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Microvascular Decompression: Salient Surgical Principles and Technical Nuances

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Published on: July 5, 2011

Selective Transarterial Embolization for a Ruptured Persistent Trigeminal Artery Variant Aneurysm.

Ryo Fujisawa^1,2, Yayoi Yoshimura^1,3, Hiroto Kawano¹

¹Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan.

NMC Case Report Journal

|July 8, 2024

Summary

This summary is machine-generated.

A ruptured persistent primitive trigeminal artery variant aneurysm caused a carotid-cavernous fistula. Endovascular trapping successfully treated the aneurysm, closing the fistula and resolving symptoms.

Keywords:

balloon occlusion test carotid-cavernous fistula persistent primitive trigeminal artery transarterial embolization

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Area of Science:

Vascular Neurology
Interventional Neuroradiology

Background:

Persistent primitive trigeminal artery (PPTA) is a rare congenital vascular anomaly.
Aneurysms arising from PPTA variants are exceptionally uncommon.
Carotid-cavernous fistulas (CCFs) can result from various etiologies, including ruptured aneurysms.

Observation:

A male patient presented with unilateral conjunctival hyperemia and exophthalmos.
Initial cerebral angiography suggested a direct carotid-cavernous fistula.
A subsequent balloon occlusion test identified the source as a ruptured aneurysm on the PPTA trunk.

Findings:

The ruptured aneurysm on the PPTA variant was the true source of the CCF.
Endovascular trapping of the affected PPTA segment was technically successful.
The procedure resulted in complete occlusion of the fistula.

Implications:

This case highlights the importance of thorough diagnostic evaluation for atypical CCF presentations.
Endovascular techniques can be effective in managing rare cerebrovascular lesions like PPTA aneurysms.
Successful treatment led to complete resolution of the patient's presenting symptoms.