Trigeminal neuralgia associated with a variant of persistent trigeminal artery

The trigeminal artery (TA) is the most common embryonic carotid-vertebrobasilar anastomosis to persist into adulthood. It typically extends from the internal carotid artery to the basilar artery. Persistent primitive arteries are usually found incidentally, but are often associated with vascular malformation, cerebral aneurysm and, in case of TA, with trigeminal neuralgia. We present one patient with TA as a cause of trigeminal neuralgia and in other three as an incidental finding, on TC and MR angiograms.

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Successful Microvascular Decompression For Trigeminal Neuralgia Secondary to a Persistent Trigeminal Artery

Operative Neurosurgery ◽

10.1093/ons/opy043 ◽

2018 ◽

Vol 16 (1) ◽

pp. 18-22

Author(s):

Shunchang Ma ◽

Pankaj K Agarwalla ◽

Harry R van Loveren ◽

Siviero Agazzi

Keyword(s):

Trigeminal Neuralgia ◽

Trigeminal Nerve ◽

Microvascular Decompression ◽

Vascular Anatomy ◽

Superior Cerebellar Artery ◽

Persistent Trigeminal Artery ◽

Trigeminal Artery ◽

3 Dimensional ◽

Endoscopic Video ◽

Operative Microscope

Abstract BACKGROUND AND IMPORTANCE Persistent trigeminal artery (PTA) is a rare but important anatomic variant that contributes to trigeminal neuralgia (TN). Microvascular decompression (MVD) of the responsible vessel(s) away from the trigeminal nerve provides the most complete and durable relief from TN. The role and technique of MVD for TN associated with a PTA has not been fully defined in the literature. Furthermore, assessment of PTA anatomy intraoperatively with a microscope is challenging. We report the first 3-dimensional (3D) microscopic video and first intraoperative endoscopic video of a successful MVD of the trigeminal nerve in a patient who suffered TN from a tortuous, compressive PTA. CLINICAL PRESENTATION A 66-yr-old right-handed female presented with right facial pain in V2 and V3 distributions with a clinical picture of TN. Imaging demonstrated trigeminal nerve compression secondary to a PTA and MVD was performed with a 3D operative microscope and an endoscope. The PTA appeared to compress the nerve directly at the trigeminal porus and also had compressive superior cerebellar artery variant branches. The nerve was decompressed at all points of compression with Teflon pledgets along its entire cisternal length. Postoperatively, she is free with trigeminal pain episodes at 4-mo follow-up. CONCLUSION In cases of TN associated with a PTA, we recommend decompression along the entire length of the nerve wherever there is compression. Furthermore, we find both the operative microscope and particularly the endoscope useful to assess vascular anatomy intraoperatively.

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Persistent trigeminal artery associated with trigeminal neuralgia: hypothesis of neurovascular compression

Neuroradiology ◽

10.1007/s00234-006-0150-8 ◽

2006 ◽

Vol 49 (1) ◽

pp. 23-26 ◽

Cited By ~ 22

Author(s):

Bert-Jan de Bondt ◽

Robert Stokroos ◽

Jan Casselman

Keyword(s):

Trigeminal Neuralgia ◽

Neurovascular Compression ◽

Persistent Trigeminal Artery ◽

Trigeminal Artery

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Coexistent trigeminal neuralgia, hemifacial spasm, and hypertension: preoperative imaging of neurovascular compression

Journal of Neurosurgery ◽

10.3171/jns.1994.80.3.0559 ◽

1994 ◽

Vol 80 (3) ◽

pp. 559-563 ◽

Cited By ~ 27

Author(s):

Eric S. Ballantyne ◽

Rosalind D. Page ◽

James F. M. Meaney ◽

Thomas E. Nixon ◽

John B. Miles

Keyword(s):

Trigeminal Neuralgia ◽

Hemifacial Spasm ◽

Preoperative Imaging ◽

Complete Relief ◽

Neurovascular Compression ◽

Persistent Trigeminal Artery ◽

Trigeminal Artery ◽

Vagus Nerves ◽

Content Type ◽

Fine Print

✓ The case is reported of a 60-year-old woman with left-sided trigeminal neuralgia, hemifacial spasm, and hypertension. Compression of the left trigeminal, facial, and vagus nerves by the anterior and posterior inferior cerebellar arteries and a persistent trigeminal artery variant were demonstrated by magnetic resonance angiography using a novel sequence. At operation the angiographic appearances were confirmed, and decompression was performed with the placement of polyvinyl sponge at all three levels. Postoperatively, the patient had complete relief from the trigeminal neuralgia and hemifacial spasm and has sustained normotension without medication.

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