Trigeminal artery

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Angiogram demonstrating persistent trigeminal artery, as indicated by the black arrow. Persistent trigeminal.JPG
Angiogram demonstrating persistent trigeminal artery, as indicated by the black arrow.

The trigeminal artery is an artery that supplies the basilar artery with blood during human embryonic development. [1] Normally, the trigeminal artery involutes after the formation of the posterior communicating artery. [2] However, in some cases, the artery persists into adulthood and can cause medical complications, including intracranial aneurysms. [3]

Basilar artery artery that supplies the brain with oxygen-rich blood

In human anatomy, the basilar artery is one of the arteries that supplies the brain with oxygen-rich blood.

Involution is the shrinking or return of an organ to a former size. At a cellular level, involution is characterized by the process of proteolysis of the basement membrane, leading to epithelial regression and apoptosis, with accompanying stromal fibrosis. The consequent reduction in cell number and reorganization of stromal tissue leads to the reduction in the size of the organ.

Posterior communicating artery

In human anatomy, the left and right posterior communicating arteries are arteries at the base of the brain that form part of the circle of Willis. Each posterior communicating artery connects the three cerebral arteries of the same side. Anteriorly, it connects to the internal carotid artery (ICA) prior to the terminal bifurcation of the ICA into the anterior cerebral artery and middle cerebral artery. Posteriorly, it communicates with the posterior cerebral artery.

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Normal development

The trigeminal artery arises from the primitive internal carotid artery during development, when the embryo is approximately 6 weeks old. The trigeminal artery then anastomoses with the basilar artery. [3] At this point in development, the trigeminal artery serves as the main blood supply for the hindbrain, as other vessels in the region have yet to mature. [4] As the internal carotid artery branches more caudally to form the posterior communicating artery, the trigeminal artery becomes less important in supplying blood and ultimately involutes. [2] The time period from the initial development of the artery to its ultimate involution is only 7 to 10 days; if the artery has not involuted at the end of this period it persists into adulthood. [5]

Internal carotid artery

The internal carotid artery is a major paired artery, one on each side of the head and neck, in human anatomy. They arise from the common carotid arteries where these bifurcate into the internal and external carotid arteries at cervical vertebral level 3 or 4; the internal carotid artery supplies the brain, while the external carotid nourishes other portions of the head, such as face, scalp, skull, and meninges.

Persistent trigeminal artery

In around 0.1 to 0.6% of individuals, as sampled by magnetic resonance angiography, the trigeminal artery fails to involute and remains in the adult brain, in a condition called persistent trigeminal artery. [3] This condition is more common in women than in men, with approximately 1.8 times as many women having the condition. [6] Knowledge of a persistent trigeminal artery may be important in certain brain surgeries, as the condition is rare and an accidental cut to the artery could lead to hemorrhage. [1] Although the discovery of a persistent trigeminal artery is sometimes an incidental finding, its presence is also associated with various pathological conditions, and must therefore be considered carefully when diagnosing these conditions. [7]

Magnetic resonance angiography group of techniques based on magnetic resonance imaging (MRI) to image blood vessels.

Magnetic resonance angiography (MRA) is a group of techniques based on magnetic resonance imaging (MRI) to image blood vessels. Magnetic resonance angiography is used to generate images of arteries in order to evaluate them for stenosis, occlusions, aneurysms or other abnormalities. MRA is often used to evaluate the arteries of the neck and brain, the thoracic and abdominal aorta, the renal arteries, and the legs.

Associated conditions

A persistent trigeminal artery is associated with an increased risk of aneurysm, though some studies have suggested that this finding may be an effect of selection bias, as most individuals do not undergo the tests necessary to identify the condition. [3] Persistent trigeminal artery has been identified as a rare cause of trigeminal neuralgia, with 2.2% prevalence of persistent trigeminal artery among trigeminal neuralgia patients. [8] Surgery to move the persistent trigeminal artery away from the trigeminal nerve has been successful in treating the trigeminal neuralgia in some cases. [9] In some cases, presence of a persistent trigeminal artery concurs with hypoplasia of the basilar artery, in which case the internal carotid artery is responsible for most blood flow to the upper pons, cerebellum, midbrain, and parts of the temporal and occipital lobes, meaning that anything disrupting blood flow in the internal carotid artery could lead to ischemia in these regions. [10] In addition, persistent trigeminal artery has been associated with vertebrobasilar insufficiency, brainstem ischemia, and carotid cavernous fistulae. [2]

Selection bias is the bias introduced by the selection of individuals, groups or data for analysis in such a way that proper randomization is not achieved, thereby ensuring that the sample obtained is not representative of the population intended to be analyzed. It is sometimes referred to as the selection effect. The phrase "selection bias" most often refers to the distortion of a statistical analysis, resulting from the method of collecting samples. If the selection bias is not taken into account, then some conclusions of the study may not be accurate.

