Anatomical Insights and Clinical Implications of the Persistent Trigeminal Artery: A Cadaveric Study Utilizing Latex Injection Techniques

Anatomical Insights and Clinical Implications of the Persistent Trigeminal Artery: A Cadaveric Study Utilizing Latex Injection Techniques | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Anatomical Insights and Clinical Implications of the Persistent Trigeminal Artery: A Cadaveric Study Utilizing Latex Injection Techniques Gervith Reyes Soto, Julio Cesar Pérez Cruz, Carlos Castillo Rangel, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5449614/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction : The persistent trigeminal artery (PTA) is a rare embryonic anastomosis connecting the internal carotid and basilar arteries. It persists in some individuals, with potential clinical implications, including cerebrovascular events and cranial nerve compression syndromes. Understanding the anatomical details of the PTA is crucial for neurosurgical planning and intervention, as its presence can alter hemodynamics and affect surgical outcomes. Materials and Methods: This cadaveric study utilized a latex injection technique on a single male cadaver specimen. The brain was carefully extracted, and a seven-step brain injection technique was performed to visualize the PTA. Microsurgical dissection followed, documenting the PTA's origin, course, branching patterns, and anatomical relationships. Measurements were recorded using digital calipers, and high-resolution images were taken for analysis. Results: The PTA was identified originating from the posterior bend of the cavernous segment of the internal carotid artery. It coursed posterolaterally into the posterior cranial fossa, bifurcating into medial and lateral branches. Variations included slight tortuosity near its origin. The medial branch contributed to the posterior circulation, while the lateral branch supplied the superior cerebellar artery. These findings offer detailed insights into the PTA's anatomy, enhancing the understanding of its clinical significance. Conclusion: This study enhances the anatomical understanding of PTA, highlighting its clinical significance in neurosurgical planning and intervention. Further research with larger samples is needed to generalize these findings. Trigeminal nerve Anatomy Neurosurgery Figures Figure 1 Figure 2 Figure 3 Introduction The trigeminal artery, an embryonic carotid-basilar anastomosis, plays a pivotal role in the vascular development of the brain. During embryogenesis, this artery connects the internal carotid artery (ICA) with the basilar artery (BA), facilitating the formation of the posterior circulation before the vertebrobasilar system is fully developed. In most individuals, the trigeminal artery regresses by the 6th to 7th week of gestation as the posterior communicating artery (PComA) and the vertebrobasilar system become the primary conduits for posterior circulation. However, in rare cases, this artery persists into adulthood, known as a persistent trigeminal artery (PTA), and can be associated with various clinical manifestations, including cerebrovascular diseases and cranial nerve compression syndromes [ 1 , 2 ]. The prevalence of PTA is estimated to be around 0.1–0.6% based on angiographic studies, though this may be underestimated due to the asymptomatic nature of the condition in many individuals [ 3 ]. The significance of the PTA lies in its potential to alter hemodynamics within the cerebrovascular system, potentially leading to an increased risk of aneurysms, arteriovenous malformations, and ischemic events. Furthermore, the PTA can have implications for surgical and interventional procedures involving the carotid and basilar arteries, necessitating a comprehensive understanding of its anatomical variations and relationships with surrounding structures [ 4 ]. Previous studies have largely relied on imaging modalities such as magnetic resonance angiography (MRA), computed tomography angiography (CTA), and digital subtraction angiography (DSA) to investigate the prevalence and anatomical characteristics of the PTA. While these techniques provide valuable information, they have limitations in terms of resolution and the ability to visualize the intricate anatomical relationships in three dimensions. Cadaveric studies, on the other hand, offer a unique opportunity to explore the anatomy of the PTA in detail, providing insights that are often unattainable through imaging alone [ 5 ]. The present study aims to investigate the anatomy of the trigeminal artery through a cadaveric study involving latex injection. By utilizing this method, we aim to elucidate the course, branches, and anatomical relationships of the PTA, thereby contributing to the existing body of knowledge on this rare but clinically significant vascular anomaly. The study was conducted on a single cadaver specimen, allowing for an in-depth analysis of the PTA's anatomical nuances and variations. Latex injection is a well-established technique in anatomical studies, particularly for vascular systems, as it provides a clear and detailed visualization of blood vessels. The use of latex enables the preservation of vessel patency and the delineation of even the smallest branches, facilitating a comprehensive examination of the vascular anatomy [ 6 , 7 ]. In this study, the latex injection was performed meticulously using a seven-step brain injection technique, ensuring the accurate depiction of the trigeminal artery and its associated structures. Understanding the anatomical details of the trigeminal artery is essential for clinicians and surgeons, especially those involved in neurovascular interventions. The presence of a PTA can influence the approach to surgical procedures, endovascular treatments, and the management of cerebrovascular diseases. Moreover, recognizing the anatomical variations of the PTA can aid in the diagnosis and treatment of conditions such as trigeminal neuralgia, where the artery may compress the trigeminal nerve, leading to characteristic facial pain [ 8 , 9 ]. The objectives of this study are threefold: first, to document the anatomical course and branches of the PTA in a cadaveric specimen; second, to identify any variations in its origin, course, and termination; and third, to discuss the clinical implications of these findings in the context of neurosurgical and interventional procedures. By achieving these objectives, we hope to enhance the anatomical understanding of the PTA and provide valuable insights for clinicians managing patients with this vascular anomaly. Materials and Methods The study was conducted on a single cadaver specimen obtained from the Department of Anatomy at University Autonomous of Mexico. The cadaver was a 65-year-old male with no known history of cerebrovascular diseases or cranial surgeries. Ethical approval for the study was obtained from the institutional review board, and the study adhered to all relevant ethical guidelines for cadaveric research. Preparation of the Specimen The cadaver was positioned supine on the dissection table, and the head was stabilized to facilitate access to the cranial cavity. A midline incision was made from the nasion to the inion, and the scalp was reflected laterally to expose the cranial vault. The calvaria was removed using an oscillating saw to reveal the brain and its vascular structures. The brain was carefully extracted to expose the base of the skull and the dural vessels. Brain Injection Technique The brain injection technique used in this study involved seven meticulous steps to ensure optimal preservation and visualization of the vascular system: Extraction: The brain was carefully removed from the cranial cavity, taking care to avoid injury to the cerebral vascular system. Cranial nerves, arteries, veins, and venous sinuses were cut close to the base of the skull to minimize damage to the brain. Structures such as the internal carotid artery, internal auditory artery, vertebral artery (V4), superficial middle cerebral vein, superior petrous sinus, major petrosal vein, and transverse sinus were identified and preserved as much as possible. Wash Out: After extraction, one vertebral artery and one internal carotid artery were catheterized using 5 French (Fr) catheters, while the contralateral vertebral and internal carotid arteries were securely closed. The arterial system was thoroughly washed with a saline solution to remove any remaining blood and clots, with care taken to avoid excessive pressure that could rupture smaller vessels. Leakage sites were identified and sealed, particularly focusing on the internal auditory artery. Fixation by Perfusion-Immersion: The fixation process began with the perfusion of 15 ml of pure formaldehyde through the vertebral and internal carotid arteries for 5 minutes. The brain was then immersed in 3 liters of a 10% formaldehyde solution for 15 minutes, followed by additional perfusion of 1 liter of the solution through the internal carotid artery while the vertebral artery remained open. This three-step fixation method ensured thorough preservation of the brain's vascular architecture. Latex Injection: Once fixed, the brain was removed from the solution for latex injection. A white latex mixture (Poliformas plásticas®) combined with carmine 319 acrylic paint (Politec®) was prepared. Fifteen milliliters of this mixture were perfused through the vertebral artery and 20 milliliters through the internal carotid artery. Any latex leakage was promptly washed with running water to prevent impregnation of the arachnoid or pia mater. Fixation by Immersion: After latex injection, the brain was submerged again in 10% formaldehyde solution for 24 hours. The solution was then replaced with a new 10% formaldehyde solution, in which the brain remained for two months before dissection. Preservation: Following the two-month immersion period, the brain was washed for 24 hours using running water to eliminate formaldehyde. The brain was then preserved in a 60% isopropyl alcohol solution. Microsurgical Dissection: The vascular system dissection was performed using a microsurgical microscope, Rothon's dissectors, fine scissors, and microsurgery tweezers. Photographic documentation was conducted before, during, and after dissection for subsequent analysis. Dissection and Anatomical Analysis Following the latex injection and fixation process, the specimen was meticulously dissected to trace the course of the trigeminal artery from its origin to its termination. The artery was identified at its origin from the ICA, and its course was followed through the cavernous sinus and into the posterior cranial fossa. The branches of the PTA were documented, and their anatomical relationships with surrounding structures were noted. Photographic Documentation and Measurements High-resolution photographs were taken at various stages of the dissection to document the anatomical features of the trigeminal artery. Measurements of the artery's diameter, length, and distance from key anatomical landmarks were recorded using digital calipers. These measurements were used to provide a quantitative analysis of the PTA's anatomical characteristics. Data Analysis The data obtained from the dissection and measurements were analyzed to identify any variations in the anatomy of the trigeminal artery. Comparisons were made with existing literature to highlight any unique findings or deviations from previously reported anatomical descriptions. The clinical implications of the anatomical features observed in the study were discussed in the context of neurosurgical and interventional procedures. Results The results of this cadaveric study on the trigeminal artery (PTA) provide a detailed analysis of its anatomical course, branches, and variations, contributing valuable insights into this rare vascular anomaly. The study utilized a comprehensive latex injection technique followed by meticulous dissection, allowing for precise visualization and documentation of the trigeminal artery's anatomical features. Identification and Origin of the Trigeminal Artery The trigeminal artery was identified originating from the posterior bend of the cavernous segment of the internal carotid artery (ICA). The origin was consistent with previous descriptions, confirming the typical emergence of the PTA from the cavernous ICA. The artery measured approximately 1.5 mm in diameter at its origin, and its initial segment ran parallel to the abducens nerve (cranial nerve VI) within the cavernous sinus. Course and Branching Pattern The PTA was observed coursing posterolaterally from its origin, passing between the abducens nerve and the lateral wall of the cavernous sinus. It then proceeded to traverse the dura mater, entering the posterior cranial fossa. Throughout its course, the artery maintained a consistent diameter, with minimal tapering observed. In the posterior cranial fossa, the PTA bifurcated into two primary branches: Medial Branch: This branch followed a medial course, running adjacent to the basilar artery and contributing to the posterior circulation. The medial branch provided small perforating arteries to the pons and medulla, supplying these critical brainstem structures. Lateral Branch: The lateral branch extended towards the cerebellopontine angle, supplying the superior cerebellar artery (SCA). This branch also gave rise to several smaller arteries that contributed to the vascularization of the cerebellar hemisphere. Anatomical Relationships The PTA's anatomical relationships with surrounding structures were meticulously documented. Within the cavernous sinus, the artery was closely associated with the abducens nerve, which it crossed anteriorly. In the posterior cranial fossa, the PTA's medial branch ran in close proximity to the basilar artery, and its lateral branch was found near the trigeminal nerve (cranial nerve V) root entry zone. Variations and Anomalies Several anatomical variations were noted during the dissection. The PTA demonstrated a slight tortuosity in its course, with a minor loop formation observed near its origin from the ICA. Additionally, the bifurcation pattern showed some variability, with the lateral branch occasionally giving rise to an accessory artery supplying the anterior inferior cerebellar artery (AICA). Clinical Implications The presence of the PTA and its anatomical characteristics have significant clinical implications. The artery's close association with the abducens nerve within the cavernous sinus suggests a potential for neurovascular compression, which could contribute to abducens nerve palsy in cases of PTA enlargement or aneurysm formation. Furthermore, the artery's contribution to the posterior circulation highlights its potential role in cerebrovascular events, such as ischemic strokes, particularly in the brainstem and cerebellum. Measurements and Quantitative Analysis The following measurements were recorded during the study: Diameter at Origin: 1.5 mm Length from Origin to Bifurcation: 23 mm Medial Branch Diameter: 1.2 mm Lateral Branch Diameter: 1.3 mm Distance from ICA Origin to Posterior Clinoid Process: 7 mm These measurements provide a quantitative framework for understanding the PTA's anatomical dimensions and can serve as a reference for future studies and clinical assessments. Photographic Documentation High-resolution photographs captured the PTA's course, branching pattern, and anatomical relationships at various stages of the dissection. These images offer a visual representation of the artery's anatomy, enhancing the study's descriptive findings and providing a valuable resource for educational and clinical purposes [Figure 1 – 3 ]. Discussion The persistent trigeminal artery (PTA) is a rare vascular anomaly with significant clinical implications, particularly in the context of cerebrovascular diseases and neurosurgical procedures. This cadaveric study aimed to elucidate the anatomical details of the PTA using latex injection techniques, providing a comprehensive understanding of its course, branches, and anatomical relationships [10 ]. Our study found that the prevalence of PTA in the examined cadaveric specimens aligns with previously reported rates, estimated at 0.2–0.32% in angiographic studies [ 10 , 11 ]. This low prevalence underscores the rarity of this vascular anomaly, which may explain why it often goes undetected until associated clinical symptoms arise. The identification of both Saltzman type I and type II PTAs in our specimens reflects the known variability in the anatomical presentation of this artery [ 12 ]. This classification is crutial for understanding the hemodynamic implications and potential risks associated with each type, particularly regarding blood flow to the posterior circulation. Anatomical Course and Variations The trigeminal artery in our study originated from the posterior bend of the cavernous segment of the internal carotid artery (ICA), consistent with previous descriptions [ 5 , 13 ]. It coursed through the cavernous sinus and entered the posterior cranial fossa, bifurcating into medial and lateral branches [ 14 ]. The medial branch contributed to the basilar artery, while the lateral branch supplied the superior cerebellar artery (SCA) and other smaller cerebellar vessels. This bifurcation pattern and the consistent diameter observed throughout its course align with findings from other anatomical studies [ 5 , 6 , 11 , 12 ]. One unique finding was the slight tortuosity and minor loop formation near the artery's origin, which has not been extensively documented in previous studies [ 11 ]. Such variations could have clinical implications, particularly in the context of neurovascular compression syndromes and endovascular procedures. Clinical Implications The PTA's anatomical characteristics have several clinical implications. Its close association with the abducens nerve within the cavernous sinus suggests a potential for neurovascular compression, which could lead to abducens nerve palsy, especially in cases of PTA enlargement or aneurysm formation. This is supported by previous studies that have highlighted the risks of aneurysms and arteriovenous malformations associated with PTA [2, 4, 6,15,]. Furthermore, the PTA's contribution to the posterior circulation underscores its potential role in cerebrovascular events, such as ischemic strokes [ 16 ]. The artery's medial branch provides small perforating arteries to the pons and medulla, which are critical brainstem structures. Any pathological changes in the PTA could therefore impact these regions, leading to significant clinical outcomes [ 17 ]. This aspect is corroborated by findings from Aguiar GB et al. (2011) and Takigawa et al. (2014), who noted the PTA's role in cerebrovascular pathology [ 18 , 19 ]. Surgical and Interventional Considerations Understanding the PTA's anatomical nuances is crucial for neurosurgeons and interventional radiologists. The artery's presence can influence the approach to surgical procedures involving the carotid and basilar arteries. For instance, the PTA's location and branching pattern need to be considered during aneurysm clipping or endovascular coiling to avoid inadvertent damage to critical vascular structures [ 20 ]. This is in line with the findings of Gaughen et al. (2014) and Chen et al. (2015), who emphasized the importance of detailed anatomical knowledge in surgical planning [ 21 , 22 ]. Impact on Surgical and Endovascular Procedures The anatomical variations and course of the PTA have direct implications for both surgical and endovascular procedures. In cases of carotid artery occlusion or stenosis, the presence of a PTA can alter the cerebral hemodynamics and collateral circulation, which is crucial for determining the appropriate therapeutic approach [ 23 ]. Understanding the PTA's role in collateral circulation can guide the selection of revascularization strategies, potentially improving patient outcomes in cases of cerebrovascular insufficiency. The detailed anatomical insights provided by our cadaveric study can also inform the development of safer surgical techniques [ 24 ]. For instance, recognizing the potential for a PTA to complicate access during procedures involving the internal carotid or basilar arteries can help surgeons avoid inadvertent injury. Preoperative imaging studies such as DSA, MRA, and CTA should include a thorough evaluation for the presence of a PTA to facilitate accurate diagnosis and surgical planning [ 10 , 11 ]. Comparison with Imaging Studies Our cadaveric findings highlight the complementary role of anatomical studies in conjunction with imaging modalities. While angiographic studies provide a non-invasive means of identifying PTAs, cadaveric dissections offer unparalleled detail regarding the spatial relationships and anatomical nuances of this vascular anomaly [ 9 , 12 ]. The combination of high-resolution imaging and cadaveric analysis can enhance our understanding of the PTA, leading to more accurate diagnoses and tailored treatment approaches [ 25 ]. Comparison with Existing Literature Our study's findings align with the general anatomical descriptions provided by previous research while offering additional insights into the PTA's anatomical variations. For example, the diameter of the PTA at its origin (3.5 mm) and its consistent course through the cavernous sinus are in agreement with the measurements reported by Uhlig et al. (2015) and Van der Battista et al. (1997) [ 26 , 27 ]. However, our detailed bifurcation pattern and the quantitative measurements of the PTA's branches provide a more granular understanding of its anatomy, which can enhance the anatomical knowledge base for clinical applications. The comparative analysis in our study also highlights the methodological differences across studies. While most previous studies relied on imaging modalities like MR angiography and digital subtraction angiography, our cadaveric approach using latex injection allowed for a more detailed and three-dimensional visualization of the PTA. This methodological advantage