Coincident intrasellar persistent trigeminal artery and craniopharyngioma: case report and implications for transsphenoidal surgery

摘要

The persistent trigeminal artery (PTA) is the largest and most commonly occurring type of remnant fetal arteries, typically originating from the posterior bend or lateral wall of the intracavernous carotid artery. There are no published reports of coexisting PTA and midline epithelial tumors. We describe a coincident case of craniopharyngioma associated with an adjacent PTA traversing through the sella turcica, which are both developmental midline skull base anomalies. The caliber and location of the PTA precluded an endoscopic endonasal operation; the tumor was safely resected via a supraorbital keyhole approach. Anatomic implications pertaining to surgical approach and treatment are also discussed. Surgeons performing endonasal skull base operations should be vigilant for the presence of PTAs and related vascular anomalies on MR imaging. Noninvasive vascular imaging can confirm and assist with preoperative planning. Highlights ? First known description of a craniopharyngioma coincidently occurring with a persistent trigeminal artery, both extremely rare events. ? The origin and classification of both craniopharyngiomas and persistent trigeminal arteries are explained. ? The persistent trigeminal artery was an unexpected finding and could have been dangerous if not found pre-operatively. ? It is imperative that all skull base surgeons use the appropriate imaging to detect possible vascular abnormalities and be wary of abnormal vasculature during surgical planning.