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Prevalence and clinical implications of the primitive trigeminal artery and its variants
EANS Academy. Brzegowy K. 09/26/19; 275952; EP04065
Ms. Karolina Brzegowy
Ms. Karolina Brzegowy

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Abstract
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Background: The primitive trigeminal artery (PTA) is the most common and the largest persistent carotid-basilar anastomosis. Primitive trigeminal artery variants (PTAV) are anastomoses between the internal carotid artery (ICA) and cerebellar arteries. These vessels pose a risk of hemorrhagic or ischemic complications during neurosurgical procedures in the para- and intra-sellar regions. The aim of this study was to determine the prevalence of both PTA and PTAVs and their clinically important anatomical features.
Methods: Major electronic databases were thoroughly searched for studies on PTA and PTAV. References in the included articles were also evaluated. Data regarding prevalence, laterality, origin, course patterns and associated anomalies were extracted and pooled into a meta-analysis.
Results: A total of 39 studies (110,866 patients) were included in the meta-analysis. The total pooled prevalence estimate of PTA and PTAVs combined was 0.4% (95%CI: 0.3-0.5). Individually, PTA was present in 0.3% (95%CI: 0.2-0.4) of patients and PTAV in 0.2% (95%CI: 0.1-0.3). Both arteries most often originated from the C4 ICA (97.6%, 95%CI: 93.7-100.0) and took a course lateral to (89.0%, 95%CI: 84.2-93.1) or through (11.0%, 95%CI: 6.9-15.8) the dorsum sellae. Anterior inferior cerebellar artery-type was the predominant PTAV (72.1%, 95%CI: 50.0- 95.7), followed by posterior inferior cerebellar artery-type (17.7%, 95%CI: 1.9-44.2) and superior cerebellar artery-type (10.2%, 95%CI: 0.0-30.2). Other unclassified PTAVs were also identified. There was basilar artery hypoplasia in 42.5% (95%CI: 23.0-63.1) of patients with a PTA.
Conclusions: PTA and PTAVs are rare vessels, but they are clinically important in neurosurgery, especially in minimally invasive approaches to the pituitary gland. Preoperative detection of a PTA and PTAVs and detailed anatomical knowledge of their course is necessary for developing optimal treatment plans. The presence of an intrasellar-type PTA warrants extreme caution during transsphenoidal approaches to the skull base, such as the endoscopic endonasal surgery for pituitary adenoma.
Background: The primitive trigeminal artery (PTA) is the most common and the largest persistent carotid-basilar anastomosis. Primitive trigeminal artery variants (PTAV) are anastomoses between the internal carotid artery (ICA) and cerebellar arteries. These vessels pose a risk of hemorrhagic or ischemic complications during neurosurgical procedures in the para- and intra-sellar regions. The aim of this study was to determine the prevalence of both PTA and PTAVs and their clinically important anatomical features.
Methods: Major electronic databases were thoroughly searched for studies on PTA and PTAV. References in the included articles were also evaluated. Data regarding prevalence, laterality, origin, course patterns and associated anomalies were extracted and pooled into a meta-analysis.
Results: A total of 39 studies (110,866 patients) were included in the meta-analysis. The total pooled prevalence estimate of PTA and PTAVs combined was 0.4% (95%CI: 0.3-0.5). Individually, PTA was present in 0.3% (95%CI: 0.2-0.4) of patients and PTAV in 0.2% (95%CI: 0.1-0.3). Both arteries most often originated from the C4 ICA (97.6%, 95%CI: 93.7-100.0) and took a course lateral to (89.0%, 95%CI: 84.2-93.1) or through (11.0%, 95%CI: 6.9-15.8) the dorsum sellae. Anterior inferior cerebellar artery-type was the predominant PTAV (72.1%, 95%CI: 50.0- 95.7), followed by posterior inferior cerebellar artery-type (17.7%, 95%CI: 1.9-44.2) and superior cerebellar artery-type (10.2%, 95%CI: 0.0-30.2). Other unclassified PTAVs were also identified. There was basilar artery hypoplasia in 42.5% (95%CI: 23.0-63.1) of patients with a PTA.
Conclusions: PTA and PTAVs are rare vessels, but they are clinically important in neurosurgery, especially in minimally invasive approaches to the pituitary gland. Preoperative detection of a PTA and PTAVs and detailed anatomical knowledge of their course is necessary for developing optimal treatment plans. The presence of an intrasellar-type PTA warrants extreme caution during transsphenoidal approaches to the skull base, such as the endoscopic endonasal surgery for pituitary adenoma.
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