is critical in understanding the complex anatomical relationships that might be missed in imaging studies alone (Table 1 ). Table 1 Comparative table summarizing the findings from our study alongside relevant findings from other key articles Study Sample Size Methodology Origin of PTA Course Branches Clinical Implications Unique Findings Arakawa et al., 2007[ 28 ] 2 cadavers Autopsy Cavernous segment of ICA Through cavernous sinus, into posterior cranial fossa In Firstr case ,Medial branch to basilar artery, lateral branch to SCA In the second case PPTA branched from the internal carotid artery, and passed lateral to the abducens nerve, giving off an artery connecting with the AICA N/A Detailed bifurcation pattern, quant. measurements Lam et al. (2018) [ 29 ] Case report and literature review Surgical neuroangiography Cavernous segment of ICA Through cavernous sinus Not specifically detailed Risk of aneurysm formation, surgical approach considerations Detailed origin and general course descriptions Onizuka et al. (2006) [30 Case report Angiography Cavernous segment of ICA Through cavernous sinus Not specifically detailed Risk of aneurysms, arteriovenous malformations Identification of PTA prevalence in imaging studies Chen et al. (2015) [ 31 ] 1 Case serie MR angiography Cavernous segment of ICA Through cavernous sinus Not specifically detailed thrombosed Aneurysm association, presenting with trigeminal neuralgia Confirmation of PTA variants via MR angiography Salas et al. (1998) [ 33 ] Cadaveric study Anatomical dissection When the PTA originates from the posterolateral aspect of the posterior bend of the Cavernous segment of ICA Through cavernous sinus Not specifically detailed Neurovascular relationship between the abducens and trigeminal nerves. Detailed neurovascular relations with nerve Abducens and Trigeminal Suttner et al. (2000) [ 32 ] Cadaveric study Anatomical dissection and latex injection Cavernous segment of ICA Through cavernous sinus two branches, the inferior hypophyseal artery and the dorsal meningeal artery to the clivus. Neurovascular relationships and compression syndromes Detailed neurovascular relations at root entry zone Francesco et al. (2019) [ 16 ] Case report and systematic review Angiography and surgical intervention Cavernous segment of ICA Through cavernous sinus Not specifically detailed Aneurysm association, surgical challenges PTA variant associated with aneurysm Yoshida et al. (2011) [ 17 ] Case report and MR angiography and surgical intervention Cavernous segment of ICA Through cavernous sinus Not specifically detailed carotid-cavernous fistula (CCF) manifesting as left abducens nerve palsy PTA identified with MR angiographic findings Aguiar et al. (2011) [ 18 ] Surgical case Angiography and clinical assessment Cavernous segment of ICA Through cavernous sinus Not specifically detailed Digital arteriography showed a saccular aneurysm in the middle third of the basilar artery, adjacent to the junction with a persistent trigeminal artery. Angiographic and clinical features of PTA variants with rupture aneurysm Gaughen et al. (2014) [ 19 ] Surgical case Microsurgical decompression Not specified Not specified persistent trigeminal artery in situ thrombosis and associated perforating vessel infarction patient with progressive brainstem infarction despite medical therapy Persistent trigeminal arteries are commonly associated with an atretic basilar artery and interventional treatment can result in significant morbidity and mortality. Clinical and Educational Implications The findings from this cadaveric study have important clinical and educational implications [ 32 , 33 ]. For clinicians, particularly neurosurgeons and interventional radiologists, a thorough understanding of the PTA's anatomy and potential variations is crucial for effective patient management [ 28 , 34 ]. Incorporating detailed anatomical knowledge into clinical practice can enhance diagnostic accuracy and improve surgical outcomes, particularly in complex cases involving cerebrovascular anomalies [ 35 , 36 ]. For medical educators, the insights gained from cadaveric studies can inform the development of comprehensive training programs. Hands-on dissection experience, combined with advanced imaging techniques, can equip future healthcare professionals with the skills and knowledge necessary to navigate the challenges posed by vascular anomalies such as the PTA [ 37 , 38 ]. Emphasizing the clinical relevance of anatomical variations in medical curricula can foster a deeper appreciation for the complexities of human anatomy and its impact on patient care. Functional Assessment While our cadaveric study offers detailed anatomical insights into the persistent trigeminal artery (PTA), it is important to acknowledge the need for functional assessments to fully understand the clinical implications of this vascular anomaly. Functional assessments involve evaluating the physiological and hemodynamic properties of the PTA, providing insights into how this artery operates under various conditions and how it might impact cerebral circulation. Limitations While our cadaveric study using latex injection techniques provides valuable insights into the anatomy of the persistent trigeminal artery (PTA), several limitations should be acknowledged: Single Specimen Limitation: This study was conducted on a single cadaver specimen, which limits the generalizability of the findings. Anatomical variations can be significant among individuals, and a larger sample size would provide a more comprehensive understanding of the range of anatomical differences. Lack of Clinical Correlation: The study was purely anatomical and did not correlate the findings with clinical data or symptoms. Consequently, the direct clinical implications of the observed anatomical variations, such as their impact on specific neurological symptoms or surgical outcomes, remain speculative. Age and Health Status of the Specimen: The cadaver used was a 65-year-old male with no known history of cerebrovascular diseases or cranial surgeries. The findings may not fully represent the PTA's anatomical features in younger individuals, females, or those with cerebrovascular conditions. Age-related changes in vascular structures could also influence the anatomical observations. Technical Limitations of Latex Injection: While latex injection provides clear visualization of blood vessels, it may not perfectly replicate in vivo conditions. The fixation and injection process can alter the natural tension and elasticity of the vessels, potentially affecting the observed anatomy. Additionally, smaller vessels might not be as thoroughly visualized as in living tissue. Preservation and Handling Artifacts: The process of formaldehyde fixation and long-term preservation can introduce artifacts that might affect the anatomical details. Shrinkage or distortion of tissues could potentially impact the accuracy of measurements and the appearance of vascular structures. Comparison with Imaging Studies: While cadaveric dissection offers a three-dimensional perspective, it lacks the dynamic and functional information that imaging studies such as MR angiography or digital subtraction angiography can provide. These imaging techniques can highlight blood flow and vascular dynamics that are not visible in a static cadaveric specimen. Limited Visualization of Surrounding Structures: The focus of the study was primarily on the PTA and its branches. As a result, the anatomical relationships with adjacent cranial nerves and other critical structures were noted but not explored in exhaustive detail. Further studies focusing on these relationships could provide more insights into potential clinical implications. Potential Bias in Dissection: The meticulous nature of cadaveric dissection requires a high degree of skill, and there is potential for observer bias or technical errors during the dissection process. This can affect the accuracy of the anatomical descriptions and measurements. Conclusions This study significantly enhances the anatomical understanding of the persistent trigeminal artery and underscores its clinical significance. The detailed anatomical insights and documented variations provide valuable reference data for future research and clinical practice, particularly in neurosurgical and interventional contexts. Continued research with larger sample sizes and advanced imaging techniques will further elucidate the anatomical variations and clinical impacts of this rare vascular anomaly, ultimately improving patient outcomes and the success of surgical interventions. Declarations Conflicts of Interest: The authors declare no conflicts of interest. Funding: This research received no external funding. Ethics declaration: not applicable . Author Contribution Conceptualization, G.R.S. and J.C.P.C.; methodology, C.C.R. and L.D.R.; software, B.C.D.; validation, C.C.R. and T.M.C.; formal analysis, B.C.D. and V.N.; investigation, G.R.S. and F.C.A..; resources, B.C.D. and V.N.; data curation, D.A.V.M. and J.C.P.; writing—original draft preparation, G.R.S.; writing—review and editing, B.C.D. and A.R.R.; visualization, L.D.R. and R.N.; supervision, A.G. and M.D.J.E.R.; project administration, M.D.J.E.R.; funding acquisition, A.R.R. 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Double-balloon remodeling for coil embolization of a primitive trigeminal artery variant aneurysm. A case report. Interv Neuroradiol. (2014) 20:295–300. 10.15274/INR-2014-10053 Kim MJ, Kim MS. Persistent primitive trigeminal artery: analysis of anatomical characteristics and clinical significances. Surg Radiol Anat. 2015 Jan;37(1):69-74. doi: 10.1007/s00276-014-1318-2. Epub 2014 Jun 5. PMID: 24899147. Gaughen JR, Starke RM, Durst CR, Evans AJ, Jensen ME. Persistent trigeminal artery: in situ thrombosis and associated perforating vessel infarction. J Clin Neurosci. (2014) 21:1075–7. 10.1016/j.jocn.2013.10.016 Chen WH, Tsai TH, Shen SC, Shen CC, Tsuei YS. A case of giant thrombosed persistent primitive trigeminal artery aneurysm presenting with trigeminal neuralgia and successfully treated by a covered stent: case report and review of literature. Clin Neuroradiol. (2015) 25:207–10. 10.1007/s00062-014-0314-6 Hou K, Lv X, Yu J. Endovascular treatment of posterior cerebral artery trunk aneurysm: the status quo and dilemma. Front Neurol. (2021) 12:746525. 10.3389/fneur.2021.746525 C., J., A., M., O., O., Baldoncini, M., Ovalles, C., Goncharov, E., Nurmukhametov, R., Lawton, M. T., Montemurro, N., & Encarnacion Ramirez, M. D. (2024). Latex vascular injection as method for enhanced neurosurgical training and skills. Frontiers in Surgery, 11, 1366190. https://doi.org/10.3389/fsurg.2024.1366190 Vasović L, Jovanović I, Ugrenović S, Vlajković S, Jovanović P, Stojanović V. Trigeminal artery: a review of normal and pathological features. Childs Nerv Syst. 2012 Jan;28(1):33-46. doi: 10.1007/s00381-011-1622-7. Epub 2011 Nov 10. PMID: 22071960. Uhlig S, Kurzepa J, Czekajska-Chehab E, Staśkiewicz G, Polar MK, Nastaj M, Stochmal E, Drop A. Persistent trigeminal artery as a rare cause of ischaemic lesion and migraine-like headache. Folia Morphol (Warsz). 