitive trigeminal artery (PPTA) is the most common remnant.
  • These fetal connections typically involute but can persist into adulthood.

Observation:

  • A unique PPTA variant was observed in a 70-year-old female with subarachnoid hemorrhage.
  • Angiography revealed a fetal origin of the left posterior cerebral artery (PCA) with a P2 aneurysm.
  • The PPTA originated from the left internal carotid artery, supplying the distal basilar artery (BA).

Findings:

  • The patient presented with a rare PPTA variant and a four-way division of the vertebrobasilar circulation.
  • The persistent primitive trigeminal artery supplied bilateral superior cerebellar arteries and the right PCA.
  • The basilar artery was atretic, with cerebellar arteries supplied by the right vertebral artery.

Implications:

  • This case demonstrates a unique PPTA variant not previously well-described.
  • Hemodynamic influence of PPTA can prevent basilar artery fusion.
  • Understanding such variants is crucial for cerebrovascular disease management.