J Cerebrovasc Endovasc Neurosurg.  2023 Jun;25(2):189-195. 10.7461/jcen.2022.E2022.06.009.

An interesting case of survival to multiple ruptures of aneurysms, with persistent trigeminal artery, cranial nerve deficit, and evolutionary exposure of neurovascular treatment

• Lezcano H
• Solorzano MF

• KMID: 2543515
• DOI: http://doi.org/10.7461/jcen.2022.E2022.06.009

Abstract

Subarachnoid hemorrhage secondary to rupture of an aneurysm is a severe condition, associated with a high rate of morbidity and mortality. There are few cases in the literature of rupture of an aneurysm of the persistent trigeminal artery. This is the case of a 62-year-old female who has suffered multiple ruptures of aneurysms, in different decades of her life, with the development of de novo aneurysm, been this the presented case, a rupture of aneurysm of the persistent trigeminal artery. This patient has survival to these conditions and remain without important morbidity. The case manifested with a clinical picture of third and seventh cranial nerve deficit, which this last one, there are not previous publications of cases with this deficit. This aneurysm was embolized with coils, and the postoperative condition was satisfactory, been discharged at 4 postoperative days.

Keyword

Brain aneurysm; aneurysm; Persistent trigeminal artery; Cranial nerve deficit; Microsurgery; Endovascular

Figure

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  Fig. 1. Head computed tomography (CT) scan. (A) Subarachnoid hemorrhage is observed at the level of the suprasellar cistern. (B) There is no evidence of drainage of blood to the ventricular system.

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  Fig. 2. Head computed tomography (CT) scan (bone window). (A) A foreign object is observed which seems to represent a vascular spring clip on the right side. (B) Another foreign body appears suggestive of a malleable vascular clip on the left side.

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  Fig. 3. Cerebral angiography (3D reconstruction). Image (A) shows the panoramic view, with a cross indicating the aneurysm with dimensions of 7.2×8.5 mm and a neck of 4 mm. (B) Anteroposterior view (note the relationship of the aneurysm with the anatomical exit of the third cranial nerve and a caudal twist of the persistent trigeminal artery, which could explain the III and VII cranial nerve palsy, respectively). (C) Side view. Note the anterior orientation of the patent trigeminal artery toward the petrous portion of the internal carotid artery. Cross and yellow line: aneurysm. White arrow: persistent trigeminal artery.

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  Fig. 4. Cerebral angiography. (A) The introduction of the coils and the occlusion of the aneurysm are shown. (B) Patency of the persistent trigeminal artery is observed after placement of the coils. Black arrow: coils within the aneurysm. White arrow: persistent trigeminal artery.

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  Fig. 5. Cerebral angiography (panoramic lateral view). The three types of materials that have revolutionized the management of cerebral aneurysms throughout history and that were used in this case are shown. 1. Malleable clips, 2. Spring clip, 3. Coils.

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