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Persistent trigeminal artery aneurysms: case report and systematic review
  1. Francesco Diana1,
  2. Salvatore Mangiafico2,
  3. Vinicio Valente3,
  4. Andrea Wlderk4,
  5. Giovanni Grillea5,
  6. Claudio Colonnese6,
  7. Marcello Bartolo5
  1. 1 Interventional Neuroradiology, Neuroradiology Unit, Maurizio Bufalini Hospital, Cesena, Italy
  2. 2 Interventional Neurovascular Unit, University Hospital Careggi, Firenze, Italy
  3. 3 Cosenza Hospital Districts, Cosenza, Italy
  4. 4 Interventional Neuroradiology, Fondazione PTV Policlinico Tor Vergata, Roma, Italy
  5. 5 NEUROMED, Pozzilli, Italy
  6. 6 Department of Neurology and Psychiatry, Neuroradiology, “Sapienza” University of Rome, Italy and IRCCS INM Neuromed Pozzilli, Rome, Italy
  1. Correspondence to Dr Francesco Diana, Maurizio Bufalini Hospital, Cesena 47521, Italy;{at}


Background The persistent trigeminal artery (PTA) is an adult carotid-basilar anastomosis with debated pathologic aspects, such as its association with brain aneurysms. True trigeminal artery aneurysms are rare vascular anomalies, reported in a few case reports.

Objective To report our experience with a ruptured trigeminal artery aneurysm and to provide a systematic review of the literature in order to analyse potential links between the anatomic configuration of the PTA and PTA aneurysm (PTAA) type, and implications of each PTAA type for the diagnostic and therapeutic approach.

Methods We reviewed the medical literature on trigeminal artery aneurysms according to the PRISMA guidelines. Population characteristics, aneurysms features, and PTA type and side were assessed.

Results 40 previously published cases of PTAAs were included in the analysis. The mean age of subjects was 55 years, with a strong female predominance (77%). Four PTAAs were accidentally discovered, while 16 caused compressive symptoms and 20 were ruptured. Successful endovascular treatment was performed in 62% of cases.

Conclusions PTAAs are rare vascular anomalies, underdiagnosed in the presence of a trigemino-cavernous fistula. Parent vessel occlusion seems to be the best therapeutic option for ruptured or symptomatic unruptured PTAAs in Saltzman type II and III PTAs. Patency of the parent vessel is the main target in Saltzman type I PTA.

  • aneurysm
  • artery
  • congenital
  • fistula
  • blood pressure

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  • Contributors Conception and design of the work: FD. Data acquisition: FD, SM, AW, and GG. Data analysis and interpretation: FD, VV, AW, and GG. Drafting the work: FD and VV. Critical revision: CC, SM, and MB. Final approval: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.