Endovascular management of a persistent primitive trigeminal artery aneurysm initially misdiagnosed as pituitary adenoma: A case report

Abstract

Persistence of primitive intracranial embryonic anastomoses such as the permanent primitive trigeminal artery (PPTA) is rare, with the PPTA representing 80-85% of these cases. Aneurysms associated with PPTA are rare. This presents diagnostic and therapeutic challenges. We report a 64-year-old woman, initially evaluated for headache and dizziness, where cranial computed tomography (CT) incidentally suggested a hypodense sellar lesion. Subsequently, on CT angiography, a 9 mm saccular aneurysm in the PPTA and an 18 mm aneurysm in the right internal carotid artery (ICA) cavernous segment were identified. Endovascular treatment with flow diverter stent implantation was successfully performed, followed by post-operative ticagrelor and acetylsalicylic acid therapy. The patient was discharged neurologically intact after three days of care in the hospital and there was no deterioration in neurological examination at 1-year follow-up. This case underscores the necessity of careful angiographic evaluation in patients with suspected pituitary masses to avoid potentially catastrophic misdiagnoses. It also highlights the critical role of imaging techniques in identifying rare vascular anomalies.

Keywords

• aneurysm
• carotid-vertebrobasilar anastomoses
• case report
• endovascular technique
• persistent primitive trigeminal artery

References

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