Cerebellar artery arising from the cavernous segment of the internal carotid artery and persistent trigeminal artery: a spectrum of incomplete longitudinal fusion

Abstract

Background

The embryological relationship between cerebellar arteries originating directly from the cavernous segment of the internal carotid artery and persistent trigeminal artery is not well understood.

Purpose

To evaluate the incidence and pattern of cerebellar arteries originating from the internal carotid artery and persistent trigeminal artery, and to discuss their probable embryological relationship.

Material and Methods

We reviewed 5113 angiographic studies from 5093 patients at our institution over the last eight years, searching for patients with persistent trigeminal artery and cerebellar arteries originating from a cavernous segment of internal carotid artery (persistent trigeminal artery variant).

Results

Of the 5093 patients, 27 patients had persistent trigeminal artery or persistent trigeminal artery variant (0.53%). Twenty patients (6 men, 14 women; median age = 54 years) had persistent trigeminal artery (0.39%). Seven patients (2 men, 5 women, age range = 37–72 years; median age = 57 years) had a persistent trigeminal artery variant with persistent trigeminal artery terminating in a cerebellar artery without direct connection to the basilar artery (persistent trigeminal artery variant; 0.14%). The terminal branch of the persistent trigeminal artery variant was an anterior inferior carotid artery in five patients and a superior cerebellar artery in two patients. Of the seven patients having persistent trigeminal artery variant, four patients had another artery from the basilar artery to the anterior inferior carotid artery territory. In 6/20 patients with persistent trigeminal artery, there was an anterior inferior carotid artery arising from the persistent trigeminal artery. One of these patients showed another arterial branch from the basilar artery to the anterior inferior carotid artery territory.

Conclusion

Persistent trigeminal artery variant and cerebellar arteries originating from the persistent trigeminal artery are both believed to be a spectrum of incomplete fusion of the longitudinal neural arteries. Understanding the precise anatomy is important in diagnostic and therapeutic settings for related vascular disease.

Keywords

Persistent trigeminal artery cerebellar artery internal carotid artery basilar artery

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References

Fields

WS.

The significance of persistent trigeminal artery. Carotid-Basilar anastomosis.

Radiology 1968; 91:1095–1101.

Chen

, et al. Incidental findings of persistent primitive trigeminal artery on 3-dimensional time-of-flight magnetic resonance angiography at 3.0 T: an analysis of 25 cases. J Neuroimaging 2011; 21:152–158.

Allen

Alastra

Nelson

PK.

Proximal intracranial internal carotid artery branches: prevalence and importance for balloon occlusion test.

J Neurosurg 2005; 102:45–52.

O’Uchi

O'Uchi

Persistent primitive trigeminal arteries (PTA) and its variant (PTAV): analysis of 103 cases detected in 16,415 cases of MRA over 3 years. Neuroradiology 2010; 52:1111–1119.

Ali

Radaideh

Shaibani

, et al. Persistent trigeminal artery terminating in the posterior inferior cerebellar artery: case report. Neurosurgery 2008; 62:E746–748; discussion E746–748.

Raybaud

Normal and abnormal embryology and development of the intracranial vascular system.

Neurosurg Clin N Am 2010; 21:399–426.

Haughton

Rosenbaum

Pearce

Internal carotid artery origins of the inferior cerebellar arteries.

AJR Am J Roentgenol 1978; 130:1191–1192.

Meckel

Spittau

McAuliffe

The persistent trigeminal artery: development, imaging anatomy, variants, and associated vascular pathologies.

Neuroradiology 2013; 55:5–16.

Siqueira

Piske

Ono

, et al. Cerebellar arteries originating from the internal carotid artery. AJNR Am J Neuroradiol 1993; 14:1229–1235.

10.

Hochmuth

Spetzger

Schumacher

Comparison of three-dimensional rotational angiography with digital subtraction angiography in the assessment of ruptured cerebral aneurysms.

AJNR Am J Neuroradiol 2002; 23:1199–1205.

11.

Sugahara

Korogi

Nakashima

, et al. Comparison of 2D and 3D digital subtraction angiography in evaluation of intracranial aneurysms. AJNR Am J Neuroradiol 2002; 23:1545–1552.

12.

van Rooij

Sprengers

de Gast

, et al. 3D rotational angiography: the new gold standard in the detection of additional intracranial aneurysms. AJNR Am J Neuroradiol 2008; 29:976–979.

13.

Rhee

Kim

Lee

, et al. Persistent trigeminal artery variant detected by conventional angiography and magnetic resonance angiography-incidence and clinical significance. J Korean Neurosurg Soc 2007; 42:446–449.

14.

Uchino

Sawada

Takase

, et al. Moyamoya disease associated with an anterior inferior cerebellar artery arising from a persistent trigeminal artery. Eur Radiol 2002; 12 Suppl 3:S14–17.

15.

Weon

Choi

Hwang

, et al. Classification of persistent primitive trigeminal artery (PPTA): a reconsideration based on MRA. Acta Radiol 2011; 52:1043–1051.

16.

Teal

Rumbaugh

Bergeron

, et al. Persistent carotid-superior cerebellar artery anastomosis: a variant of persistent trigeminal artery. Radiology 1972; 103:335–341.

17.

Ito

Takeda

Suzuki

, et al. Anomalous origin of the anterior inferior cerebellar arteries from the internal carotid artery. Neuroradiology 1980; 19:105–109.

18.

Cobb

Hieshima

Mehringer

, et al. Persistent trigeminal artery variant. Carotid-anterior inferior cerebellar artery anastomosis. Surg Neurol 1983; 19:263–266.

19.

Manabe

Oda

Ishii

, et al. The posterior inferior cerebellar artery originating from the internal carotid artery, associated with multiple aneurysms. Neuroradiology 1991; 33:513–515.

20.

Ahuja

Graves

Crosby

, et al. Anomalous origin of the posterior inferior cerebellar artery from the internal carotid artery. AJNR Am J Neuroradiol 1992; 13:1625–1626.

21.

Hui

Choi

Liu

, et al. Anomalous origin of the posterior inferior cerebellar artery from the pre-cavernous portion of the internal carotid artery–a primitive trigeminal artery variant. Eur J Radiol 1994; 19:10–13.

22.

Andoh

Tanohata

Moriya

, et al. The posterior inferior cerebellar artery arising from the extracranial segment of the internal carotid artery via the hypoglossal canal without an interposed segment of the basilar artery: a persistent primitive hypoglossal artery variant. Clin Imaging 2001; 25:86–89.

23.

Raphaeli

Bandeira

Mine

, et al. A rare variant of persistent trigeminal artery: cavernous carotid-cerebellar artery anastomosis–a case report and a systematic review. Cerebellum 2009; 8:445–447.

24.

Meila

Papke

Schlunz-Hendann

, et al. Bilateral persistent trigeminal arteries, one of them ending in the posterior inferior cerebellar artery: case report and review of the literature. Clin Neuroradiol 2011; 21:95–99.

25.

Hwang

Kim

JW.

Variant PTA terminating in cerebellar artery, associated with multiple aneurysms.

Case Rep Radiol 2016 ;2016:4594326.

26.

Lee

Heo

Jung

, et al. Persistent trigeminal artery variant terminating in the posterior inferior cerebellar artery: a case report. Surg Radiol Anat 2018; 40:237–240.

27.

Scotti

Anterior inferior cerebellar artery originating from the cavernous portion of the internal carotid artery.

Radiology 1975; 116:93–94.

28.

Shin

Kim

, et al. Ruptured aneurysm of the anomalous cerebellar artery originating from internal carotid artery presenting with carotid cavernous fistula: a case report. AJNR Am J Neuroradiol 2005; 26:1849–1851.

29.

Shoja

Loukas

Tubbs

, et al. An aberrant cerebellar artery originating from the internal carotid artery. Surg Radiol Anat 2012; 34:285–288.

30.

Park

Kim

Jun

, et al. Persistent carotid-vertebrobasilar anastomosis: Radiologic findings. J Korean Radiol Soc 1998; 39:863–867.

31.

Arakawa

Koizumi

Terashima

, et al. Two anatomical autopsy cases of direct communication between a persistent primitive trigeminal artery and an anterior inferior cerebellar artery. Ann Anat 2007; 189:489–498.

32.

Yamada

Kondo

Tanabe

Trigeminal neuralgia associated with an anomalous artery originating from the persistent primitive trigeminal artery.

Neurol Med Chir (Tokyo) 2006; 46:194–197.

33.

Padge

DH.

The development of the cranial arteries in the human embryo. Washington, DC: Carnegie Institution of Washington, 1948.

34.

Gregg

Gailloud

The role of the primitive lateral basilovertebral anastomosis of Padget in variations of the vertebrobasilar arterial system.

Anat Rec (Hoboken) 2017; 300:2025–2038.

35.

Lasjaunias

Berenstein

Ter Brugge

KG.

Surgical Neuroangiography. Berlin: Springer-Verlag, 2001.

36.

Perot

Clarencon

Di Maria

, et al. Persistent trigeminal artery feeding a hemispheric branch of the posterior inferior cerebellar artery: a rare anatomic variant. J Neuroradiol 2011; 38:251–254.

37.

Uchino A, Saito N, Okada Y, et al. Persistent trigeminal artery and its variants on MR angiography. Surg and Radiol Anat 2012;34:271–276.