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The Primitive Arterial Connections within the Central Nervous System and their Neurological Implications in Everyday Medical Practice
Author(s) -
Zarzecki Michał P.,
Brzegowy Karolina,
Pękala Jakub R.,
Pękala Przemysław A.,
Walocha Jerzy A.,
Tomaszewski Krzysztof A.
Publication year - 2019
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.2019.33.1_supplement.616.11
Subject(s) - medicine , trigeminal artery , superior cerebellar artery , basilar artery , trigeminal neuralgia , anterior inferior cerebellar artery , cerebellar artery , anastomosis , artery , trigeminal nerve , internal carotid artery , cranial nerves , vertebral artery , surgery , aneurysm
The primitive trigeminal artery (PTA) is an anastomosis between the internal carotid artery (ICA) and the basilar artery (BA), that runs close to the trigeminal ganglion (hence its name). Conversely, the primitive trigeminal artery variants (PTAV) connect the ICA with cerebellar arteries. The trigeminal artery is said to regress following the development of the posterior communicating artery during the foetal life. However, when it persists, it might cause neuralgia and nerve palsies due to its proximity and compression of the III, IV, V and VIth cranial nerves. Aim The following study aimed to find the pooled prevalence estimate (PPE) of the presence of the PTA and the PTAVs, their types, as well as probe for sources of heterogeneity. Materials and methods The authors conducted a thorough search of major medical online databases. The references of the primarily identified studies were screened for any other potentially eligible articles. Data from the studies that met the inclusion criteria was extracted and pooled into the Meta‐analysis. The quality of the included studies was evaluated by the AQUA tool. Results The authors deemed eligible 39 studies (110 866 patients). The overall PPE of the PTA and PTAVs was found to be 0.39% (95% CI: 0.31–0.49), slightly more prevalent in females (0.7%, 95% CI: 0.5–0.8) than males (0.4%, 95% CI:0.3–0.6). The PTA was solely found in 0.3% (95% CI: 0.2–0.4), whereas the PTAV only was noted in 0.2% (95% CI: 0.1–0.3). The PTA and the PTAVs originated most commonly from the C4 of the ICA (97.6%, 95% CI:93.7–100.0), had the lateral (parasellar) course in 89.0% (95% CI: 84.2–93.1) and the medial (intrasellar) in 11.0% (95% CI: 6.9–15.8). The anastomosis between the ICA and the anterior inferior cerebellar artery predominated amongst the PTAVs (72.1%, 95% CI: 50.0–95.7). Hypoplasia of the BA was noted in 42.5% (95% CI: 23.0–63.1)of patients with the PTA or the PTAV. Conclusions Although this study showed that both the PTA and PTAV are rare variants (0.3% and 0.2% respectively), a neurosurgeon should be vigilant of their presence especially during the transspehnoidal approach to the pituitary neoplasms. The medial (intrasellar) type might pose a higher risk of iatrogenic complications due to its proximity to the pituitary gland. Similarly, the lateral (parasellar) type might complicate the percutaneous gasserian ganglion procedure. Support or Funding Information This study was supported by “The Best of the Best! 3.0 (Najlepszy z Najlepszych! 3.0)” Grant of the Polish Ministry of Science and Higher Education. This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .