Basilar artery aneurysm at a persistent trigeminal artery junction. A case report and literature review

Abstract

The trigeminal artery is an anastomosis between the embryonic precursors of the vertebrobasilar and carotid systems, and may persist into adult life. The association of the persistent primitive trigeminal artery (PTA) with cerebral aneurysm is well documented in the literature and, in general, aneurysms are located in the anterior circulation. We describe a patient who presented with a panencephalic Fisher III subarachnoid hemorrhage due to rupture of an intracranial aneurysm. Digital arteriography showed a saccular aneurysm in the middle third of the basilar artery, adjacent to the junction with a persistent trigeminal artery. She was submitted to endovascular treatment with embolization of the basilar artery aneurysm with coils. Aneurysms at the PTA junction with the basilar artery are rare. This paper describes a case of PTA associated with an aneurysm in the basilar artery at PTA junction and briefly reviews the literature.

Figure 1

A) Computed tomography scan showing SAH Fisher III. Cerebral angiography of the left internal carotid artery (B - frontal incidence and C - lateral incidence) and the left vertebral artery (D - frontal incidence and E – lateral incidence) showing the persistent trigeminal artery (arrow) and the aneurysm (arrowhead) in its junction with basilar artery (double arrow).

Figure 2

Cerebral angiography in oblique incidence. A) Aneurysm in the basilar artery (arrowhead), in the junction with the persistent trigeminal artery (arrow). B) Microcatheterism of the aneurysm during the installation of coils, with inflated balloon. C) Final angiographic control showing the absence of opacification of the aneurysm (arrowhead).

Figure 3

Schematic representation of the variations of the trigeminal persistent artery according to Saltzman; (comments in the discussion). ICA - internal carotid artery; SCA - superior cerebellar artery; PTA - persistent trigeminal artery; AICA - anterior inferior cerebellar artery; PICA - posterior inferior cerebellar artery; PCA - posterior cerebral artery; BA - basilar artery; VA - vertebral artery (modified from Ali et al. ).