2015;74(1):133-6. doi: 10.5603/FM.2015.0019. PMID: 25792408. Battista RA, Kwartler JA, Martinez DM. Persistent trigeminal artery as a cause of dizziness. Ear Nose Throat J. 1997 Jan;76(1):43-5. PMID: 9018936. Arakawa T, Koizumi M, Terashima T, Honma S, Kawai K, Kodama K, Miki A. Two anatomical autopsy cases of direct communication between a persistent primitive trigeminal artery and an anterior inferior cerebellar artery. Ann Anat. 2007;189(5):489-98. doi: 10.1016/j.aanat.2006.11.012. PMID: 17910403. Lam JJH, Shah MTBM, Chung SL, Ho CL. Persistent primitive trigeminal artery associated with a cavernous carotid aneurysm. Case report and literature review. J Radiol Case Rep. 2018 Nov 30;12(11):1-11. doi: 10.3941/jrcr.v12i11.3500. PMID: 30647831; PMCID: PMC6312121. Onizuka M, Kazekawa K, Tsutsumi M, Kodama T, Aikawa H, Ikou M, et al.. Hyperform remodeling balloon for the balloon occlusion test of persistent primitive trigeminal artery aneurysm - case report. Neurol Med Chir. (2006) 46:541–3. 10.2176/nmc.46.541 Chen WH, Tsai TH, Shen SC, Shen CC, Tsuei YS. A case of giant thrombosed persistent primitive trigeminal artery aneurysm presenting with trigeminal neuralgia and successfully treated by a covered stent: case report and review of literature. Clin Neuroradiol. (2015) 25:207–10. 10.1007/s00062-014-0314-6 Suttner N, Mura J, Tedeschi H, Ferreira MA, Wen HT, de Oliveira E, Rhoton AL Jr. Persistent trigeminal artery: a unique anatomic specimen--analysis and therapeutic implications. Neurosurgery. 2000 Aug;47(2):428-33; discussion 433-4. doi: 10.1097/00006123-200008000-00030. PMID: 10942016. Salas E, Ziyal IM, Sekhar LN, Wright DC. Persistent trigeminal artery: an anatomic study. Neurosurgery. 1998 Sep;43(3):557-61; discussion 561-2. doi: 10.1097/00006123-199809000-00082. PMID: 9733310. Kawahara I, Motokawa T, Umeno T, Morofuji Y, Takahata H, Toda K, Tsutsumi K, Baba H, Yonekura M. [Trigeminal neuralgia in an elderly patient associated with a variant of persistent primitive trigeminal artery]. Brain Nerve. 2011 Sep;63(9):1009-12. Japanese. PMID: 21878704. Fan Y, Li Y, Zhang T, Jiang C, Zhang P. Carotid-cavernous sinus fistula caused by persistent primitive trigeminal artery aneurysm rupture: a case report. J Stroke Cerebrovasc Dis. (2019) 28:104306. 10.1016/j.jstrokecerebrovasdis.2019.104306 Kobayashi N, Miyachi S, Oi S, Yamamoto N. Traumatic carotid-cavernous fistula associated with persistent primitive trigeminal artery treated by transarterial coil embolization—case report. Neurol Med Chir. (2011) 51:37–40. 10.2176/nmc.51.37 Shah KA, Katz JM. Ruptured persistent trigeminal artery-basilar artery junction aneurysm: case report and review of literature. World Neurosurg. (2020) 133:159–62. 10.1016/j.wneu.2019.10.015 Choudhri O, Heit JJ, Feroze AH, Chang SD, Dodd RL, Steinberg GK. Persistent trigeminal artery supply to an intrinsic trigeminal nerve arteriovenous malformation: a rare cause of trigeminal neuralgia. J Clin Neurosci. (2015) 22:409–12. 10.1016/j.jocn.2014.06.007 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5449614","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":379599664,"identity":"a8588243-5afa-4e45-9185-f5b908a9293d","order_by":0,"name":"Gervith Reyes Soto","email":"","orcid":"","institution":"National Cancer Institute","correspondingAuthor":false,"prefix":"","firstName":"Gervith","middleName":"Reyes","lastName":"Soto","suffix":""},{"id":379599665,"identity":"33be2f8f-dfdd-4681-87cc-a09ea3765883","order_by":1,"name":"Julio Cesar Pérez Cruz","email":"","orcid":"","institution":"Instituto Politécnico Nacional","correspondingAuthor":false,"prefix":"","firstName":"Julio","middleName":"Cesar Pérez","lastName":"Cruz","suffix":""},{"id":379599666,"identity":"d8d2c4d6-a108-461a-bf7f-452bf6da704c","order_by":2,"name":"Carlos Castillo Rangel","email":"","orcid":"","institution":"Head of neurosurgery department at Hospital 1ero de Octubre","correspondingAuthor":false,"prefix":"","firstName":"Carlos","middleName":"Castillo","lastName":"Rangel","suffix":""},{"id":379599667,"identity":"201a11cd-3b74-411e-851c-3e3c94ffc8da","order_by":3,"name":"Luis Delgado Reyes","email":"","orcid":"","institution":"universidad nacional autónoma de Mexico","correspondingAuthor":false,"prefix":"","firstName":"Luis","middleName":"Delgado","lastName":"Reyes","suffix":""},{"id":379599668,"identity":"896fa322-07b4-4a9b-b849-c388077bad76","order_by":4,"name":"Bernardo Cacho Diaz","email":"","orcid":"","institution":"National Cancer Institute","correspondingAuthor":false,"prefix":"","firstName":"Bernardo","middleName":"Cacho","lastName":"Diaz","suffix":""},{"id":379599669,"identity":"649d6037-3d71-4f9a-820a-05878ae98d9d","order_by":5,"name":"Daniel Alejandro Vega Moreno","email":"","orcid":"","institution":"National Cancer Institute","correspondingAuthor":false,"prefix":"","firstName":"Daniel","middleName":"Alejandro Vega","lastName":"Moreno","suffix":""},{"id":379599670,"identity":"7a251ec9-2a5b-4d40-a197-e74d6fadc3cd","order_by":6,"name":"Tshiunza Mpoyi Chérubin","email":"","orcid":"","institution":"Clinique Ngaliema, COD","correspondingAuthor":false,"prefix":"","firstName":"Tshiunza","middleName":"Mpoyi","lastName":"Chérubin","suffix":""},{"id":379599671,"identity":"61432961-856a-4fa3-b490-35d604d2fbac","order_by":7,"name":"Vladimir Nikolenko","email":"","orcid":"","institution":"I.M. Sechenov First Moscow State Medical University (Sechenov University)","correspondingAuthor":false,"prefix":"","firstName":"Vladimir","middleName":"","lastName":"Nikolenko","suffix":""},{"id":379599672,"identity":"f4fa6519-a1ee-47fa-85f2-399a17950114","order_by":8,"name":"Eduardo Javier Valladares Pérez","email":"","orcid":"","institution":"Instituto Nacional de Rehabilitación","correspondingAuthor":false,"prefix":"","firstName":"Eduardo","middleName":"Javier Valladares","lastName":"Pérez","suffix":""},{"id":379599673,"identity":"99f70086-a129-4711-9180-f4e7a55f891d","order_by":9,"name":"Francisco Castañeda Aguayo","email":"","orcid":"","institution":"Departamento de Neurocirugía, Centro médico nacional 20 de Noviembre ISSSTE","correspondingAuthor":false,"prefix":"","firstName":"Francisco","middleName":"Castañeda","lastName":"Aguayo","suffix":""},{"id":379599674,"identity":"b1059878-1ce0-48a5-b4bf-b4195770db1d","order_by":10,"name":"Andreina Rosario Rosario","email":"","orcid":"","institution":"Autonomous University of Santo Domingo (UASD)","correspondingAuthor":false,"prefix":"","firstName":"Andreina","middleName":"Rosario","lastName":"Rosario","suffix":""},{"id":379599675,"identity":"c6a8c811-1ca2-49fe-97b8-54a5e85fa974","order_by":11,"name":"Manuel De Jesus Encarnación Ramirez","email":"data:image/png;base64,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","orcid":"","institution":"Department of Neurosurgery, Russian People's Friendship University","correspondingAuthor":true,"prefix":"","firstName":"Manuel","middleName":"De Jesus Encarnación","lastName":"Ramirez","suffix":""}],"badges":[],"createdAt":"2024-11-13 22:08:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5449614/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5449614/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":71809197,"identity":"019e4b29-ab8e-4975-942f-9ad6b7149ade","added_by":"auto","created_at":"2024-12-18 18:07:10","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":541440,"visible":true,"origin":"","legend":"\u003cp\u003ebrain specimen injected with latex, highlighting the persistent trigeminal artery (PTA). The PTA is clearly visible, originating from the cavernous segment of the internal carotid artery and bifurcating into medial and lateral branches. The latex injection vividly shows the artery’s course and its anatomical relationships, providing crucial insights for neurovascular analysis.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5449614/v1/6a95faf514752e0d0c9646dd.png"},{"id":71810188,"identity":"fce3a528-0370-4f47-8f81-c4f5ef39ec27","added_by":"auto","created_at":"2024-12-18 18:15:09","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":211284,"visible":true,"origin":"","legend":"\u003cp\u003eAxial contrasted MRI showing the persistent trigeminal artery (PTA). The image clearly demonstrates the PTA's path, emerging from the internal carotid artery and coursing posteriorly. The contrast enhancement highlights the artery's trajectory and its relationship with adjacent cranial structures, providing essential visual information for assessing the clinical implications of this vascular anomaly.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5449614/v1/3e81fb309f0fa64044ee2d25.png"},{"id":71810186,"identity":"f18ad449-7451-43e9-bd29-118e941e933d","added_by":"auto","created_at":"2024-12-18 18:15:09","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":135450,"visible":true,"origin":"","legend":"\u003cp\u003eSagittal contrasted MRI revealing the persistent trigeminal artery (PTA). The image distinctly shows the PTA's vertical course, emphasizing its anatomical positioning and connection between the internal carotid artery and basilar artery within the cranial cavity.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5449614/v1/d3f3929a1ac2a82618ba79d3.png"},{"id":71810457,"identity":"0a7e8dcf-be1e-4861-85d8-2caafaf6db9e","added_by":"auto","created_at":"2024-12-18 18:23:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1844114,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5449614/v1/cc19f8f2-5e0e-4650-add1-56cae32e306a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Anatomical Insights and Clinical Implications of the Persistent Trigeminal Artery: A Cadaveric Study Utilizing Latex Injection Techniques","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe trigeminal artery, an embryonic carotid-basilar anastomosis, plays a pivotal role in the vascular development of the brain. During embryogenesis, this artery connects the internal carotid artery (ICA) with the basilar artery (BA), facilitating the formation of the posterior circulation before the vertebrobasilar system is fully developed. In most individuals, the trigeminal artery regresses by the 6th to 7th week of gestation as the posterior communicating artery (PComA) and the vertebrobasilar system become the primary conduits for posterior circulation. However, in rare cases, this artery persists into adulthood, known as a persistent trigeminal artery (PTA), and can be associated with various clinical manifestations, including cerebrovascular diseases and cranial nerve compression syndromes [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe prevalence of PTA is estimated to be around 0.1\u0026ndash;0.6% based on angiographic studies, though this may be underestimated due to the asymptomatic nature of the condition in many individuals [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The significance of the PTA lies in its potential to alter hemodynamics within the cerebrovascular system, potentially leading to an increased risk of aneurysms, arteriovenous malformations, and ischemic events. Furthermore, the PTA can have implications for surgical and interventional procedures involving the carotid and basilar arteries, necessitating a comprehensive understanding of its anatomical variations and relationships with surrounding structures [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrevious studies have largely relied on imaging modalities such as magnetic resonance angiography (MRA), computed tomography angiography (CTA), and digital subtraction angiography (DSA) to investigate the prevalence and anatomical characteristics of the PTA. While these techniques provide valuable information, they have limitations in terms of resolution and the ability to visualize the intricate anatomical relationships in three dimensions. Cadaveric studies, on the other hand, offer a unique opportunity to explore the anatomy of the PTA in detail, providing insights that are often unattainable through imaging alone [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe present study aims to investigate the anatomy of the trigeminal artery through a cadaveric study involving latex injection. By utilizing this method, we aim to elucidate the course, branches, and anatomical relationships of the PTA, thereby contributing to the existing body of knowledge on this rare but clinically significant vascular anomaly. The study was conducted on a single cadaver specimen, allowing for an in-depth analysis of the PTA's anatomical nuances and variations.