Direct surgical obliteration of a persistent trigeminal artery aneurysm

✓ A woman with a fusiform aneurysm of a persistent trigeminal artery sustained a subarachnoid hemorrhage and presented with hypalgesia in the distribution of the maxillary and mandibular nerves. The first successful direct operative treatment of this rare aneurysm is reported.

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Intracranial aneurysm on a persistent primitive trigeminal artery

Journal of Neurosurgery ◽

10.3171/jns.1971.35.5.0601 ◽

1971 ◽

Vol 35 (5) ◽

pp. 601-604 ◽

Cited By ~ 92

Author(s):

Ajax E. George ◽

Joseph P. Lin ◽

Robert A. Morantz

Keyword(s):

Intracranial Aneurysm ◽

Rare Case ◽

Artery Aneurysm ◽

Persistent Trigeminal Artery ◽

Trigeminal Artery ◽

Content Type ◽

Persistent Primitive Trigeminal Artery ◽

Primitive Trigeminal Artery ◽

Angiographic Demonstration ◽

Fine Print

✓ The angiographic demonstration of a rare case of persistent trigeminal artery aneurysm is reported. The incidence of persistent trigeminal artery in the authors' series is 0.6%. Approximately 14% of patients with a persistent trigeminal artery also have an intracranial aneurysm. The embryology involved and related cases are reviewed.

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Trigeminal artery to cavernous sinus fistula treated by balloon occlusion

Journal of Neurosurgery ◽

10.3171/jns.1983.58.4.0611 ◽

1983 ◽

Vol 58 (4) ◽

pp. 611-613 ◽

Cited By ~ 21

Author(s):

Charles W. Kerber ◽

William Manke

Keyword(s):

Carotid Artery ◽

Cavernous Sinus ◽

Femoral Artery ◽

Balloon Occlusion ◽

Persistent Trigeminal Artery ◽

Trigeminal Artery ◽

Content Type ◽

Flow Through ◽

Sinus Flow ◽

Fine Print

✓ A spontaneous cavernous sinus fistula developed following presumed sinusitis, and was found to originate not from the carotid artery but from a persistent trigeminal artery. The fistula was treated by introducing a detachable latex balloon via a femoral artery approach through the trigeminal artery and then into the cavernous sinus. Flow through the carotid, vertebral, and trigeminal arteries was preserved.

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Intrasellar persistent trigeminal artery associated with a pituitary adenoma

Journal of Neurosurgery ◽

10.3171/jns.1989.70.2.0271 ◽

1989 ◽

Vol 70 (2) ◽

pp. 271-273 ◽

Cited By ~ 27

Author(s):

K. Stuart Lee ◽

David L. Kelly

Keyword(s):

Pituitary Adenoma ◽

Sella Turcica ◽

Preoperative Imaging ◽

Persistent Trigeminal Artery ◽

Pituitary Macroadenoma ◽

Trigeminal Artery ◽

Imaging Studies ◽

Content Type ◽

Fine Print ◽

Transsphenoidal Resection

✓ The case of a patient with Cushing's disease and a pituitary macroadenoma, who also had a persistent trigeminal artery coursing through the sella turcica on preoperative imaging studies, is presented. The patient was treated by transsphenoidal resection of the tumor.

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Persistent trigeminal artery: its relationship to the normal branches of the cavernous carotid

Journal of Neurosurgery ◽

10.3171/jns.1974.40.2.0244 ◽

1974 ◽

Vol 40 (2) ◽

pp. 244-248 ◽

Cited By ~ 41

Author(s):

Dwight Parkinson ◽

Christopher B. Shields

Keyword(s):

Persistent Trigeminal Artery ◽

Trigeminal Artery ◽

Content Type ◽

Autopsy Specimen ◽

Meningohypophyseal Trunk ◽

Fine Print

✓ The authors report a detailed study of an autopsy specimen indicating that the meningohypophyseal trunk and a persistent trigeminal artery apparently exist independently and have separate origins.

