Why Not the Eighth Nerve? Neurovascular Compression—Probable Cause for Pulsatile Tinnitus

1979 ◽  
Vol 87 (1) ◽  
pp. 89-94 ◽  
Author(s):  
S. George Lesinski ◽  
Albert A. Chambers ◽  
Raymond Komray ◽  
Michael Keiser ◽  
Ghahreman Khodadad
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Human Fetus ◽  
Internal Carotid ◽  
Posterior Inferior Cerebellar Artery ◽  
Neurovascular Compression ◽  
Pulsatile Tinnitus ◽  
Trigeminal Artery ◽  
Eighth Nerve ◽  
Cerebellar Artery

Carotid arteriograms on three patients with unilateral pulsatile tinnitus demonstrated an ipsilateral atypical trigeminal artery extending from the cavernous portion of the internal carotid artery to form the posterior inferior cerebellar artery. Illustrations and a dissection of a human fetus with a similar finding show this artery crossing the cochlear nerve near its insertion in the pons. Evidence is presented suggesting that neurovascular compression of the eighth nerve is the source of pulsatile tinnitus in these patients.

PERSISTENT TRIGEMINAL ARTERY TERMINATING IN THE POSTERIOR INFERIOR CEREBELLAR ARTERY

Neurosurgery ◽  
2008 ◽  
Vol 62 (3) ◽  
pp. E746-E748 ◽  
Author(s):  
Saad Ali ◽  
Majdi M. Radaideh ◽  
Ali Shaibani ◽  
Eric J. Russell ◽  
Matthew T. Walker
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Posterior Inferior Cerebellar Artery ◽  
Cerebellar Hemisphere ◽  
Persistent Trigeminal Artery ◽  
Trigeminal Artery ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
Cerebellar Artery

Abstract OBJECTIVE Persistent trigeminal arteries are rare and represent a remnant of the fetal carotid-basilar circulation. They typically extend from the internal carotid artery to the basilar artery. An unusual case of a patient with a trigeminal artery originating from the internal carotid artery and terminating as the dominant hemispheric branch of the posterior inferior cerebellar artery is presented. CLINICAL PRESENTATION A 66-year-old woman presented to the emergency department with pulsatile tinnitus, increasing left eye pain, proptosis, conjunctival injection, diplopia, and decreased visual acuity. Conventional contrast-enhanced computed tomographic and magnetic resonance imaging demonstrated findings consistent with a left carotid-cavernous fistula. The patient underwent an emergency diagnostic cerebral angiogram. Besides an indirect carotid-cavernous fistula on the left side, a right-sided persistent trigeminal artery terminating as the dominant hemispheric trunk of the posteroinferior cerebellar artery was incidentally noted. The vermian branch of the right posteroinferior cerebellar artery arose from the ipsilateral vertebral artery, whereas duplicate superior cerebellar arteries supplied the left posteroinferior cerebellar artery region. INTERVENTION The patient was treated for the indirect carotid-cavernous fistula with detachable platinum coils and N-butyl cyanoacrylate, resulting in the resolution of her symptoms. CONCLUSION We report a case of a persistent trigeminal artery supplying only the cerebellar hemisphere. The clinical significance of this anomaly relates to its role in endovascular therapeutic and surgical complications and the paradoxical lesions in the cerebellum that occur as a result of carotid disease. We also discuss the Saltzman classification of persistent trigeminal arteries and their variants.