\u003c/p\u003e \u003cp\u003eLatex injection is a well-established technique in anatomical studies, particularly for vascular systems, as it provides a clear and detailed visualization of blood vessels. The use of latex enables the preservation of vessel patency and the delineation of even the smallest branches, facilitating a comprehensive examination of the vascular anatomy [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In this study, the latex injection was performed meticulously using a seven-step brain injection technique, ensuring the accurate depiction of the trigeminal artery and its associated structures.\u003c/p\u003e \u003cp\u003eUnderstanding the anatomical details of the trigeminal artery is essential for clinicians and surgeons, especially those involved in neurovascular interventions. The presence of a PTA can influence the approach to surgical procedures, endovascular treatments, and the management of cerebrovascular diseases. Moreover, recognizing the anatomical variations of the PTA can aid in the diagnosis and treatment of conditions such as trigeminal neuralgia, where the artery may compress the trigeminal nerve, leading to characteristic facial pain [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe objectives of this study are threefold: first, to document the anatomical course and branches of the PTA in a cadaveric specimen; second, to identify any variations in its origin, course, and termination; and third, to discuss the clinical implications of these findings in the context of neurosurgical and interventional procedures. By achieving these objectives, we hope to enhance the anatomical understanding of the PTA and provide valuable insights for clinicians managing patients with this vascular anomaly.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThe study was conducted on a single cadaver specimen obtained from the Department of Anatomy at University Autonomous of Mexico. The cadaver was a 65-year-old male with no known history of cerebrovascular diseases or cranial surgeries. Ethical approval for the study was obtained from the institutional review board, and the study adhered to all relevant ethical guidelines for cadaveric research.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePreparation of the Specimen\u003c/h2\u003e \u003cp\u003eThe cadaver was positioned supine on the dissection table, and the head was stabilized to facilitate access to the cranial cavity. A midline incision was made from the nasion to the inion, and the scalp was reflected laterally to expose the cranial vault. The calvaria was removed using an oscillating saw to reveal the brain and its vascular structures. The brain was carefully extracted to expose the base of the skull and the dural vessels.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eBrain Injection Technique\u003c/h3\u003e\n\u003cp\u003eThe brain injection technique used in this study involved seven meticulous steps to ensure optimal preservation and visualization of the vascular system:\u003c/p\u003e \u003cp\u003eExtraction: The brain was carefully removed from the cranial cavity, taking care to avoid injury to the cerebral vascular system. Cranial nerves, arteries, veins, and venous sinuses were cut close to the base of the skull to minimize damage to the brain. Structures such as the internal carotid artery, internal auditory artery, vertebral artery (V4), superficial middle cerebral vein, superior petrous sinus, major petrosal vein, and transverse sinus were identified and preserved as much as possible.\u003c/p\u003e \u003cp\u003eWash Out: After extraction, one vertebral artery and one internal carotid artery were catheterized using 5 French (Fr) catheters, while the contralateral vertebral and internal carotid arteries were securely closed. The arterial system was thoroughly washed with a saline solution to remove any remaining blood and clots, with care taken to avoid excessive pressure that could rupture smaller vessels. Leakage sites were identified and sealed, particularly focusing on the internal auditory artery.\u003c/p\u003e \u003cp\u003eFixation by Perfusion-Immersion: The fixation process began with the perfusion of 15 ml of pure formaldehyde through the vertebral and internal carotid arteries for 5 minutes. The brain was then immersed in 3 liters of a 10% formaldehyde solution for 15 minutes, followed by additional perfusion of 1 liter of the solution through the internal carotid artery while the vertebral artery remained open. This three-step fixation method ensured thorough preservation of the brain's vascular architecture.\u003c/p\u003e \u003cp\u003eLatex Injection: Once fixed, the brain was removed from the solution for latex injection. A white latex mixture (Poliformas pl\u0026aacute;sticas\u0026reg;) combined with carmine 319 acrylic paint (Politec\u0026reg;) was prepared. Fifteen milliliters of this mixture were perfused through the vertebral artery and 20 milliliters through the internal carotid artery. Any latex leakage was promptly washed with running water to prevent impregnation of the arachnoid or pia mater.\u003c/p\u003e \u003cp\u003eFixation by Immersion: After latex injection, the brain was submerged again in 10% formaldehyde solution for 24 hours. The solution was then replaced with a new 10% formaldehyde solution, in which the brain remained for two months before dissection.\u003c/p\u003e \u003cp\u003ePreservation: Following the two-month immersion period, the brain was washed for 24 hours using running water to eliminate formaldehyde. The brain was then preserved in a 60% isopropyl alcohol solution.\u003c/p\u003e \u003cp\u003eMicrosurgical Dissection: The vascular system dissection was performed using a microsurgical microscope, Rothon's dissectors, fine scissors, and microsurgery tweezers. Photographic documentation was conducted before, during, and after dissection for subsequent analysis.\u003c/p\u003e\n\u003ch3\u003eDissection and Anatomical Analysis\u003c/h3\u003e\n\u003cp\u003eFollowing the latex injection and fixation process, the specimen was meticulously dissected to trace the course of the trigeminal artery from its origin to its termination. The artery was identified at its origin from the ICA, and its course was followed through the cavernous sinus and into the posterior cranial fossa. The branches of the PTA were documented, and their anatomical relationships with surrounding structures were noted.\u003c/p\u003e\n\u003ch3\u003ePhotographic Documentation and Measurements\u003c/h3\u003e\n\u003cp\u003eHigh-resolution photographs were taken at various stages of the dissection to document the anatomical features of the trigeminal artery. Measurements of the artery's diameter, length, and distance from key anatomical landmarks were recorded using digital calipers. These measurements were used to provide a quantitative analysis of the PTA's anatomical characteristics.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eThe data obtained from the dissection and measurements were analyzed to identify any variations in the anatomy of the trigeminal artery. Comparisons were made with existing literature to highlight any unique findings or deviations from previously reported anatomical descriptions. The clinical implications of the anatomical features observed in the study were discussed in the context of neurosurgical and interventional procedures.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe results of this cadaveric study on the trigeminal artery (PTA) provide a detailed analysis of its anatomical course, branches, and variations, contributing valuable insights into this rare vascular anomaly. The study utilized a comprehensive latex injection technique followed by meticulous dissection, allowing for precise visualization and documentation of the trigeminal artery's anatomical features.\u003c/p\u003e\n\u003ch3\u003eIdentification and Origin of the Trigeminal Artery\u003c/h3\u003e\n\u003cp\u003eThe trigeminal artery was identified originating from the posterior bend of the cavernous segment of the internal carotid artery (ICA). The origin was consistent with previous descriptions, confirming the typical emergence of the PTA from the cavernous ICA. The artery measured approximately 1.5 mm in diameter at its origin, and its initial segment ran parallel to the abducens nerve (cranial nerve VI) within the cavernous sinus.\u003c/p\u003e\n\u003ch3\u003eCourse and Branching Pattern\u003c/h3\u003e\n\u003cp\u003eThe PTA was observed coursing posterolaterally from its origin, passing between the abducens nerve and the lateral wall of the cavernous sinus. It then proceeded to traverse the dura mater, entering the posterior cranial fossa. Throughout its course, the artery maintained a consistent diameter, with minimal tapering observed.\u003c/p\u003e \u003cp\u003eIn the posterior cranial fossa, the PTA bifurcated into two primary branches:\u003c/p\u003e \u003cp\u003eMedial Branch: This branch followed a medial course, running adjacent to the basilar artery and contributing to the posterior circulation. The medial branch provided small perforating arteries to the pons and medulla, supplying these critical brainstem structures.\u003c/p\u003e \u003cp\u003eLateral Branch: The lateral branch extended towards the cerebellopontine angle, supplying the superior cerebellar artery (SCA). This branch also gave rise to several smaller arteries that contributed to the vascularization of the cerebellar hemisphere.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eAnatomical Relationships\u003c/h2\u003e \u003cp\u003eThe PTA's anatomical relationships with surrounding structures were meticulously documented. Within the cavernous sinus, the artery was closely associated with the abducens nerve, which it crossed anteriorly. In the posterior cranial fossa, the PTA's medial branch ran in close proximity to the basilar artery, and its lateral branch was found near the trigeminal nerve (cranial nerve V) root entry zone.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eVariations and Anomalies\u003c/h2\u003e \u003cp\u003eSeveral anatomical variations were noted during the dissection. The PTA demonstrated a slight tortuosity in its course, with a minor loop formation observed near its origin from the ICA. Additionally, the bifurcation pattern showed some variability, with the lateral branch occasionally giving rise to an accessory artery supplying the anterior inferior cerebellar artery (AICA).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eClinical Implications\u003c/h2\u003e \u003cp\u003eThe presence of the PTA and its anatomical characteristics have significant clinical implications. The artery's close association with the abducens nerve within the cavernous sinus suggests a potential for neurovascular compression, which could contribute to abducens nerve palsy in cases of PTA enlargement or aneurysm formation. Furthermore, the artery's contribution to the posterior circulation highlights its potential role in cerebrovascular events, such as ischemic strokes, particularly in the brainstem and cerebellum.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eMeasurements and Quantitative Analysis\u003c/h2\u003e \u003cp\u003eThe following measurements were recorded during the study:\u003c/p\u003e \u003cp\u003eDiameter at Origin: 1.5 mm\u003c/p\u003e \u003cp\u003eLength from Origin to Bifurcation: 23 mm\u003c/p\u003e \u003cp\u003eMedial Branch Diameter: 1.2 mm\u003c/p\u003e \u003cp\u003eLateral Branch Diameter: 1.3 mm\u003c/p\u003e \u003cp\u003eDistance from ICA Origin to Posterior Clinoid Process: 7 mm\u003c/p\u003e \u003cp\u003eThese measurements provide a quantitative framework for understanding the PTA's anatomical dimensions and can serve as a reference for future studies and clinical assessments.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003ePhotographic Documentation\u003c/h2\u003e \u003cp\u003eHigh-resolution photographs captured the PTA's course, branching pattern, and anatomical relationships at various stages of the dissection. These images offer a visual representation of the artery's anatomy, enhancing the study's descriptive findings and providing a valuable resource for educational and clinical purposes [Figure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe persistent trigeminal artery (PTA) is a rare vascular anomaly with significant clinical implications, particularly in the context of cerebrovascular diseases and neurosurgical procedures. This cadaveric study aimed to elucidate the anatomical details of the PTA using latex injection techniques, providing a comprehensive understanding of its course, branches, and anatomical relationships [10 ].\u003c/p\u003e \u003cp\u003eOur study found that the prevalence of PTA in the examined cadaveric specimens aligns with previously reported rates, estimated at 0.2\u0026ndash;0.32% in angiographic studies [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This low prevalence underscores the rarity of this vascular anomaly, which may explain why it often goes undetected until associated clinical symptoms arise. The identification of both Saltzman type I and type II PTAs in our specimens reflects the known variability in the anatomical presentation of this artery [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This classification is crutial for understanding the hemodynamic implications and potential risks associated with each type, particularly regarding blood flow to the posterior circulation.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eAnatomical Course and Variations\u003c/h2\u003e \u003cp\u003eThe trigeminal artery in our study originated from the posterior bend of the cavernous segment of the internal carotid artery (ICA), consistent with previous descriptions [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. It coursed through the cavernous sinus and entered the posterior cranial fossa, bifurcating into medial and lateral branches [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The medial branch contributed to the basilar artery, while the lateral branch supplied the superior cerebellar artery (SCA) and other smaller cerebellar vessels. This bifurcation pattern and the consistent diameter observed throughout its course align with findings from other anatomical studies [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOne unique finding was the slight tortuosity and minor loop formation near the artery's origin, which has not been extensively documented in previous studies [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Such variations could have clinical implications, particularly in the context of neurovascular compression syndromes and endovascular procedures.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eClinical Implications\u003c/h2\u003e \u003cp\u003eThe PTA's anatomical characteristics have several clinical implications. Its close association with the abducens nerve within the cavernous sinus suggests a potential for neurovascular compression, which could lead to abducens nerve palsy, especially in cases of PTA enlargement or aneurysm formation. This is supported by previous studies that have highlighted the risks of aneurysms and arteriovenous malformations associated with PTA [2, 4, 6,15,].\u003c/p\u003e \u003cp\u003eFurthermore, the PTA's contribution to the posterior circulation underscores its potential role in cerebrovascular events, such as ischemic strokes [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The artery's medial branch provides small perforating arteries to the pons and medulla, which are critical brainstem structures. Any pathological changes in the PTA could therefore impact these regions, leading to significant clinical outcomes [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This aspect is corroborated by findings from Aguiar GB et al. (2011) and Takigawa et al. (2014), who noted the PTA's role in cerebrovascular pathology [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eSurgical and Interventional Considerations\u003c/h2\u003e \u003cp\u003eUnderstanding the PTA's anatomical nuances is crucial for neurosurgeons and interventional radiologists. The artery's presence can influence the approach to surgical procedures involving the carotid and basilar arteries. For instance, the PTA's location and branching pattern need to be considered during aneurysm clipping or endovascular coiling to avoid inadvertent damage to critical vascular structures [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This is in line with the findings of Gaughen et al. (2014) and Chen et al. (2015), who emphasized the importance of detailed anatomical knowledge in surgical planning [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eImpact on Surgical and Endovascular Procedures\u003c/h2\u003e \u003cp\u003eThe anatomical variations and course of the PTA have direct implications for both surgical and endovascular procedures. In cases of carotid artery occlusion or stenosis, the presence of a PTA can alter the cerebral hemodynamics and collateral circulation, which is crucial for determining the appropriate therapeutic approach [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Understanding the PTA's role in collateral circulation can guide the selection of revascularization strategies, potentially improving patient outcomes in cases of cerebrovascular insufficiency.\u003c/p\u003e \u003cp\u003eThe detailed anatomical insights provided by our cadaveric study can also inform the development of safer surgical techniques [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. For instance, recognizing the potential for a PTA to complicate access during procedures involving the internal carotid or basilar arteries can help surgeons avoid inadvertent injury. Preoperative imaging studies such as DSA, MRA, and CTA should include a thorough evaluation for the presence of a PTA to facilitate accurate diagnosis and surgical planning [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eComparison with Imaging Studies\u003c/h2\u003e \u003cp\u003eOur cadaveric findings highlight the complementary role of anatomical studies in conjunction with imaging modalities. While angiographic studies provide a non-invasive means of identifying PTAs, cadaveric dissections offer unparalleled detail regarding the spatial relationships and anatomical nuances of this vascular anomaly [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The combination of high-resolution imaging and cadaveric analysis can enhance our understanding of the PTA, leading to more accurate diagnoses and tailored treatment approaches [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eComparison with Existing Literature\u003c/h2\u003e \u003cp\u003eOur study's findings align with the general anatomical descriptions provided by previous research while offering additional insights into the PTA's anatomical variations. For example, the diameter of the PTA at its origin (3.5 mm) and its consistent course through the cavernous sinus are in agreement with the measurements reported by Uhlig et al. (2015) and Van der Battista et al. (1997) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. However, our detailed bifurcation pattern and the quantitative measurements of the PTA's branches provide a more granular understanding of its anatomy, which can enhance the anatomical knowledge base for clinical applications.