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Trigeminal artery and microemboli to the brain stem

Journal of Neurosurgery ◽

10.3171/jns.1977.46.1.0104 ◽

1977 ◽

Vol 46 (1) ◽

pp. 104-106 ◽

Cited By ~ 15

Author(s):

Frederick T. Waller ◽

Robert L. Simons ◽

Charles Kerber ◽

Ilmar O. Kiesel ◽

Calvin T. Tanabe

Keyword(s):

Brain Stem ◽

Atherosclerotic Plaque ◽

Carotid Bifurcation ◽

Persistent Trigeminal Artery ◽

Transient Ischemic Attacks ◽

Trigeminal Artery ◽

Content Type ◽

The Brain ◽

Fine Print

✓ The authors report two cases of transient ischemic attacks (TIA's) involving the brain stem. The TIA's were due to microemboli that originated from a carotid bifurcation atherosclerotic plaque and travelled through a persistent trigeminal artery.

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Bilateral cortical blindness associated with carotid stenosis in a patient with a persistent trigeminal artery

Journal of Neurosurgery ◽

10.3171/jns.1980.52.5.0709 ◽

1980 ◽

Vol 52 (5) ◽

pp. 709-711 ◽

Cited By ~ 7

Author(s):

David J. Heeney ◽

Andrew H. Koo

Keyword(s):

Visual Cortex ◽

Carotid Plaque ◽

Internal Carotid ◽

Cortical Blindness ◽

Persistent Trigeminal Artery ◽

Trigeminal Artery ◽

Content Type ◽

Anomalous Artery ◽

Angiographic Findings ◽

Fine Print

✓ A patient with findings of bilateral cortical blindness and a unilateral carotid bruit is reported. A persistent trigeminal artery allowed emboli from a unilateral ulcerated internal carotid plaque to affect the visual cortex bilaterally. The angiographic findings and a brief discussion of this anomalous artery are presented.

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Heparin-induced thrombocytopenia and thrombosis following subarachnoid hemorrhage

Journal of Neurosurgery ◽

10.3171/jns.2000.93.1.0136 ◽

2000 ◽

Vol 93 (1) ◽

pp. 136-139 ◽

Cited By ~ 11

Author(s):

Ian F. Parney ◽

David E. Steinke

Keyword(s):

Platelet Count ◽

Subarachnoid Hemorrhage ◽

Large Body ◽

Artery Aneurysm ◽

Left Middle Cerebral Artery ◽

Cerebral Angiogram ◽

Related Disorder ◽

Heparin Induced Thrombocytopenia ◽

Content Type ◽

Fine Print

U The authors present a case of heparin-induced thrombocytopenia and thrombosis (HITT) that occurred after aneurysmal subarachnoid hemorrhage (SAH), and they review the relevant literature. An immune-mediated syndrome, HITT is characterized by moderate thrombocytopenia and paradoxical vascular thromboses. Although it has been estimated in prospective studies that HITT occurs in between 1 and 3% of patients receiving heparin, it is underrecognized in the neurosurgical literature. In the present case, a 49-year-old woman underwent clipping of a right posterior communicating artery aneurysm after suffering a Hunt and Hess Grade III SAH. She had an uncomplicated postoperative course with good clip positioning and no vasospasm observed on a cerebral angiogram obtained on Day 7.On Day 23, the patient developed a right hemiparesis and experienced a grand mal seizure. A head computerized tomography scan revealed a hemorrhagic infarct in the left middle cerebral artery distribution. Repeated cerebral angiograms did not show vasospasm. She was thrombocytopenic (platelet count as low as 46 × 109/L on Day 28 compared with 213 × 109/L on Day 1) and had been receiving heparin flushes to maintain intravenous catheter patency. An assay for HITT-associated antibodies was positive. The heparin flushes were discontinued and the platelet count recovered (121 × 109/L). She improved neurologically, but was left with a significant right hemiparesis at discharge. This patient had assay-proven heparin-induced thrombocytopenia despite minimal exposure to heparin. Because there was no evidence of vasospasm or other factors to account for her delayed hemorrhagic infarction, an HITT-related disorder seemed most likely. Despite a large body of literature describing HITT in nonneurosurgical patients, only three previous neurosurgical cases have been published. This case report may serve to heighten awareness of this disorder.

