Giant cavernous aneurysm associated with a persistent trigeminal artery and persistent otic artery

Abstract

Primitive trigeminal artery (PTA) and primitive otic artery (POA) is a very rare entity in adult life. We present a case of PTA and POA associated with a giant unruptured cavernous aneurysm in a 54-year-old woman. The PTA and the POA arose from the sac of the aneurysm directly, which greatly complicated endovascular therapy management.

Keywords: Aneurysm; Persistent otic artery; Persistent trigeminal artery.

Fig. 1

Giant cavernous aneurysm with persistent trigeminal and otic arteries in 54-year-old woman. A. Lateral image of right internal carotid artery shows giant cavernous sinus aneurysm and persistent primitive trigeminal artery (arrow). B. Three-dimensional rotational angiographic reconstructions of right internal carotid artery demonstrate persistent trigeminal artery, which arose from aneurysm sac, near normal origin of meningohypophyseal trunk (arrows). C. Before balloon occlusion test, primitive trigeminal artery is not shown in lateral image of left vertebral and basilar artery. D. After balloon occlusion test, left vertebral artery angiogram demonstrated primitive trigeminal artery (arrow). Note indefinite persistent otic artery. E. After balloon occlusion test, lateral image of right vertebral artery revealed primitive trigeminal artery (arrow). In addition, note small size of posterior communicating artery, distal end of right internal carotid artery, as well as right anterior and middle cerebral artery. F. After embolization of primitive trigeminal artery with detachable coils: anteroposterior image of left vertebral artery revealed evident persistent otic artery (arrow).