Endovascular Treatment of Basilar Artery Aneurysm via the Persistent Trigeminal Artery: A Case Report

Abstract

An 85-year-old woman presented to emergency department of our hospital with a sudden onset headache and temporary loss of consciousness. Brain CT scan revealed subarachnoid hemorrhage (SAH) located in the left ambient and quadrigeminal cisterns. Brain CT angiography revealed a narrowed-necked aneurysm measuring 3.5.x4.5x5 mm detected at the junction of the basilar artery (BA) and the left superior cerebellar artery (SCA). Both of the vertebral arteries were hypoplastic, and also proximal half of the BA was absent. Distal half of it was associated with a persistent trigeminal artery (PTA) located on the right side. The aneurysm of the basilar artery which could not be reached via the vertebral artery was embolized with detachable coils using primitive trigeminal artery. The cases with PTA are often discovered incidentally on imaging. Symptomatic cases often present with the signs of vertebrobasilar ischemia, cranial nerve palsy or rupture of the concomitant aneurysm. A BA aneurysm associated with PTA is very rare. Our case is also the second case treated endovascularly via the PTA. © 2019 OMU