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A true mycotic (Aspergillus) aneurysm leading to fatal subarachnoid hemorrhage in a patient with hereditary hemorrhagic telangiectasia

Journal of Neurosurgery ◽

10.3171/jns.1971.35.1.0071 ◽

1971 ◽

Vol 35 (1) ◽

pp. 71-76 ◽

Cited By ~ 44

Author(s):

Peter Davidson ◽

David M. Robertson

Keyword(s):

Subarachnoid Hemorrhage ◽

Basilar Artery ◽

Hereditary Hemorrhagic Telangiectasia ◽

Artery Aneurysm ◽

Content Type ◽

Intracranial Involvement ◽

Basilar Artery Aneurysm ◽

Fine Print

✓ A mycotic basilar artery aneurysm, in which Aspergillus was identified histologically, was found to be the cause of a massive subarachnoid hemorrhage in a 75-year-old man who suffered from hereditary hemorrhagic telangiectasia; there was no evidence of intracranial involvement by the latter disorder.

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Paradoxical aggravation of vasospasm with papaverine infusion following aneurysmal subarachnoid hemorrhage

Journal of Neurosurgery ◽

10.3171/jns.1996.84.4.0690 ◽

1996 ◽

Vol 84 (4) ◽

pp. 690-695 ◽

Cited By ~ 46

Author(s):

Brent L. Clyde ◽

Andrew D. Firlik ◽

Anthony M. Kaufmann ◽

MichaelP. Spearman ◽

Howard Yonas

Keyword(s):

Subarachnoid Hemorrhage ◽

Cerebral Artery ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Artery Aneurysm ◽

Anterior Communicating Artery ◽

Left Middle Cerebral Artery ◽

Xenon Ct ◽

Content Type ◽

Symptomatic Vasospasm ◽

Fine Print

✓ Reports of intraarterial papaverine infusion as treatment for cerebral vasospasm are few and documented complications are uncommon. The authors report the case of a patient with paradoxical aggravation of cerebral arterial narrowing during selective intraarterial papaverine infusion intended to treat vasospasm following aneurysmal subarachnoid hemorrhage (SAH). A 48-year-old man presented to the authors' service with symptomatic vasospasm 10 days after experiencing an SAH. The ruptured anterior communicating artery aneurysm was surgically obliterated the following day, and thereafter maximum hypervolemic and hypertensive therapies were used. However, the patient remained lethargic, and a stable xenon—computerized tomography (CT) cerebral blood flow (CBF) study revealed CBF to be 15 cc/100 g/minute in the left anterior cerebral artery (ACA) and 25 cc/100 g/minute in the right ACA territories. Cerebral arteriography demonstrated diffuse severe left ACA and mild left middle cerebral artery (MCA) vasospasm. In response intraarterial papaverine was infused into the internal carotid artery just proximal to the ophthalmic artery. During the infusion the patient became aphasic and exhibited right hemiplegia. Arteriography performed immediately after the intraarterial papaverine infusion revealed diffuse exacerbation of vasospasm in the distal ACA and MCA territories. A repeat xenon—CT CBF study showed that CBF in the left ACA and the MCA had drastically decreased (2 cc/100 g/minute and 10 cc/100 g/minute, respectively). Despite aggressive management, infarction ultimately developed. This is the first clinical case to illustrate a paradoxical effect of intraarterial papaverine treatment for vasospasm following aneurysmal SAH. The possible mechanisms of this paradoxical response and potential therapeutic reactions are reviewed.

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