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A persistent trigeminal artery (PTA) is the most common carotid-vertebrobasilar anastomosis. PTA variants terminating on cerebellar arteries instead of the basilar artery have been reported previously. We present the first case of a PTA communicating with a fetal posterior communicating artery identified on a magnetic resonance angiogram. An understanding of these anatomical variants is important to clarify pathological processes that can help guide neurosurgical and endovascular procedures.

A 30-year-old male presented with left facial pain and numbness. Initial MRI demonstrated an enhancing mass involving the left trigeminal nerve. Follow-up imaging showed interval growth with erosion of the sphenoid body. Surgical resection was performed and immunohistochemistry staining was consistent with an atypical teratoid/rhabdoid tumor. Awareness of this entity and its imaging features such as diffusion restriction, intratumoral hemorrhage, and bony destruction, can help guide confirmatory diagnostic testing and appropriate therapy., (© The Author(s) 2016.)