RARE TRIPLE ANATOMICAL VARIATION OF THE CEREBRAL ARTERIAL CIRCLE; Rara triple variación del círculo arterial cerebral.
DOI:
https://doi.org/10.31051/1852.8023.v9.n1.15416Keywords:
círculo arterial cerebral, arteria cerebral posterior, arteria trigeminal persistente, nervio abducens, cerebral arterial circle, posterior cerebral artery, persistent trigeminal artery, abducens nerveAbstract
Se reporta la rara asociación de un aneurisma de arteria trigeminal persistente lateral derecha (Tipo II de Saltzman), aplasia del segmento pre-comunicante de ambas arterias cerebrales posteriores y la presencia de arterias cerebrales posteriores fetales en forma bilateral, en una mujer de 64 años que consultó de diplopía y parálisis del nervio abducens derecho, probablemente debida a compresión del nervio en el espacio latero-celar. Se realizó con éxito la embolización endovascular con coils, sin complicaciones inmediatas. Los hallazgos de CT, RM y angiografía son presentados. Aunque cada una de estas variaciones son infrecuentes en forma individual, la combinación de las mismas no ha sido reportada en la literatura hasta nuestro conocimiento, siendo de enorme importancia en el manejo diagnóstico y terapéutico de pacientes con stroke de mecanismo embolico, así como para la planificación de procedimientos endovasculares diagnósticos y terapéuticos.
We report the rare association of an aneurysm of a lateral right persistent trigeminal artery (Saltzman type II), bilateral aplasia of the pre-communicating segment of both posterior cerebral arteries and bilateral fetal posterior cerebral arteries, in a 64 years old woman who suffered from progressive diplopia and right abducens nerve palsy, most likely due to nerve compression in the latero-cellar space. Successful endovascular coils embolization of the aneurysm was performed, with no immediate complications. CT, MR and angiographic findings are presented. Although infrequent as single variations, the association of these three arterial variations has not been reported in literature to our knowledge, having special importance in the diagnostic workup and therapeutic procedures in a patient with an embolic stroke, as well as in the planification of intracranial endovascular diagnostic and therapeutic procedures.
References
Azab W, DelAShAW J, Mohammed M. 2012. Persistent Primitive Trigeminal Artery: A Review. Turk Neurosurg 22: 399-406.
Boleaga Duran B, Ameller Terrazas S, Criales Cortez J L. 2004. Variantes anatómicas del círculo arterial de la base craneal. Revista de Radiología de México. 4: 2339-244.
Cloft HJ, Razack N, Kallmes DF. 1999. Prevalence of cerebral aneurysms in patients with persistent primitive trigeminal artery. J Neurosurg. 90:865–7.
de Bondt BJ, Stokroos R, Casselman J. 2007. Persistent trigeminal artery associated with trigeminal neuralgia: hypothesis of neurovascular compression. Neuroradiology 49: 23-26.
De Silva KRD, Silva R, Amaratunga D, Gunasekera WSL, Jayesekera, RW. 2011. Types of the cerebral arterial circle (circle of Willis) in a Sri Lankan population. BMC neurology. 11: 5.
Dimmick SJ, Faulder KC. 2009. Normal Variants of the Cerebral Circulation at Multidetector CT Angiography 1. Radiographics 29: 1027-43.
Gunnal SA, Farooqui MS, Wabale RN. 2014. Anatomical variations of the circulus arteriosus in cadaveric human brains. Neurol Res Int 2014: 1-16.
Gunnal SA, Farooqui MS, Wabale RN. 2015. Study of Posterior Cerebral Artery in Human Cadaveric Brain. Anat Res Int 2015: 1-10.
Iqbal S. 2013. A comprehensive study of the anatomical variations of the circle of Willis in adult human brains. J Clin Diagn Res 7: 2423-27.
El Khamlichi A, Azouzi M, Bellakhdar F, Ouhcein A, Lahlaidi A. 1984. Anatomic configuration of the circle of Willis in the adult studied by injection technics. Apropos of 100 brains. Neuro-Chirurgie 31: 287-93.
Klimek-Piotrowska W, Rybicka M, Wojnarska A, Wójtowicz A, Koziej M, Ho?da, MK. 2015. A multitude of variations in the configuration of the circle of Willis: an autopsy study. Anatomical science international 1:9.
Kova? JD, Stankovi? A, Stankovi? D, Kova? B, Šaranovi? D. 2014. Intracranial arterial variations: A comprehensive evaluation using CT angiography. Med Sci Monit Basic Res 20: 420-27.
Ladner TR, Ehtesham M, Davis BJ, Khan IS, Ghiassi M, Ghiassi M, Singer RJ. 2013. Resolution of trigeminal neuralgia by coil embolization of a persistent primitive trigeminal artery aneurysm. J Neurointerv Surg 6: e22-e22.
Meckel S, Spiltau B, McAuliffe W. 2013. The persistent trigeminal artery: development, imaging anatomy, variants, and associated vascular pathologies. Neuroradiology 55: 5-16.
O’uchi E, O’uchi T. 2010. Persistent primitive trigeminal arteries (PTA) and its variant (PTAV): analysis of 103 cases detected in 16,415 cases of MRA over 3 years. Neuroradiology 52: 1111-19.
Salas E, Ziyal I, Sekhar L, Wright D. Persistent trigeminal artery: An anatomic study. Neurosurgery 1998; 43:557-61.
Shaban A, Albright KC, Boehme AK, Martin-Schild S. 2013. Circle of Willis variants: fetal PCA. Stroke Res Treat 2013: 1-6.
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