Tic douloureux caused by primitive trigeminal artery or its variant

1989 ◽  
Vol 70 (3) ◽  
pp. 415-419 ◽  
Author(s):  
Akio Morita ◽  
Takanori Fukushima ◽  
Shinichiro Miyazaki ◽  
Tsuneo Shimizu ◽  
Masayuki Atsuchi
Keyword(s):  
Internal Carotid ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Trigeminal Artery ◽  
Entry Zone ◽  
Content Type ◽  
Tic Douloureux ◽  
Root Entry Zone ◽  
Cerebellar Artery ◽  
Primitive Trigeminal Artery

✓ Primitive trigeminal artery (PTA) is an extremely rare cause of tic douloureux. None of the reports on PTA variant, which is an anomalous cerebellar artery arising from the internal carotid artery without anastomosis to the basilar artery, has suggested the possibility of this vessel causing tic douloureux. Eight cases of tic douloureux are reported in which a PTA or PTA variant was found during microvascular decompression (MVD). These cases were derived from a series of 1257 patients treated with MVD for tic douloureux. In one patient, the neuralgia was caused by a combination of vessels: a PTA, the superior cerebellar artery, and the anterior inferior cerebellar artery. In the other seven cases, a PTA variant was compressing the root entry zone of the trigeminal nerve. All eight patients gained excellent pain relief after MVD of the root entry zone. The significance of PTA's and PTA variants as the cause of tic douloureux and the effectiveness of MVD in the management of such cases are discussed.

scholarly journals Double-Balloon Remodeling for Coil Embolization of a Primitive Trigeminal Artery Variant Aneurysm

2014 ◽  
Vol 20 (3) ◽  
pp. 295-300 ◽  
Author(s):  
Tomoji Takigawa ◽  
Kensuke Suzuki ◽  
Yoshiki Sugiura ◽  
Ryotaro Suzuki ◽  
Issei Takano ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Trigeminal Artery ◽  
Occlusion Balloon ◽  
Double Balloon ◽  
Persistent Primitive Trigeminal Artery ◽  
Cerebellar Artery ◽  
Primitive Trigeminal Artery ◽  
The Right

Here we describe the case of a patient with a wide-necked unruptured aneurysm arising at origin of a persistent primitive trigeminal artery (PTA) variant from the right internal carotid artery (ICA), supplying the territory of the right superior cerebellar artery and the anterior inferior cerebellar artery. To preserve the ICA and the PTA variant, coil embolization of the aneurysm was performed using a double-balloon remodeling technique (HyperForm™ and Hyper-Glide™ Occlusion Balloon Systems; ev3 Endovascular Inc., Irvine, CA, USA). The association of a PTA variant with an aneurysm is very rare. To our knowledge, this is the first description of the use of coil embolization using double-balloon remodeling to treat a PTA variant aneurysm. This technique permits complete embolization and reduces the risk of cerebral and cerebellar ischemia.

Microvascular Relations of the Trigeminal Nerve: An Anatomical Study

Neurosurgery ◽  
1986 ◽  
Vol 19 (4) ◽  
pp. 535-539 ◽  
Author(s):  
Boris Klun ◽  
Borut Prestor
Keyword(s):  
Trigeminal Neuralgia ◽  
Anatomical Study ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Marked Contrast ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Cerebellar Artery ◽  
History Of ◽  
Trigeminal Root

Abstract The neurovascular relationships in the trigeminal root entry zone were studied in 130 trigeminal root entry zones of 65 cadavers. No history of facial or trigeminal pain had been obtained during life in these subjects. The technique of intravascular injection, which allowed good visualization and evaluation of the neurovascular relationships, is described. A total of 42 examples of contact with the root entry zone and 10 examples of compression were identified. In 30 of the examples of contact, the finding could be related to an artery; in the other examples, it appeared to be due to veins. Of the arterial compressions, the superior cerebellar artery was responsible in 53.8%, the anterior inferior cerebellar artery was responsible in 25.6%, and pontine branches of the basilar artery were responsible for the remaining 20.6%. Only one instance of unequivocal compression by a vein was found. Other anatomical observations of interest are reported. The absence of a history of trigeminal neuralgia in the 7% of examined nerves in which root entry zone showed arterial compression is in marked contrast to the finding of 80% or more in the operative series for trigeminal neuralgia. It seems that vascular compressions may be the predominant but not the sole cause of trigeminal neuralgia.

