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-Persistent trigeminal artery
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... Compression of adjacent cranial nerves by the PTA has been demonstrated on pathological specimens and as intraoperative findings; in the latter, clinical improvement was reported after successful surgical decompression [23,42,[80][81][82][83]. Previously described associations of a PTA with vascular diseases such as AVM (Fig. 8), Moyamoya disease, and Sturge-Weber syndrome were based on case reports or small case series only. These could not be confirmed in large-scale studies and, therefore, represent more likely coincidental findings rather than true associations in the absence of other arterial vascular anomalies or syndromes [5,9,16,[84][85][86][87][88][89][90]. Likewise, the suggested higher incidence of mental retardation in patients with a PTA lacks proof of a true association [91]. ...
The persistent trigeminal artery (PTA) is the most common and most cephalad-located embryological anastomosis between the developing carotid artery and vertebrobasilar system to persist into adulthood. As such, it is frequently reported as an incidental finding in computed tomography angiography and magnetic resonance angiography studies. Here, we review the embryology, anatomy, and angiographic imaging findings, including important variants of this commonly encountered cerebrovascular anomaly (reported incidence of PTA/PTA variants ranges from 0.1% to 0.76%). Further, the aim is to present the range of associated arterial anomalies or syndromes, as well as pathologies that are associated with a PTA: aneurysms, trigeminal cavernous fistulas, and trigeminal nerve compression. Besides summarizing the risks and clinical presentation of such pathologies, their management is discussed with endovascular strategies mostly being the primary choice for aneurysms and trigeminal cavernous fistulas. Symptomatic trigeminal nerve compression can be treated with microvascular decompression surgery. As an illustrative example, a case of a trigeminal cavernous fistula on a PTA variant is included, mainly to emphasize the importance of understanding the variant anatomy for treatment planning in such pathologies. Finally, recommendations on how to manage patients with PTA-associated vascular pathologies are advanced.
... 43 These anomalies include carotid-cavernous fistula (Fig. 7), aneurysms, Sturge-Weber syndrome, hemangioma of the head and neck, cerebral AVM, and other arterial anomalies. [47][48][49][50][51][52] Other persistent anastomoses have been shown to be associated with similar anomalies. ...
Congenital cerebral vascular anomalies include a spectrum of conditions that result from perturbation of normal developmental processes. Although some of these conditions are asymptomatic and well compensated by collateral circulation, others can cause significant morbidity or produce a range of complications for affected patients. Knowledge of the underlying developmental etiologies and the associated imaging characteristics helps fully elucidate the morphologic and hemodynamic details of these lesions and determine the necessity for any intervention.
... 35 These include carotid-cavernous fistula, aneurysms, Sturge-Weber syndrome, hemangioma of the head and neck, cerebral arteriovenous malformations, and other arterial anomalies. [39][40][41][42][43][44] Other persistent anastomoses have been shown to be associated with similar anomalies. ...
An aneurysm of the right basilar-superior cerebellar artery, associated with a persistent primitive trigeminal artery (PPTA), was treated by surgical clipping.
Relations between the thenar branch (R1) and the palmar proper digital nerves of the thumb, the radial (R1), the ulnar (C1) and the radial palmar digital nerve of the index finger (R2) are discussed. The thenar branch always arises from the lateral fascicle of the trifurcation of the median nerve, common palmar digital nerve and may appear on the volar surface or from the lateral side of the nerve, by exception in the posterior side. When the origen is located in the volar surface, three morphological variations are observerd, all of them passing over the sensory branches R1, C1, R2 on their way to the thenar eminence. However. if the origin is on the lateral side of the median nerve, related to R1, its position will be lateral to the sensory branches, but when it is related to R2, it go under the sensory branches of the thumb in tis road to thenar eminence. These results shoud be taken into account in the release or microsurgical repair of the median nerve.
This chapter discusses uncommon causes of stroke. They are a heterogeneous group of diseases and may be the initial manifestation of other systemic diseases. These forms of stroke are rare and represent less than one percent of the total admissions to a stroke unit. Based on the clinical presentation, unusual causes of stroke can be divided in two main groups: unusual systemic disorders leading to stroke and unusual cerebral angiopathies predisposing to stroke. Unusual systemic disorders leading to stroke are nonhereditary systemic disorders and constitute a heterogeneous group of syndromes characterized by stroke resulting from an involvement of arteries generally in the absence of atherosclerosis and without inflammation. They are rare causes of stroke, and most of these pathologies are sporadic. Rare cerebral angiopathies predisposing to stroke are divided into sporadic and hereditary arteriopathies. Rare cerebral angiopathies predisposing to stroke are very rare and are estimated to account for among 1 in 50,000 and 1 in 350,000 strokes. Therefore, their contribution to the absolute numbers of stroke is small.