Trigeminal neuralgia neuropathic disorder

Trigeminal neuralgia is a chronic pain disorder that affects the trigeminal nerve. There are two main types: typical and atypical trigeminal neuralgia. The typical form results in episodes of severe, sudden, shock-like pain in one side of the face that lasts for seconds to a few minutes. Groups of these episodes can occur over a few hours. The atypical form results in a constant burning pain that is less severe. Episodes may be triggered by any touch to the face. Both forms may occur in the same person. It is one of the most painful conditions, and can result in depression.

Hypoplasia is underdevelopment or incomplete development of a tissue or organ. Although the term is not always used precisely, it properly refers to an inadequate or below-normal number of cells. Hypoplasia is similar to aplasia, but less severe. It is technically not the opposite of hyperplasia. Hypoplasia is a congenital condition, while hyperplasia generally refers to excessive cell growth later in life.

Related Research Articles

Intracranial aneurysm cerebrovascular disorder

Intracranial aneurysm, also known as brain aneurysm, is a cerebrovascular disorder in which weakness in the wall of a cerebral artery or vein causes a localized dilation or ballooning of the blood vessel.

Circle of Willis circulatory anastomosis that supplies blood to the brain and surrounding structures

The circle of Willis is a circulatory anastomosis that supplies blood to the brain and surrounding structures. It is named after Thomas Willis (1621–1675), an English physician.

Subarachnoid hemorrhage bleeding into the subarachnoid space

Subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space—the area between the arachnoid membrane and the pia mater surrounding the brain. Symptoms may include a severe headache of rapid onset, vomiting, decreased level of consciousness, fever, and sometimes seizures. Neck stiffness or neck pain are also relatively common. In about a quarter of people a small bleed with resolving symptoms occurs within a month of a larger bleed.

Cerebral angiography

Cerebral angiography is a form of angiography which provides images of blood vessels in and around the brain, thereby allowing detection of abnormalities such as arteriovenous malformations and aneurysms. It was pioneered in 1927 by the Portuguese neurologist Egas Moniz at the University of Lisbon, who also helped develop thorotrast for use in the procedure.

Takayasus arteritis syndrome that involves inflammation of the aorta that carries blood from the heart to the rest of the body

Takayasu's arteritis is a form of large vessel granulomatous vasculitis with massive intimal fibrosis and vascular narrowing, most commonly affecting often young or middle-age women of Asian descent, though anyone can be affected. It mainly affects the aorta and its branches, as well as the pulmonary arteries. Females are about 8–9 times more likely to be affected than males.

Moyamoya disease A cerebral arterial disease characterized by constriction of certain arteries at the base of the brain. Blood flow is blocked by the constriction and also by blood clots.

Moyamoya disease is a disease in which certain arteries in the brain are constricted. Blood flow is blocked by the constriction, and also by blood clots (thrombosis).

Anterior cerebral artery

The anterior cerebral artery (ACA) is one of a pair of arteries on the brain that supplies oxygenated blood to most midline portions of the frontal lobes and superior medial parietal lobes. The two anterior cerebral arteries arise from the internal carotid artery and are part of the circle of Willis. The left and right anterior cerebral arteries are connected by the anterior communicating artery.

Carotid artery stenosis narrowing or constriction of the inner surface (lumen) of the carotid artery, usually caused by atherosclerosis

Carotid artery stenosis is a narrowing or constriction of any part of the carotid arteries, usually caused by atherosclerosis.

Cavernous sinus

The cavernous sinus within the human head, is one of the dural venous sinuses creating a cavity called the lateral sellar compartment bordered by the temporal bone of the skull and the sphenoid bone, lateral to the sella turcica.

Fibromuscular dysplasia Human disease

Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory disease of the blood vessels that causes abnormal growth within the wall of an artery. FMD has been found in nearly every arterial bed in the body although the most common arteries affected are the renal and carotid arteries.

