Persistent Trigeminal Artery of the Sellar Region

Fig. 65.1

Persistent trigeminal artery (PTA) extending through the sella turcica and pituitary gland. (a) Axial noncontrast MRI showing a flow void through the dorsum sellae (arrow) arising from the left ICA. (b) Axial CT angiogram showing the PTA arising from the left ICA (arrow) and communicating with the basilar artery system after passing through the dorsum sellae. (c) Three-dimensional reconstruction (anteroposterior view) showing PTA arising from the left ICA and communicating with the basilar artery (arrow). (d) Three-dimensional reconstruction (lateral view) showing PTA arising from the left ICA and communicating with the basilar artery (arrow)

PTAs arise from the intracavernous ICA and run caudally, either passing beneath the dorsum sellae (lateral type) or passing directly through the sella and dorsum sellae (medial type), to communicate with the basilar artery. The types occur with equal frequency [9, 10].

The Saltzman classification of PTA has also been widely used to classify these anomalies. In the Saltzman type 1 PTA, the posterior communicating (PCOM) artery is absent. In the Saltzman type 2 PTA, the ipsilateral posterior cerebral artery (PCA) arises directly from the ICA, and the P1 segment is absent, indicating a fetal origin of the PCA. A hypoplastic basilar artery proximal to the anastomotic point is usually seen with both types [10, 11].

PTAs occur on the left side in 62.5 % of cases [12].

65.3 Clinical and Surgical Management

No clinical management is required. The importance of a sellar PTA is that it may affect surgical planning for other lesions of the sellar and parasellar region [13].
Successful transsphenoidal surgery for a pituitary adenoma has been performed in a patient with an intrasellar PTA [3].
In rare cases, microvascular decompression or coil embolization may be warranted in patients with PTA causing trigeminal neuralgia [1, 14].

References

Meckel S, Spittau B, McAuliffe W. The persistent trigeminal artery: development, imaging anatomy, variants, and associated vascular pathologies. Neuroradiology. 2013;55:5–16.CrossRefPubMed

Abe T, Fujita S, Ozawa H, Kawamura N, Shimazu M, Ikeda H, et al. Haemorrhagic nonsecreting pituitary adenoma associated with persistent primitive trigeminal artery. Acta Neurochir (Wien). 2000;142:1423–4.CrossRef

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