Trigeminal Neuralgia Associated with a Primitive Trigeminal Artery Variant: Case Report

Neurosurgery ◽  
2003 ◽  
Vol 52 (5) ◽  
pp. 1217-1220
Author(s):  
Yoji Tamura ◽  
Hiroshi Shimano ◽  
Toshihiko Kuroiwa ◽  
Yoshihito Miki
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Trigeminal Neuralgia ◽  
Internal Carotid ◽  
Left Internal Carotid Artery ◽  
Decompression Surgery ◽  
Trigeminal Artery ◽  
Cerebellar Artery ◽  
Primitive Trigeminal Artery ◽  
Perforating Arteries

Abstract OBJECTIVE AND IMPORTANCE A variant type of the primitive trigeminal artery (PTA) is a rare anomalous vessel that originates from the internal carotid artery and directly supplies the territory of the anteroinferior cerebellar artery and/or the superior cerebellar artery. We report a case of trigeminal neuralgia associated with this PTA variant, and we discuss the characteristics of this vessel. CLINICAL PRESENTATION A 51-year-old woman presented with a 10-year history of left paroxysmal facial pain. Magnetic resonance angiography and cerebral angiography demonstrated that an aberrant vessel originating from the left internal carotid artery directly supplied the cerebellum, without a basilar artery anastomosis. INTERVENTION Surgical exploration was performed via a left retrosigmoid approach. A loop of the aberrant vessel, which entered the posterior fossa through the isolated dural foramen, was compressing the trigeminal nerve. This aberrant vessel was displaced medially from the nerve with a prosthesis, with care to avoid kinking and avulsion of the perforating arteries. The patient's neuralgia resolved postoperatively. CONCLUSION Although the PTA variant is frequently associated with intracranial aneurysms, it is extremely rare for the variant to lead to trigeminal neuralgia. During microvascular decompression surgery, surgeons should be careful to prevent injury of the perforating arteries arising from the PTA variant.

scholarly journals Trigeminal neuralgia caused by a new variant of persistent trigeminal artery associated with agenesis of internal carotid artery

2017 ◽  
Vol 23 (6) ◽  
pp. 566-570
Author(s):  
Gorky Medhi ◽  
Hima Pendharkar ◽  
Karel terBrugge ◽  
Chandrajit Prasad ◽  
Arun Kumar Gupta
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Trigeminal Neuralgia ◽  
Internal Carotid ◽  
Lateral Displacement ◽  
Posterior Inferior Cerebellar Artery ◽  
Persistent Trigeminal Artery ◽  
3D Images ◽  
Cerebellar Artery ◽  
New Variant

We report a hitherto undescribed persistent carotid vertebral anastomosis associated with ipsilateral internal carotid artery agenesis and bilateral duplication of the intradural vertebral arteries. This rare anomaly was detected on MRI, supplemented by CT angiography while evaluating for cause trigeminal neuralgia in a 37-year-old woman. The aberrant vessel was seen to cause thinning and lateral displacement of the left trigeminal nerve on CISS 3D images. Also noted was a bilateral vertebral artery duplication of the PSA variant with the posterior inferior cerebellar artery arising from the medial limb of the duplication on the left.

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

2019 ◽  
Vol 61 (3) ◽  
pp. 386-394
Author(s):  
Dong Young Cho ◽  
Bum-soo Kim ◽  
Jinhee Jang ◽  
Hyun Seok Choi ◽  
So Lyung Jung ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Basilar Artery ◽  
Internal Carotid ◽  
Incomplete Fusion ◽  
Superior Cerebellar Artery ◽  
Terminal Branch ◽  
Persistent Trigeminal Artery ◽  
Trigeminal Artery ◽  
Cerebellar Artery

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.

scholarly journals Persistent trigeminal artery: angio-tomography and angio-magnetic resonance finding

2009 ◽  
Vol 67 (3b) ◽  
pp. 882-885 ◽  
Author(s):  
Lícia Pachêco Pereira ◽  
Lara A.M. Nepomuceno ◽  
Pablo Picasso Coimbra ◽  
Sabino Rodrigues de Oliveira Neto ◽  
Marcelo Ricardo C. Natal
Keyword(s):  
Magnetic Resonance ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Trigeminal Neuralgia ◽  
Basilar Artery ◽  
Internal Carotid ◽  
Incidental Finding ◽  
Persistent Trigeminal Artery ◽  
Trigeminal Artery ◽  
Magnetic Resonance Finding

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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