To report the prevalence and characteristic features of persistent trigeminal artery (PTA), PTA variant (PTAV), and other variants of the head and neck vessels, identified using magnetic resonance angiography (MRA).
The three-dimensional (3D) time of flight (TOF) MRA and 3D contrast-enhanced (CE) MRA images of 6095 consecutive patients who underwent 3 T MRA at Liaocheng People's Hospital from 1 September 2008 through 31 May 2012 were retrospectively reviewed and analysed. Thirty-two patients were excluded because of suboptimal image quality or internal carotid artery (ICA) occlusion.
The prevalence of both PTA and PTAV was 0.63% (PTA, 26 cases; PTAV, 12 cases). The prevalence of coexisting variants of the head and neck vessels in cases of PTA/PTAV was 52.6% (20 of 38 cases). The vascular variants that coexisted with cases of PTA/PTAV were as follows: the intracranial arteries varied in 10 cases, the origin of the supra-aortic arteries varied in nine cases, the vertebral artery (VA) varied in 14 cases, and six cases displayed fenestrations. Fifteen of the 20 cases contained more than two types of variants.
The prevalence of both PTA and PTAV was 0.63%. Although PTA and PTAV are rare vascular variants, they frequently coexist with other variants of the head and neck vessels. Multiple vascular variations can coexist in a single patient. Recognizing PTA, PTAV, and other variants of the head and neck vessels is crucial when planning a neuroradiological intervention or surgery. Recognizing the medial PTA is very important in clinical practice when performing trans-sphenoidal surgery on the pituitary as failure to do so could result in massive haemorrhage.
We report the case of a patient that presented with an intense headache caused by a subarachnoid hemorrhage. Magnetic resonance angiography demonstrated the existence of an aneurysm of the left posterior communicating artery, as well as of a persistent primitive trigeminal artery.
Sturge-Weber syndrome (SWS) (OMIM # 185300), also known as encephalofacial or encephalotrigeminal angiomatosis or meningofacial angiomatosis, is
a (usually) sporadic congenital neurocutaneous disorder affecting the cephalic venous microvasculature. The hallmark anomaly
is a capillary malformation affecting: (a) the brain and meninges with or without involvement of (b) the choroid and/or episclera
or conjunctive and (c) the skin (the latter typically in the cranial nerve V1-V3 territory including the mouth, pharynx and
nasal mucosa or elsewhere in the body) (Baselga 2004, Gorlin et al. 2001, Thomas-Sohl et al. 2004, Di Rocco and Tamburrini 2006). Many incomplete forms, lacking one or more features of this triad exist (Baselga 2004). Other clinical features associated with SWS are seizures, glaucoma, headache, transient stroke-like neurological deficits,
and behavioural problems. Hemiparesis, hemiatrophy, and hemianopia may occur contralaterally to the cortical abnormality (Thomas-Sohl et al. 2004).
Carotid-vertebrobasilar anastomoses-the trigeminal, otic, hypoglossal, and proatlantal intersegmental arteries-serve as transitory channels between primitive internal carotid arteries and bilateral longitudinal neural arterial plexus, which is the precursor of future basilar artery, when the human embryo reaches about 4-mm length.
Normal and/or abnormal morphofunctional aspects of the prenatal and postnatal forms of the trigeminal artery are described according to personal and literature data. Many arteries of similar origin and course are also noted in the differential diagnosis of the trigeminal artery.
The persistent primitive trigeminal artery, as the most commonly carotid-vertebrobasilar anastomosis, has a reported incidence of 0.03-2.2% in the literature. There is female sex predilection, and it may be discovered in patients of any age, on either side, and in association with many vascular variants. Although the significance of persistent primitive trigeminal artery regarding the development of an aneurysm or association with another pathological condition may not be clear, its (ab)normal morphology is the inspiration for anatomists, especially for neurosurgeons, before planning diagnostic and therapeutic procedures.
