scholarly journals Bihemispheric Posterior Inferior Cerebellar Artery Occurring with an Azygos Anterior Cerebral Artery: Case Study

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Jamie Toms ◽  
Rishi Wadhwa ◽  
Sudheer Ambekar ◽  
Hugo Cuellar
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Pathological Condition ◽  
Anatomic Variation ◽  
Posterior Inferior Cerebellar Artery ◽  
Anatomical Variations ◽  
Vascular Abnormality ◽  
Cerebellar Artery ◽  
Azygous Anterior Cerebral Artery

Variations in intracranial vasculature are well known. We report a rare anatomic variation in a patient who underwent cerebral angiography for suspected intracranial aneurysm. Digital subtraction angiography revealed a bihemispheric posterior inferior cerebellar artery (PICA) and an azygous anterior cerebral artery (ACA). There was no evidence of any aneurysm or vascular abnormality. To our knowledge, this is the first reported case of a patient with a common PICA supplying both the cerebellar hemispheres and a common ACA supplying ACA territory bilaterally. It is important for the physician to be aware of these anatomical variations in order to differentiate a normal variant from a pathological condition.

Rupture of previously documented small asymptomatic saccular intracranial aneurysms

1992 ◽  
Vol 76 (6) ◽  
pp. 1019-1024 ◽  
Author(s):  
Wouter I. Schievink ◽  
David G. Piepgras ◽  
Fremont P. Wirth
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Careful Consideration ◽  
Middle Cerebral Artery Aneurysm ◽  
Internal Carotid Artery Aneurysm ◽  
Cerebellar Artery ◽  
Cerebral Artery Aneurysm

✓ In a recent study from the Mayo Clinic on the natural history of intact saccular intracranial aneurysms, none of the aneurysms smaller than 10 mm in diameter ruptured. It was concluded that these aneurysms carry a negligible risk for future hemorrhage and that surgery for their repair could not be recommended. These findings and recommendations have been the subject of much controversy. The authors report three patients with previously documented asymptomatic intact saccular intracranial aneurysms smaller than 5 mm in diameter that subsequently ruptured. In Case 1, a 70-year-old man bled from a 4-mm middle cerebral artery aneurysm that had been discovered incidentally 2½ years previously during evaluation of cerebral ischemic symptoms. A 10-mm internal carotid artery aneurysm and a contralateral 4-mm middle cerebral artery aneurysm had not ruptured. Case 2 was that of a 66-year-old woman who bled from a 4-mm pericallosal aneurysm that had been present 9½ years previously when she suffered subarachnoid hemorrhage (SAH) from a 7 × 9-mm posterior inferior cerebellar artery aneurysm. Although the pericallosal aneurysm had not enlarged in the intervening years, a daughter aneurysm had developed. The third patient was a 45-year-old woman who bled from a 4- to 5-mm posterior inferior cerebellar artery aneurysm that had measured approximately 2 mm on an angiogram obtained 4 years previously; at that time she had suffered SAH due to rupture of a 5 × 12-mm posterior communicating artery aneurysm. These cases show that small asymptomatic intact saccular intracranial aneurysms are not innocuous and that careful consideration must be given to their surgical repair and long-term follow-up study.

scholarly journals Parent Artery Occlusion for Intracranial Aneurysms

2009 ◽  
Vol 15 (3) ◽  
pp. 309-315 ◽  
Author(s):  
Lishan Cui ◽  
Qiang Peng ◽  
Wenbo Ha ◽  
Dexiang Zhou ◽  
Yang Xu
Keyword(s):  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Posterior Inferior Cerebellar Artery ◽  
Cerebral Aneurysms ◽  
Artery Occlusion ◽  
Anterior Inferior Cerebellar Artery ◽  
Parent Artery ◽  
Parent Artery Occlusion ◽  
Cerebellar Artery ◽  
Dissecting Aneurysms

Peripheral cerebral aneurysms are difficult to treat with preservation of the parent arteries. We report the clinical and angiographic outcome of 12 patients with cerebral aneurysms located peripherally. In the past five years, 12 patients, six females and six males, presented at our institution with intracranial aneurysms distal to the circle of Willis and were treated endovascularly. The age of our patients ranged from four to 58 years with a mean age of 37 years. Seven of the 12 patients had subarachnoid and/or intracerebral hemorrhage upon presentation. Two patients with P2 dissecting aneurysms presented with mild hemiparesis and hypoesthesia, one patient with a large dissecting aneurysm complained of headaches and two patients with M3 dissecting aneurysms had mild hemiparesis and hypoesthesia of the right arm. Locations of the aneurysms were as follows: posterior cerebral artery in seven patients, anterior inferior cerebellar artery in two, posterior inferior cerebellar artery in one, middle cerebral artery in two. Twelve patients with peripheral cerebral aneurysms underwent parent artery occlusion (PAO). PAO was performed with detachable coils. No patient developed neurologic deficits. Distally located cerebral aneurysms can be treated with parent artery occlusion when selective embolization of the aneurysmal sac with detachable platinum coils or surgical clipping cannot be achieved.

