Coexistence of Persistent Primitive Trigeminal Artery, Moyamoya Disease, and Multiple Intracranial Aneurysms: A Case Report and Literature Review

Background: Persistent primitive trigeminal artery (PPTA) is a rare abnormal carotid-basilar anastomosis. In rare circumstances, PPTA can be associated with some cerebrovascular anomalies, including arteriovenous malformation, intracranial aneurysm, carotid cavernous fistula, and moyamoya disease (MMD).

Case description: In this report, we present an extremely rare case with simultaneous occurrence of PPTA, MMD, and multiple intracranial aneurysms. The patient was admitted for subarachnoid hemorrhage. Endovascular coiling of the multiple aneurysms was successfully performed. The patient experienced an uneventful recovery, and no recurrence of the intracranial aneurysms was noted during the 1-year follow-up.

Conclusions: The pathogenesis of the coexistence of PPTA and MMD, PPTA and intracranial aneurysm, and MMD and intracranial aneurysm is still unknown. According to the literature, congenital factor and hemodynamic stress may play an important role in the formation of these vascular anomalies. In case of hypoplasia of the vertebrobasilar system, PPTA could also be used as a route for endovascular coiling for some specific aneurysms in the posterior circulation. To our knowledge, this is the first report of such a case.