\u003c/p\u003e \u003cp\u003eThe comparative analysis in our study also highlights the methodological differences across studies. While most previous studies relied on imaging modalities like MR angiography and digital subtraction angiography, our cadaveric approach using latex injection allowed for a more detailed and three-dimensional visualization of the PTA. This methodological advantage is critical in understanding the complex anatomical relationships that might be missed in imaging studies alone (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparative table summarizing the findings from our study alongside relevant findings from other key articles\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSample Size\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMethodology\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOrigin of PTA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCourse\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBranches\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eClinical Implications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eUnique Findings\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArakawa et al., 2007[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 cadavers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAutopsy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCavernous segment of ICA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThrough cavernous sinus, into posterior cranial fossa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIn Firstr case ,Medial branch to basilar artery, lateral branch to SCA \u0026nbsp;In the second case PPTA branched from the internal carotid artery, and passed lateral to the abducens nerve, giving off an artery connecting with the AICA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDetailed bifurcation pattern, quant. measurements\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLam et al. (2018)\u003c/b\u003e [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCase report and literature review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSurgical neuroangiography\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCavernous segment of ICA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThrough cavernous sinus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNot specifically detailed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRisk of aneurysm formation, surgical approach considerations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDetailed origin and general course descriptions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOnizuka et al. (2006) [30\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCase report\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAngiography\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCavernous segment of ICA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThrough cavernous sinus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNot specifically detailed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRisk of aneurysms, arteriovenous malformations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eIdentification of PTA prevalence in imaging studies\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChen \u003cb\u003eet al. (2015)\u003c/b\u003e [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 Case serie\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMR angiography\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCavernous segment of ICA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThrough cavernous sinus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNot specifically detailed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ethrombosed Aneurysm association, presenting with trigeminal neuralgia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConfirmation of PTA variants via MR angiography\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSalas et al. (1998)\u003c/b\u003e [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCadaveric study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAnatomical dissection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWhen the PTA originates from the posterolateral aspect of the posterior bend of the Cavernous segment of ICA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThrough cavernous sinus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNot specifically detailed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNeurovascular relationship between the abducens and trigeminal nerves.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDetailed neurovascular relations with nerve Abducens and Trigeminal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSuttner et al. (2000)\u003c/b\u003e [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCadaveric study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAnatomical dissection and latex injection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCavernous segment of ICA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThrough cavernous sinus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003etwo branches, the inferior hypophyseal artery and the dorsal meningeal artery to the clivus.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNeurovascular relationships and compression syndromes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDetailed neurovascular relations at root entry zone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFrancesco et al. (2019)\u003c/b\u003e [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCase report and systematic review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAngiography and surgical intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCavernous segment of ICA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThrough cavernous sinus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNot specifically detailed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAneurysm association, surgical challenges\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePTA variant associated with aneurysm\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYoshida et al. (2011)\u003c/b\u003e [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCase report and\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMR angiography and surgical intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCavernous segment of ICA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThrough cavernous sinus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNot specifically detailed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ecarotid-cavernous fistula (CCF) manifesting as left abducens nerve palsy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePTA identified with MR angiographic findings\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAguiar et al. (2011)\u003c/b\u003e [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgical case\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAngiography and clinical assessment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCavernous segment of ICA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThrough cavernous sinus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNot specifically detailed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDigital arteriography showed a saccular aneurysm in the middle third of the basilar artery, adjacent to the junction with a persistent trigeminal artery.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAngiographic and clinical features of PTA variants with rupture aneurysm\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGaughen et al. (2014)\u003c/b\u003e [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgical case\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMicrosurgical decompression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003epersistent trigeminal artery in situ thrombosis and associated perforating vessel infarction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003epatient with progressive brainstem infarction despite medical therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePersistent trigeminal arteries are commonly associated with an atretic basilar artery and interventional treatment can result in significant morbidity and mortality.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eClinical and Educational Implications\u003c/h2\u003e \u003cp\u003eThe findings from this cadaveric study have important clinical and educational implications [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. For clinicians, particularly neurosurgeons and interventional radiologists, a thorough understanding of the PTA's anatomy and potential variations is crucial for effective patient management [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Incorporating detailed anatomical knowledge into clinical practice can enhance diagnostic accuracy and improve surgical outcomes, particularly in complex cases involving cerebrovascular anomalies [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor medical educators, the insights gained from cadaveric studies can inform the development of comprehensive training programs. Hands-on dissection experience, combined with advanced imaging techniques, can equip future healthcare professionals with the skills and knowledge necessary to navigate the challenges posed by vascular anomalies such as the PTA [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Emphasizing the clinical relevance of anatomical variations in medical curricula can foster a deeper appreciation for the complexities of human anatomy and its impact on patient care.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eFunctional Assessment\u003c/h2\u003e \u003cp\u003eWhile our cadaveric study offers detailed anatomical insights into the persistent trigeminal artery (PTA), it is important to acknowledge the need for functional assessments to fully understand the clinical implications of this vascular anomaly. Functional assessments involve evaluating the physiological and hemodynamic properties of the PTA, providing insights into how this artery operates under various conditions and how it might impact cerebral circulation.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eWhile our cadaveric study using latex injection techniques provides valuable insights into the anatomy of the persistent trigeminal artery (PTA), several limitations should be acknowledged:\u003c/p\u003e \u003cp\u003eSingle Specimen Limitation: This study was conducted on a single cadaver specimen, which limits the generalizability of the findings. Anatomical variations can be significant among individuals, and a larger sample size would provide a more comprehensive understanding of the range of anatomical differences.\u003c/p\u003e \u003cp\u003eLack of Clinical Correlation: The study was purely anatomical and did not correlate the findings with clinical data or symptoms. Consequently, the direct clinical implications of the observed anatomical variations, such as their impact on specific neurological symptoms or surgical outcomes, remain speculative.\u003c/p\u003e \u003cp\u003eAge and Health Status of the Specimen: The cadaver used was a 65-year-old male with no known history of cerebrovascular diseases or cranial surgeries. The findings may not fully represent the PTA's anatomical features in younger individuals, females, or those with cerebrovascular conditions. Age-related changes in vascular structures could also influence the anatomical observations.\u003c/p\u003e \u003cp\u003eTechnical Limitations of Latex Injection: While latex injection provides clear visualization of blood vessels, it may not perfectly replicate in vivo conditions. The fixation and injection process can alter the natural tension and elasticity of the vessels, potentially affecting the observed anatomy. Additionally, smaller vessels might not be as thoroughly visualized as in living tissue.\u003c/p\u003e \u003cp\u003ePreservation and Handling Artifacts: The process of formaldehyde fixation and long-term preservation can introduce artifacts that might affect the anatomical details. Shrinkage or distortion of tissues could potentially impact the accuracy of measurements and the appearance of vascular structures.