scholarly journals Thrombectomy in posterior circulation stroke through persistent primitive trigeminal artery: A case report

2015 ◽  
Vol 21 (6) ◽  
pp. 715-718 ◽  
Author(s):  
MJHL Mulder ◽  
GJ Lycklama à Nijeholt ◽  
W Dinkelaar ◽  
TPW de Rooij ◽  
ACGM van Es ◽  
...  
Keyword(s):  
Posterior Circulation ◽  
Superior Cerebellar Artery ◽  
Trigeminal Artery ◽  
Left Hand ◽  
Persistent Primitive Trigeminal Artery ◽  
Cerebellar Artery ◽  
Intervention Patient ◽  
Primitive Trigeminal Artery ◽  
The Right ◽  
Neurovascular Anatomy

We describe a case of intra-arterial treatment (IAT) of acute posterior circulation occlusion in a patient with a persistent primitive trigeminal artery (PPTA). The patient presented with an acute left sided hemiparesis and loss of consciousness (Glasgow coma score of 5). Computed tomography angiography showed an acute occlusion of the right internal carotid artery (ICA), the PPTA, distal basilar artery (BA), right posterior cerebral artery (PCA), and right superior cerebellar artery (SCA). Stent-retriever assisted thrombectomy was not considered possible through the hypoplastic proximal BA. After passage of the proximal ICA occlusion, the right PCA and SCA were recanalized through the PPTA, with a single thrombectomy procedure. Ten days after intervention patient was discharged scoring optimal EMV with only a mild facial and left hand paresis remaining. PPTA is a persistent embryological carotid–basilar connection. Knowledge of existing (embryonic) variants in neurovascular anatomy is essential when planning and performing acute neurointerventional procedures.

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.

Proatlantal intersegmental artery and trigeminal artery associated with an aneurysm

1983 ◽  
Vol 59 (3) ◽  
pp. 520-523 ◽  
Author(s):  
Yuichiro Tanaka ◽  
Hideaki Hara ◽  
Genki Momose ◽  
Shigeru Kobayashi ◽  
Shigeaki Kobayashi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Incidental Findings ◽  
Internal Carotid ◽  
Trigeminal Artery ◽  
Content Type ◽  
Primitive Trigeminal Artery ◽  
Fine Print

✓ A case of coexisting proatlantal intersegmental artery and primitive trigeminal artery is described. These anomalies were incidental findings in a patient with hemiparesis due to occlusion of the middle cerebral artery. The primitive trigeminal artery had an asymptomatic aneurysm at its origin from the internal carotid artery.

Vascular Transposition of the Superior Cerebellar Artery Using a Fenestrated Clip and Fibrin Glue in Trigeminal Neuralgia: 2-Dimensional Operative Video

2019 ◽  
Vol 19 (1) ◽  
pp. E50-E51 ◽  
Author(s):  
Karl R Abi-Aad ◽  
Evelyn Turcotte ◽  
Devi P Patra ◽  
Matthew E Welz ◽  
Tanmoy Maiti ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Fibrin Glue ◽  
Trigeminal Nerve ◽  
Facial Pain ◽  
Superior Cerebellar Artery ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Cerebellar Artery ◽  
Trigeminal Nerve Root ◽  
Made In

Abstract This is the case of an 86-yr-old gentleman who presented with left facial pain exacerbated by eating, drinking, chewing, and shaving (distribution: V2, V3). The patient was diagnosed with trigeminal neuralgia and was refractory to medications. Imaging showed a superior cerebellar artery (SCA) loop adjacent to the trigeminal nerve root entry zone and a decision to perform a microvascular decompression of the fifth nerve was presented to the patient. After patient informed consent was obtained, a standard 3 cm × 3 cm retrosigmoid craniotomy was performed with the patient in a supine head turned position and in reverse Trendelenburg. The arachnoid bands tethering the SCA to the trigeminal nerve were sharply divided. A slit was then made in the tentorium and a 3 mm fenestrated clip was then used to secure the transposed SCA away from the trigeminal nerve. The SCA proximal to this was slightly patulous in its course so a small amount of a fibrin glue was also used to secure the more proximal SCA to the tentorium. The patient was symptom-free postoperatively and no longer required medical therapy. Additionally, imaging was consistent with adequate separation of the nerve from adjacent vessels.1-5

scholarly journals Identification of a Persistent Primitive Trigeminal Artery Following the Transposition Technique for Trigeminal Neuralgia: A Case Report

