• Gaurav Tyagi, Nishanth Sadashiva, Subhas Konar, Hanumanthapura Ramalingaiah Aravinda, Jitender Saini, Dhaval Shukla, and Devi Bhagavatula Indira BI Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India..
• Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India.
• World Neurosurg. 2020 Feb 1; 134: e214-e223.

IntroductionPersistent trigeminal artery (PTA) is the most common remnant of primitive circulation communicating the developing carotid and vertebrobasilar junction. Although discovered incidentally, an altered hemodynamic may lead to an increased association of aneurysms, vascular malformations, and stroke. Neurosurgeons should be aware of the presence and significance of PTA when interpreting imaging and planning interventions.MethodsWe retrospectively reviewed all magnetic resonance angiography and cerebral digital subtraction angiography performed between 2012 and 2017 for the presence of PTA. The radiologic and anatomic details were noted and analyzed along with the clinical profiles. We categorized the radiologic findings with respect to the available classification systems. A review of the available literature was done comparing our results.ResultsWe found 33 cases of incidentally detected PTA. The average age of the patients was 45.42 years. The lateral surface of the proximal cavernous internal carotid artery was the most common origin (n = 23). Only 3 cases had a medial/transsellar course. Most cases were Saltzman/Weon type I (19/33). Intracranial aneurysms were associated with 6 patients (18.18%). Trigeminal neuralgia (TN) was a presenting feature in 5 patients. None had a direct neurovascular conflict at the root entry zone.ConclusionsOur study is one of the largest to describe the incidence of PTA. We emphasized the importance of PTA to the neurosurgeons; increased association of aneurysms, as a route for intervention in occlusive disease of the posterior fossa; risk of injury and bleeding during transsphenoidal surgery; and the association with TN. However, we found that only PTA variants are likely to be associated with TN because of their cisternal course causing NV conflict.Copyright © 2019 Elsevier Inc. All rights reserved.

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