Trigeminal artery

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Schematic representation of the embryonic connections from the internal carotid artery to the longitudinal neural artery.

The arteria trigemina (primitiva) is one of the symmetrical arteries that connect the internal carotid artery with the flow area of ​​the later basilar artery during human embryonic development . Usually the trigeminal artery recedes. In a few cases, however, the vessel remains as an anatomical variant into adulthood and can then sometimes be associated with medical problems, for example with aneurysms of the cerebral arteries and bleeding of the same.

Normal development

When the human embryo is about 4–5 mm in size, the primitive trigeminal artery (the addition “primitiva” indicates the embryonic, not final character), together with other primitive arteries, connects the internal carotid artery with the reticulated longitudinal neural artery (the later fused to the basilar artery ). These compounds are used as embryonic karotido-basilar anastomosis referred to and are adjacent to the artery trigemina primitiva the artery ótica (also artery Acustica), the artery hypoglossica and the artery proatlantica (for later vertebral artery ). At this point, the primitive trigeminal artery provides the main blood supply for the hindbrain as other arteries in the region are not yet mature. If the posterior communicating artery is sufficiently strong in further development, the primitive trigeminal artery loses its importance for the blood supply and ultimately recedes. The period from the initial development of the artery to its final involution is only 7 to 10 days.

Persistent trigeminal artery

Angiography of the cerebral arteries viewed from the side. When the internal carotid artery is injected (white arrow), a strong, tortuous vessel (black arrow) emerges, which pulls towards the posterior flow area. This is a persistent trigeminal artery.
Incidental finding of a persistent trigeminal artery (arrow) here with further anomalies: The basilar artery is only weakly developed in parts. The A. trigemina joins after the release of the Aa. cerebelli superiores into the mutual posterior cerebral artery, while the other posterior cerebral artery is fed by the posterior communicating artery.

A trigeminal artery that persists into adulthood is rare. It was described for the first time in 1844 by Richard Quain after autopsies and angiographically presented for the first time in 1950 by David Sutton. In examinations of the head using magnetic resonance angiography , it was found in about 0.6 to 0.7% of the examined. Other sources indicate higher frequencies of up to 2.2%, although they do not explicitly refer to magnetic resonance angiography. A persistent trigeminal artery seems to be more common in women.

meaning

Even if a persistent trigeminal artery is discovered by chance in many cases, the common occurrence with one of the following clinical pictures is discussed:

In addition, knowledge of a persistent trigeminal artery and accompanying anomalies prior to vascular or surgical intervention in the region is important.

classification

The most frequently cited classification of the persistent trigeminal artery is that of Saltzman. It differentiates between three types according to the way the other arteries are formed or connected:

  • Saltzman Type I: Connection to the basilar artery between the superior cerebellar artery and the inferior anterior cerebellar artery . The basilar artery is hypoplastic proximally and the posterior communicating arteries are absent or only very weak.
  • Saltzman Type II: Also connection to the basilar artery between the superior cerebellar artery and the inferior anterior cerebellar artery. However, the posterior communicating arteries are present and supply the cerebral posterior arteries.
  • Saltzman Type III: The trigeminal artery opens directly into one of the cerebellar arteries:
    • Type IIIa: into the superior cerebellar artery
    • Type IIIb: into the inferior anterior cerebellar artery
    • Type IIIc: into the inferior posterior cerebelli artery

However, there are numerous variants, so that a description makes sense individually.

Web links

Commons : Trigeminal Artery  - Collection of images, videos and audio files
Commons : Persistent trigeminal artery  - collection of images, videos and audio files

Sources and literature

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  5. David Sutton: Anomalous carotid basilar anastomosis . In: The British Journal of Radiology . tape 23 , no. 274 , October 1950, p. 617 , doi : 10.1259 / 0007-1285-23-274-617 .
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  7. M. Bai, Q. Guo, S. Li: Persistent trigeminal artery / persistent trigeminal artery variant and coexisting variants of the head and neck vessels diagnosed using 3T MRA . In: Clinical Radiology . tape 68 , no. November 11 , 2013, p. e578 , doi : 10.1016 / j.crad.2013.05.099 .
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  15. J. Shen, J. Tourje, EE Chang, AN Mamelak, AW Wu: Persistent Trigeminal Artery in Endonasal Resection of Skull Base Tumors: A Systematic Review. In: Journal of neurological surgery. Part B, skull base. Volume 77, number 6, December 2016, pp. 449-455, doi: 10.1055 / s-0036-1581066 , PMID 27857870 , PMC 5112167 (free full text).
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