2011 ◽  
Vol 16 (5) ◽  
pp. 357-359 ◽  
Author(s):  
Naoki Kato ◽  
Toshihide Tanaka ◽  
Hiroki Sakamoto ◽  
Takao Arai ◽  
Yuzuru Hasegawa ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Trigeminal Artery ◽  
Resonance Imaging ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Persistent Primitive Trigeminal Artery ◽  
Orbital Pain ◽  
Primitive Trigeminal Artery

Trigeminal neuralgia is lancinating pain of a few seconds duration triggered by minor sensory stimuli such as speaking, chewing or even a breeze on the face. Vascular compression of the trigeminal nerve at the root entry zone and other vessels has been implicated in its cause. Despite the initial success of medical treatment in some cases, however, many patients become refractory over time and eventually require surgical intervention. This report describes a case involving a 62-year-old woman who presented with right orbital pain provoked by, among others, exercise and cold. Medication proved to be ineffective and, after magnetic resonance imaging, microvascular decompression and surgical observation, the diagnosis became clearer. The case highlights the importance of preoperative imaging and careful intraoperative findings to determine whether variant arteries are responsible for trigeminal neuralgia.A patient who presented with trigeminal neuralgia associated with a persistent primitive trigeminal artery (PPTA) is presented. A 62-year-old woman suffering from right orbital pain was admitted to the hospital. Medical treatment for three months was ineffective, and her neuralgia had deteriorated and gradually spread in the maxillary division. Magnetic resonance imaging demonstrated the flow void signal attached to the right trigeminal nerve. Thus, microvascular decompression was performed. The superior cerebellar artery was the responsible artery, and it was transposed to decompress the trigeminal nerve. After this manoeuvre, an artery was identified running parallel to the trigeminal nerve toward Meckel’s cave. The artery, which turned out to be a PPTA, communicated with the basilar artery. The PPTA was carefully observed, and it was found not to be the artery causing the neuralgia because it did not compress the nerve at surgical observation. No additional procedure between the PPTA and the trigeminal nerve was performed. The patient’s symptom improved dramatically following surgery, and her postoperative course was uneventful. Postoperative three-dimensional computed tomography showed the PPTA. The findings in the present case suggest that transposition of the responsible artery effectively decompresses the root entry zone and assists in determining whether the PPTA is affecting the trigeminal nerve.

Trigeminal Neuralgia and Multiple Sclerosis

Neurosurgery ◽  
1979 ◽  
Vol 5 (6) ◽  
pp. 711-717 ◽  
Author(s):  
Martin L. Lazar ◽  
Joel B. Kirkpatrick
Keyword(s):  
Multiple Sclerosis ◽  
Trigeminal Neuralgia ◽  
Nerve Root ◽  
Superior Cerebellar Artery ◽  
Electron Microscopic ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Cerebellar Artery ◽  
Microsurgical Approach ◽  
Electron Microscopic Demonstration

Abstract Trigeminal neuralgia is unique to humans. The most common cause seems to be an injury to the myelin of the trigeminal nerve root entry zone as it extends for several millimeters lateral to the pons. Jannetta has developed an elegant retromastoid microsurgical approach to this region. He has identified a compression-distortion phenomenon of this nerve root entry zone, usually from an anomalous position of the superior cerebellar artery. Trigeminal neuralgia can also occur in association with multiple sclerosis, when the plaque lies in this same location. The historical evidence for this explanation is reinforced by the electron microscopic demonstration of the plaque in this region in a patient with multiple sclerosis who was suffering from tic douloureux.

Glossopharyngeal neuralgia

1977 ◽  
Vol 47 (3) ◽  
pp. 316-320 ◽  
Author(s):  
Ranjit K. Laha ◽  
Peter J. Jannetta
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Cranial Nerves ◽  
Glossopharyngeal Neuralgia ◽  
Vascular Compression ◽  
Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Cerebellar Artery ◽  
Sporadic Cases ◽  
Fine Print

✓ Various factors have been considered in the etiology and pathogenesis of glossopharyngeal neuralgia. Vascular compression of the involved cranial nerves has been demonstrated in sporadic cases. In this series of six patients, it was noted with the aid of the operating microscope that the ninth and tenth cranial nerves were compressed by a tortuous vertebral artery or posterior inferior cerebellar artery at the nerve root entry zone in five cases. In selected patients, microvascular decompression without section of the nerves may result in a cure.

Sign in / Sign up

Export Citation Format

Share Document