Kawaguchi Kimiyuki, Onodera Hidetaka, Ueda Toshihiro, Takaishi Satoshi, Usuki Noriko, Tatsuno Kentaro, Kaburagi Kei, Murata Hidetoshi
Department of Neurosurgery, Stroke Center, St. Marianna University School of Medicine Toyoko Hospital, Kawasaki, Kanagawa, Japan.
Department of Neurosurgery, Yokohama Municipal Citizens Hospital, Yokohama, Kanagawa, Japan.
NMC Case Rep J. 2024 Nov 22;11:357-361. doi: 10.2176/jns-nmc.2024-0151. eCollection 2024.
The most frequent of the embryonic persistent arteries that connect the internal carotid artery to the posterior circulation is the persistent primitive trigeminal artery (PPTA), which is recognized on 0.1%-0.6% on the basis of conventional angiography or magnetic resonance imaging (MRI). It is usually asymptomatic; however, in rare cases, symptoms of cerebral neuropathy or vascular disease may take place. The patient was a 50-year-old woman who had a history of dyslipidemia and no history of trauma. After a visit to her local doctor, she was referred to us with complaints of mild headache and unilateral tinnitus. MRI revealed a cavernous sinus fistula. She had temporary symptom relief, but ipsilateral ocular symptoms appeared eventually and extended to the contralateral side. Through cerebral angiography, a direct cavernous sinus fistula due to a ruptured PPTA trunk aneurysm was revealed. Coil embolization was carried out via PPTA. The PPTA aneurysm was partially embolized from within the venous sinus using a fistula. The aneurysm and cavernous sinus fistula disappeared without transvenous embolization while preserving the PPTA. Although reports on the treatment of PPTA aneurysms have been numerous already, this report describes a unique case in which a ruptured spontaneous aneurysm on the PPTA trunk resulted in a cavernous sinus fistula, which was treated successfully.
连接颈内动脉与后循环的胚胎期永存动脉中，最常见的是永存原始三叉动脉（PPTA），根据传统血管造影或磁共振成像（MRI），其发生率为0.1% - 0.6%。它通常无症状；然而，在罕见情况下，可能会出现脑神经病变或血管疾病的症状。患者为一名50岁女性，有血脂异常病史，无外伤史。在看过当地医生后，因轻度头痛和单侧耳鸣前来就诊。MRI显示为海绵窦瘘。她的症状暂时缓解，但最终同侧眼部症状出现并扩展至对侧。通过脑血管造影，发现因PPTA主干动脉瘤破裂导致的直接海绵窦瘘。经PPTA进行弹簧圈栓塞。PPTA动脉瘤通过瘘口在静脉窦内部分栓塞。动脉瘤和海绵窦瘘消失，无需经静脉栓塞，同时保留了PPTA。尽管关于PPTA动脉瘤治疗的报道已有很多，但本报告描述了一例独特病例，即PPTA主干上的自发性动脉瘤破裂导致海绵窦瘘，并成功进行了治疗。
