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

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.