Unusual origin of the left ophthalmic artery from the basilar trunk

Abstract

The formation of the ophthalmic artery (OA) is a complex process with two different proposed embryological steps for its development. Several anatomical variants have been described. We present a very unusual origin of the ophthalmic artery from the basilar trunk, in a 45-year-old male with a history of pontine hemorrhagic stroke. MRI and CTA showed evidence of previous hemorrhage in the pons and several intracranial arterial dysplastic dilatations. DSA confirmed several fusiform dilatations of the basilar trunk. In the left ICA, no ophthalmic artery was seen arising from the carotid siphon. The left ophthalmic artery arises from the basilar trunk and runs lateral to the cavernous sinus through the middle cranial fossa, entering the left orbit at the superior orbital fissure. The patient was treated conservatively. Two main theories for this anomaly are known, one from Lasjaunias and the other from Paget. To our knowledge, this basilar origin of the OA has only been described three times in the literature. For its origin, we propose a partial persistence of the trigeminal artery together with a dominance of the dorsal ophthalmic artery.

Basilar artery origin of an orbital artery – A rare variant and review of the embryology of the orbital arterial supply

“…The persistent trigeminal remnant as seen in our case represents the lateral type (Saltzman type 2). 13,14 To our knowledge the basilar origin of an ophthalmic artery has been reported infrequently in the past 3–5 with the first case related to an orbital AVM. Two theories have been proposed to explain this variant anatomy.…”

“…A wide variety of anatomical variants to the ophthalmic artery have been described with one of the rarest types being the basilar artery origin. 3–5…”

An update on the variations of the orbital blood supply and hemodynamic

“…Exceptionally, the OA has been reported to stem from other intracranial arteries like the middle cerebral artery [41], the posterior communicating artery [15, 47], the basilar artery [57–59], and the contralateral ICA [50]. …”

Anatomy of the Ophthalmic Artery: Embryological Consideration

“…Double origins of the OphA may be observed mostly from the ICA and the MMA, 12 , 14 , 16) and rarely from the cavernous and supraclinoid segments of the ICA. 17 – 22) The following extremely rare variations of the origin of the OphA have been reported in the literatures: the anterior cerebral artery (ACA), 21 , 23 , 24) the posterior communicating artery, 25) the ICA bifurcation, 26) the basilar artery, 27 – 29) the marginal tentorial artery. 30) The MMA arising from the OphA 31 – 33) and the infraoptic course of the ACA 34 – 36) also have been reported.…”