Persistent primitive trigeminal artery associated with a cavernous carotid aneurysm. Case report and literature review.

Abstract

The persistent primitive trigeminal artery is the most common persistent carotid-vertebrobasilar anastomosis. Patients are usually asymptomatic and the persistent primitive trigeminal artery is commonly found incidentally on imaging. Rarely, they may present with symptoms of neurovascular conflict or cranial nerve compression syndromes as the artery may be intimately related to the cranial nerves. The basilar artery is often hypoplastic in this condition and blood supply to the posterior circulation is predominantly via the persistent primitive trigeminal artery. Recognizing the persistent primitive trigeminal artery is imperative as disease of the artery may result in ischemia of the posterior circulation. To date, there is no clear association between this artery and cerebral aneurysms. We present a rare case of a patient with a persistent primitive trigeminal artery and a concomitant cavernous carotid aneurysm together with a literature review.

Diplopia due to a neurovascular compression

“…The primitive trigeminal artery is the most common carotid-vertebrobasilar anastomosis, and can be found in 0.1-1% of the population [9]. Anomalies involving this persistent artery may lead to other visual disturbances as well, such as visual field defects [10].…”

Is a trident or a bident? Appearance of a primitive trigeminal artery on sagittal views

“…Early angiographists did not describe a specific sign for this vascular variant, however, in 1994 it was mentioned that these anatomical features give a characteristic appearance on MR sagittal images of the brain which resembles the Greek letter tau (s) [2]. In 1999 the appearance on sagittal MRI images was likened to Neptune's trident and this term is now found in many publications [3,4,8]. Unfortunately the appearance on lateral projection of the internal carotid artery and PPTA connecting it to the upper part of the basilar artery only has two prongs and therefore the term trident is misleading.…”

Persistent Trigeminal Artery Causing an Abducens Nerve Palsy: A Case Report

“…The trigeminal artery is the most common persistent embryological carotid-vertebrobasilar anastomosis. 1 During development, the trigeminal artery forms when the embryo is approximately 6 weeks old. 2 At this stage, it is the main blood vessel that provides the basilar artery with blood before the development of the vertebral and posterior communicating arteries.…”