Subclavian steal syndrome constellation of signs and symptoms that arise from retrograde (reversed) blood flow in the vertebral artery or the internal thoracic artery, due to a proximal stenosis (narrowing) and/or occlusion of the subclavian artery

Subclavian steal syndrome (SSS), also called subclavian steal phenomenon or subclavian steal steno-occlusive disease, is a constellation of signs and symptoms that arise from retrograde (reversed) blood flow in the vertebral artery or the internal thoracic artery, due to a proximal stenosis (narrowing) and/or occlusion of the subclavian artery. The arm may be supplied by blood flowing in a retrograde direction down the vertebral artery at the expense of the vertebrobasilar circulation. This is called the subclavian steal. It is more severe than typical vertebrobasilar insufficiency.

Vertebral artery dissection

Vertebral artery dissection (VAD) is a flap-like tear of the inner lining of the vertebral artery, which is located in the neck and supplies blood to the brain. After the tear, blood enters the arterial wall and forms a blood clot, thickening the artery wall and often impeding blood flow. The symptoms of vertebral artery dissection include head and neck pain and intermittent or permanent stroke symptoms such as difficulty speaking, impaired coordination and visual loss. It is usually diagnosed with a contrast-enhanced CT or MRI scan.

Intracranial dolichoectasias

The term dolichoectasia means elongation and distension. It is used to characterize arteries throughout the human body which have shown significant deterioration of their tunica intima, weakening the vessel walls and causing the artery to elongate and distend.

In human anatomy, the stapedial branch of posterior auricular artery, or stapedial artery for short, is a small artery supplying the stapedius muscle in the inner ear.

Joshua B. Bederson, M.D., is a neurosurgeon and Professor and Chairman of Neurosurgery at the Mount Sinai Health System in New York City. He is a Fellow of the American College of Surgeons and an attending neurosurgeon at both Mount Sinai and Elmhurst Hospital in Elmhurst, Queens.

Interventional Neuroradiology (INR) or Endovascular Surgical Neuroradiology (ESN) is a medical subspecialty specializing in minimally invasive image-based technologies and procedures used in diagnosis and treatment of diseases of the head, neck, and spine.

Alexander Coon, M.D. is an American neurosurgeon and Adjunct Professor of Neurosurgery, Neurology, and Radiology at the Johns Hopkins Hospital. He is known for his work in cerebrovascular and endovascular neurosurgery and his research in neuroendovascular devices and clinical outcomes in the treatment of cerebral aneurysms, subarachnoid hemorrhage, and AVMs.

References

  1. 1 2 Simon J. Dimmick and Kenneth C. Faulder. "Normal Variants of the Cerebral Circulation at Multidetector CT Angiography". RadioGraphics (2009) 29: 1036.
  2. 1 2 3 Waleed Azab, Johnny Delashaw, and Mohammed Mohammed. "Persistent Primitive Trigeminal Artery: A Review." Turkish Neurosurgery (2012) 22:400.
  3. 1 2 3 4 Stephan Meckel, Bjoern Spittau & William McAuliffe. "The persistent trigeminal artery: development, imaging anatomy, variants, and associated vascular pathologies." Neuroradiology (2013) 55:5–16.
  4. ↑ William S. Fields. "The significance of persistent trigeminal artery: Carotid-basilar anastomosis. Radiology (1968) 91: 1096-1101.
  5. ↑ Ljiljana Vasovic, et al. "Trigeminal artery: a review of normal and pathological features." Child's Nervous System (2012) 28: 33-46.
  6. ↑ Eri O'uchi and Toshihiro O'uchi. "Persistent primitive trigeminal arteries (PTA) and its variant (PTAV): analysis of 103 cases detected in 16,415 cases of MRA over 3 years. Interventional Neuroradiology (2010) 52:1111-1119.
  7. ↑ Alejandro M. Russo and Maria C. Sienra. "Persistent trigeminal artery: case report". International Journal of Anatomical Variations (2011) 4: 157-160.
  8. ↑ Licia Pereira, et al. "Persistent trigeminal artery: Angio-tomography and angio-magnetic resonance finding". Arquivos de Neuro-Psiquiatria (2009) 67:882-885.
  9. ↑ Chang Kyu Park, et al. "Trigeminal neuralgia caused by persistent primitive trigeminal artery." Journal of Korean Neurosurgery Society (2014) 56: 278-280.
  10. ↑ Gabriel Alcalá-Cerra, R Shane Tubbs, and Lucía M Niño-Hernández. "Anatomical features and clinical relevance of a persistent trigeminal artery". Surgical Neurology International (2012) 3:111.
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