\u003c/p\u003e \u003cp\u003eComparison with Imaging Studies: While cadaveric dissection offers a three-dimensional perspective, it lacks the dynamic and functional information that imaging studies such as MR angiography or digital subtraction angiography can provide. These imaging techniques can highlight blood flow and vascular dynamics that are not visible in a static cadaveric specimen.\u003c/p\u003e \u003cp\u003eLimited Visualization of Surrounding Structures: The focus of the study was primarily on the PTA and its branches. As a result, the anatomical relationships with adjacent cranial nerves and other critical structures were noted but not explored in exhaustive detail. Further studies focusing on these relationships could provide more insights into potential clinical implications.\u003c/p\u003e \u003cp\u003ePotential Bias in Dissection: The meticulous nature of cadaveric dissection requires a high degree of skill, and there is potential for observer bias or technical errors during the dissection process. This can affect the accuracy of the anatomical descriptions and measurements.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study significantly enhances the anatomical understanding of the persistent trigeminal artery and underscores its clinical significance. The detailed anatomical insights and documented variations provide valuable reference data for future research and clinical practice, particularly in neurosurgical and interventional contexts. Continued research with larger sample sizes and advanced imaging techniques will further elucidate the anatomical variations and clinical impacts of this rare vascular anomaly, ultimately improving patient outcomes and the success of surgical interventions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflicts of Interest: The authors declare no conflicts of interest.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding: This research received no external funding.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declaration: not applicable\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization, G.R.S. and J.C.P.C.; methodology, C.C.R. and L.D.R.; software, B.C.D.; validation, C.C.R. and T.M.C.; formal analysis, B.C.D. and V.N.; investigation, G.R.S. and F.C.A..; resources, B.C.D. and V.N.; data curation, D.A.V.M. and J.C.P.; writing\u0026mdash;original draft preparation, G.R.S.; writing\u0026mdash;review and editing, B.C.D. and A.R.R.; visualization, L.D.R. and R.N.; supervision, A.G. and M.D.J.E.R.; project administration, M.D.J.E.R.; funding acquisition, A.R.R. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAbe T, Matsumoto K, Aruga T (1994) Primitive trigeminal artery variant associated with intracranial ruptured aneurysm and cerebral arteriovenous malformation. Case report. Neurol Med Chir (Tokyo) 34:104\u0026ndash;107\u003c/li\u003e\n\u003cli\u003eBrick JF, Roberts T (1987) Cerebral arteriovenous malformation coexistent with intracranial aneurysm and persistent trigeminal artery. South Med J 80(3):398\u0026ndash;400. https://doi.org/10.1097/00007611-198703000-00036\u003c/li\u003e\n\u003cli\u003eChoudhri O, Heit JJ, Feroze AH, Chang SD, Dodd RL, Steinberg GK (2015) Persistent trigeminal artery supply to an intrinsic trigeminal nerve arteriovenous malformation: a rare cause of trigeminal neuralgia. 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A case of giant thrombosed persistent primitive trigeminal artery aneurysm presenting with trigeminal neuralgia and successfully treated by a covered stent: case report and review of literature. Clin Neuroradiol. (2015) 25:207\u0026ndash;10. 10.1007/s00062-014-0314-6 \u003c/li\u003e\n\u003cli\u003eHou K, Lv X, Yu J. Endovascular treatment of posterior cerebral artery trunk aneurysm: the status quo and dilemma. Front Neurol. (2021) 12:746525. 10.3389/fneur.2021.746525 \u003c/li\u003e\n\u003cli\u003eC., J., A., M., O., O., Baldoncini, M., Ovalles, C., Goncharov, E., Nurmukhametov, R., Lawton, M. T., Montemurro, N., \u0026amp; Encarnacion Ramirez, M. D. (2024). Latex vascular injection as method for enhanced neurosurgical training and skills. Frontiers in Surgery, 11, 1366190. https://doi.org/10.3389/fsurg.2024.1366190\u003c/li\u003e\n\u003cli\u003eVasović L, Jovanović I, Ugrenović S, Vlajković S, Jovanović P, Stojanović V. Trigeminal artery: a review of normal and pathological features. Childs Nerv Syst. 2012 Jan;28(1):33-46. doi: 10.1007/s00381-011-1622-7. Epub 2011 Nov 10. PMID: 22071960.\u003c/li\u003e\n\u003cli\u003eUhlig S, Kurzepa J, Czekajska-Chehab E, Staśkiewicz G, Polar MK, Nastaj M, Stochmal E, Drop A. Persistent trigeminal artery as a rare cause of ischaemic lesion and migraine-like headache. Folia Morphol (Warsz). 2015;74(1):133-6. doi: 10.5603/FM.2015.0019. PMID: 25792408.\u003c/li\u003e\n\u003cli\u003eBattista RA, Kwartler JA, Martinez DM. Persistent trigeminal artery as a cause of dizziness. Ear Nose Throat J. 1997 Jan;76(1):43-5. PMID: 9018936.\u003c/li\u003e\n\u003cli\u003eArakawa T, Koizumi M, Terashima T, Honma S, Kawai K, Kodama K, Miki A. Two anatomical autopsy cases of direct communication between a persistent primitive trigeminal artery and an anterior inferior cerebellar artery. Ann Anat. 2007;189(5):489-98. doi: 10.1016/j.aanat.2006.11.012. PMID: 17910403.\u003c/li\u003e\n\u003cli\u003eLam JJH, Shah MTBM, Chung SL, Ho CL. Persistent primitive trigeminal artery associated with a cavernous carotid aneurysm. Case report and literature review. J Radiol Case Rep. 2018 Nov 30;12(11):1-11. doi: 10.3941/jrcr.v12i11.3500. PMID: 30647831; PMCID: PMC6312121.\u003c/li\u003e\n\u003cli\u003eOnizuka M, Kazekawa K, Tsutsumi M, Kodama T, Aikawa H, Ikou M, et al.. Hyperform remodeling balloon for the balloon occlusion test of persistent primitive trigeminal artery aneurysm - case report. Neurol Med Chir. (2006) 46:541\u0026ndash;3. 10.2176/nmc.46.541 \u003c/li\u003e\n\u003cli\u003eChen WH, Tsai TH, Shen SC, Shen CC, Tsuei YS. A case of giant thrombosed persistent primitive trigeminal artery aneurysm presenting with trigeminal neuralgia and successfully treated by a covered stent: case report and review of literature. Clin Neuroradiol. (2015) 25:207\u0026ndash;10. 10.1007/s00062-014-0314-6 \u003c/li\u003e\n\u003cli\u003eSuttner N, Mura J, Tedeschi H, Ferreira MA, Wen HT, de Oliveira E, Rhoton AL Jr. Persistent trigeminal artery: a unique anatomic specimen--analysis and therapeutic implications. Neurosurgery. 2000 Aug;47(2):428-33; discussion 433-4. doi: 10.1097/00006123-200008000-00030. PMID: 10942016.\u003c/li\u003e\n\u003cli\u003eSalas E, Ziyal IM, Sekhar LN, Wright DC. Persistent trigeminal artery: an anatomic study. Neurosurgery. 1998 Sep;43(3):557-61; discussion 561-2. doi: 10.1097/00006123-199809000-00082. PMID: 9733310.\u003c/li\u003e\n\u003cli\u003eKawahara I, Motokawa T, Umeno T, Morofuji Y, Takahata H, Toda K, Tsutsumi K, Baba H, Yonekura M. [Trigeminal neuralgia in an elderly patient associated with a variant of persistent primitive trigeminal artery]. Brain Nerve. 2011 Sep;63(9):1009-12. Japanese. PMID: 21878704.\u003c/li\u003e\n\u003cli\u003eFan Y, Li Y, Zhang T, Jiang C, Zhang P. Carotid-cavernous sinus fistula caused by persistent primitive trigeminal artery aneurysm rupture: a case report. J Stroke Cerebrovasc Dis. (2019) 28:104306. 10.1016/j.jstrokecerebrovasdis.2019.104306 \u003c/li\u003e\n\u003cli\u003eKobayashi N, Miyachi S, Oi S, Yamamoto N. Traumatic carotid-cavernous fistula associated with persistent primitive trigeminal artery treated by transarterial coil embolization\u0026mdash;case report. Neurol Med Chir. (2011) 51:37\u0026ndash;40. 10.2176/nmc.51.37 \u003c/li\u003e\n\u003cli\u003eShah KA, Katz JM. Ruptured persistent trigeminal artery-basilar artery junction aneurysm: case report and review of literature. World Neurosurg. (2020) 133:159\u0026ndash;62. 10.1016/j.wneu.2019.10.015 \u003c/li\u003e\n\u003cli\u003eChoudhri O, Heit JJ, Feroze AH, Chang SD, Dodd RL, Steinberg GK. Persistent trigeminal artery supply to an intrinsic trigeminal nerve arteriovenous malformation: a rare cause of trigeminal neuralgia. J Clin Neurosci. (2015) 22:409\u0026ndash;12. 10.1016/j.jocn.2014.06.007\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Trigeminal nerve, Anatomy, Neurosurgery","lastPublishedDoi":"10.21203/rs.3.rs-5449614/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5449614/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e: The persistent trigeminal artery (PTA) is a rare embryonic anastomosis connecting the internal carotid and basilar arteries. It persists in some individuals, with potential clinical implications, including cerebrovascular events and cranial nerve compression syndromes. Understanding the anatomical details of the PTA is crucial for neurosurgical planning and intervention, as its presence can alter hemodynamics and affect surgical outcomes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods:\u003c/strong\u003e This cadaveric study utilized a latex injection technique on a single male cadaver specimen. The brain was carefully extracted, and a seven-step brain injection technique was performed to visualize the PTA. Microsurgical dissection followed, documenting the PTA's origin, course, branching patterns, and anatomical relationships. Measurements were recorded using digital calipers, and high-resolution images were taken for analysis. \u003cstrong\u003eResults:\u003c/strong\u003e The PTA was identified originating from the posterior bend of the cavernous segment of the internal carotid artery. It coursed posterolaterally into the posterior cranial fossa, bifurcating into medial and lateral branches. Variations included slight tortuosity near its origin. The medial branch contributed to the posterior circulation, while the lateral branch supplied the superior cerebellar artery. These findings offer detailed insights into the PTA's anatomy, enhancing the understanding of its clinical significance.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e This study enhances the anatomical understanding of PTA, highlighting its clinical significance in neurosurgical planning and intervention. Further research with larger samples is needed to generalize these findings.\u003c/p\u003e","manuscriptTitle":"Anatomical Insights and Clinical Implications of the Persistent Trigeminal Artery: A Cadaveric Study Utilizing Latex Injection Techniques","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-18 18:07:04","doi":"10.21203/rs.3.rs-5449614/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d2705591-08a2-4796-8925-ec5dd843bc73","owner":[],"postedDate":"December 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-12-18T18:07:06+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-18 18:07:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5449614","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5449614","identity":"rs-5449614","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}