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J Neurol Surg B Skull Base 2016; 77(06): 449-455
DOI: 10.1055/s-0036-1581066
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Persistent Trigeminal Artery in Endonasal Resection of Skull Base Tumors: A Systematic Review

Jasper Shen
1   Caruso Department of Otolaryngology, University of Southern California, Los Angeles, California, United States
,
James Tourje
2   Imaging Medical Group, Cedars-Sinai Medical Center, Los Angeles, California, United States
,
Elena E. Chang
3   Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California, United States
,
Adam N. Mamelak
4   Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, United States
,
Arthur W. Wu
5   Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California, United States
› Author Affiliations
Further Information

Publication History

27 December 2015

17 February 2016

Publication Date:
31 March 2016 (online)

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Abstract

Background Primitive persistent trigeminal artery (PTA) is an uncommon embryologic vascular communication between the carotid and basilar arteries, which can be intimately involved by skull base tumors (SBT). Owing to its rarity, skull base surgeons should familiarize themselves with the anatomical variations of PTA to avoid catastrophic complications.

Objective To appraise and summarize the available evidence of PTA involved by SBTs while advocating a standardized algorithm for the surgical planning of these patients.

Methods MEDLINE and PubMed databases were searched using keywords pertaining to PTA and SBTs. Demographics, clinical presentation, radiographic findings, outcomes, and adverse events were extracted and analyzed.

Results A total of 13 cases between 1973 and 2015 were identified. The mean patient age at presentation was 43 years with predilections toward females and pituitary adenomas. Headaches and endocrine abnormalities were the most common symptoms. The tumors were more frequently associated with Salas medial-type PTA (70%) and Saltzman type-I PTA (31%) than seen in the general population in angiographic studies. We also present a new case of atypical meningioma with Saltzman type-1 PTA.

Conclusion With endoscopic approaches to SBTs becoming more commonplace, surgeons may encounter this anatomical abnormality more frequently. It is important for both otolaryngologists and neurosurgeons to gain a complete understanding of the anatomical variations and neurointerventional capabilities for the successful endoscopic management of these situations.

Level of Evidence: 4.

Keywords

persistent trigeminal artery - arterial variants - skull base surgery - skull base tumor - meningioma - arteriovenous malformation
 

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