- Department of Neurosurgery, Faculty of Life Sciences, Kumamoto University School of Medicine, 1-1-1, Honjo, Kumamoto 861-8556, Japan
Department of Neurosurgery, Faculty of Life Sciences, Kumamoto University School of Medicine, 1-1-1, Honjo, Kumamoto 861-8556, Japan
DOI:10.4103/2152-7806.85058Copyright: © 2011 Yamamoto T. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Yamamoto T, Hasegawa Y, Ohmori Y, Kawano T, Kai Y, Morioka M, Kuratsu J. Ruptured cerebral aneurysm associated with a persistent primitive trigeminal artery variant. Surg Neurol Int 17-Sep-2011;2:126
How to cite this URL: Yamamoto T, Hasegawa Y, Ohmori Y, Kawano T, Kai Y, Morioka M, Kuratsu J. Ruptured cerebral aneurysm associated with a persistent primitive trigeminal artery variant. Surg Neurol Int 17-Sep-2011;2:126. Available from: http://sni.wpengine.com/surgicalint_articles/ruptured-cerebral-aneurysm-associated-with-a-persistent-primitive-trigeminal-artery-variant/
Background:Primitive trigeminal artery variants (PTAVs) are one of the rare persistent fetal anastomoses between the carotid and vertebrobasilar circulations. They originate from the internal carotid artery and join one of the cerebellar arteries instead of the basilar artery.
Case Description:We present an 82-year-old woman with subarachnoid hemorrhage due to a ruptured aneurysm originating at a PTAV. Three-dimensional computed tomography angiogram and cerebral angiography revealed bilateral PTAV and two aneurysms originating at the left PTAV. The proximal and distal aneurysms were saccular and fusiform, respectively. She underwent surgical treatment and her postoperative course was uneventful.
Conclusion:Our case demonstrates that extremely rare cerebral aneurysms associated with PTAV can be addressed successfully by surgical intervention.
Keywords: Fusiform, intracranial aneurysm, persistent primitive trigeminal artery variant, saccular, subarachnoid hemorrhage, surgical treatment
The primitive trigeminal artery (PTA) originates from the internal carotid artery and joins the basilar artery (BA). It is the most common carotid basilar anastomosis, whose incidence is reported to be between 0.1% and 0.6% of individuals.[
An 82-year-old woman was admitted to the emergency department of a hospital with sudden-onset severe headache. Her past medical history included hypertension and hyperlipidemia, and she had undergone surgery 1 year earlier after SAH due to the rupture of a saccular aneurysm originating at the left internal carotid-posterior communicating artery. Postoperatively, she manifested no neurological disorders and she reported for regular follow-up of her unruptured intracranial aneurysms. Cranial computed tomography (CT) performed at admission revealed SAH (Hunt and Kosnik grade 2, WFNS grade 1,Fisher group 3) [
Three-dimensional computed tomography angiogram revealing two aneurysms (arrow) on the left persistent trigeminal artery variant, (arrow head). Note the clip from the earlier procedure to address a previously ruptured left internal carotid-posterior communicating artery aneurysm (open arrow)
(a) Left internal carotid angiogram showing that the left PTAV supplies the ipsilateral anterior inferior cerebellar artery region (arrow). Note the two aneurysms originating from the vessel. (b) Right internal carotid angiogram showing that the left persistent trigeminal artery variant, supplies the ipsilateral anterior inferior cerebellar artery and the posterior inferior cerebellar artery region (arrow head)
We addressed a rare case of multiple cerebral aneurysms on a PTAV by surgical intervention.
PTAVs originate at the cavernous or pre-cavernous portion of the internal carotid artery and course along the trigeminal nerve without joining the BA and directly supply the cerebellum, terminating as the cerebellar artery.[
Many cases of PTAV were reported to be associated with intracranial aneurysms. The high prevalence of intracranial aneurysms on a PTAV has been explained by the presence of structural defects in the wall of the cerebral arteries.[
To date, nine patients with cerebral aneurysms on a PTAV, including ours, have been documented [
The reported interventions for PTA/PTAV aneurysms are endovascular embolization and surgical intervention.[
We presented an extremely rare case of SAH associated with multiple cerebral aneurysms on a PTAV that was treated successfully by direct surgery. Additional studies are needed to clarify the features of PTAV and the relationship between PTAV and aneurysms.
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