Azygous Anterior Cerebral Artery Acute Occlusion Managed With Endovascular Mechanical Thrombectomy: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (4) ◽  
pp. 514-515 ◽  
Author(s):  
Leonardo Rangel-Castilla ◽  
Adnan H Siddiqui
Keyword(s):  
Cerebral Artery ◽  
Cerebral Blood Volume ◽  
Mechanical Thrombectomy ◽  
Anterior Cerebral Artery ◽  
Stent Retriever ◽  
Vessel Occlusion ◽  
Nihss Score ◽  
Acute Occlusion ◽  
Intravenous Tissue Plasminogen Activator ◽  
Azygous Anterior Cerebral Artery

Abstract Mechanical thrombectomy has become the standard of care for management of most acute large-vessel occlusion (LVO) strokes. Most intracranial occlusions are located in the middle cerebral and internal carotid arteries. We present a unique case of acute occlusion of an azygous anterior cerebral artery (ACA). A 59-yr-old man with known hypertension and alcoholism presented with right hemiparesis, right facial palsy, aphasia, and dysarthria. His initial National Institutes of Health Stroke Scale (NIHSS) score was 20. Computed tomographic angiography and perfusion imaging demonstrated acute bilateral ACA occlusion with viable penumbra and preserved cerebral blood volume. The patient was not a candidate for intravenous tissue plasminogen activator because he presented with a wake-up stroke. After consent was obtained from his family, the patient was taken urgently for endovascular recanalization. Digital subtraction angiography confirmed acute azygous ACA occlusion. Under conscious sedation, the patient underwent mechanical thrombectomy with a stent retriever and a large-bore aspiration catheter. Successful revascularization (thrombolysis in cerebral infarction [TICI] grade 3) of the azygous ACA and both A2 arteries was obtained after 2 attempts and the use of a different stent retriever (first a 3 × 30 mm Trevo [Stryker Neurovascular, Kalamazoo, Michigan] and then a 4 × 40 mm Solitaire Platinum [Medtronic, Dublin, Ireland]). A reperfusion catheter was used during both attempts. No procedure-related complications occurred. The patient was discharged to a rehabilitation facility 3 d after the procedure with an NIHSS score of 2. In this video, we present the operative nuances of an uncommon location of LVO and its endovascular management.

Revascularization and Aneurysm Surgery

Neurosurgery ◽  
2014 ◽  
Vol 74 (5) ◽  
pp. 482-498 ◽  
Author(s):  
M. Yashar S. Kalani ◽  
Wyatt Ramey ◽  
Felipe C. Albuquerque ◽  
Cameron G. McDougall ◽  
Peter Nakaji ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Cerebral Artery ◽  
Superficial Temporal Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Superior Cerebellar Artery ◽  
External Carotid ◽  
Occipital Artery ◽  
Aneurysm Surgery ◽  
Cerebellar Artery

Abstract BACKGROUND: Given advances in endovascular technique, the indications for revascularization in aneurysm surgery have declined. OBJECTIVE: We sought to define indications, outline technical strategies, and evaluate the outcomes of patients treated with bypass in the endovascular era. METHODS: We retrospectively reviewed all aneurysms treated between September 2006 and February 2013. RESULTS: We identified 54 consecutive patients (16 males and 39 females) with 56 aneurysms. Aneurysms were located along the cervical internal carotid artery (ICA) (n = 1), petrous/cavernous ICA (n = 1), cavernous ICA (n = 16), supraclinoid ICA (n = 7), posterior communicating artery (n = 2), anterior cerebral artery (n = 4), middle cerebral artery (MCA) (n = 13), posterior cerebral artery (PCA) (n = 3), posterior inferior cerebellar artery (n = 4), and vertebrobasilar arteries (n = 5). Revascularization was performed with superficial temporal artery (STA) to MCA bypass (n = 25), STA to superior cerebellar artery (SCA) (n = 3), STA to PCA (n = 1), STA-SCA/STA-PCA (n = 1), occipital artery (OA) to PCA (n = 2), external carotid artery/ICA to MCA (n = 15), OA to MCA (n = 1), OA to posterior inferior cerebellar artery (n = 1), and in situ bypasses (n = 8). At a mean clinical follow-up of 18.5 months, 45 patients (81.8%) had a good outcome (Glasgow Outcome Scale 4 or 5). There were 7 cases of mortality (12.7%) and an additional 9 cases of morbidity (15.8%). At a mean angiographic follow-up of 17.8 months, 14 bypasses were occluded. Excluding the 7 cases of mortality, the majority of aneurysms (n = 42) were obliterated. We identified 7 cases of residual aneurysm and recurrence in 6 patients at follow-up. CONCLUSION: Given current limitations with existing treatments, cerebral revascularization remains an essential technique for aneurysm surgery.

Human fetal medial striate artery or artery of Heubner

2009 ◽  
Vol 3 (4) ◽  
pp. 296-301 ◽  
Author(s):  
Ljiljana Vasović ◽  
Sladjana Ugrenović ◽  
Ivan Jovanović
Keyword(s):  
Middle Cerebral Artery ◽  
Diagnostic Test ◽  
Cerebral Artery ◽  
Cerebral Circulation ◽  
Anterior Cerebral Artery ◽  
Anatomical Variations ◽  
Test Results ◽  
Terminal Part ◽  
The Brain

Object The authors describe some of the features of the medial striate branch or recurrent artery of Heubner (RAH). This structure has indisputable functional, neurological, and neurosurgical significance, and originates from the A1 and/or A2 segments of the anterior cerebral artery. Methods Microdissection of 94 human fetal specimens was performed. The RAH was observed in 97.3% (single in 71.6%, double in 25.1%, and triple in 3.3%) of the cases. Its origin was from A2 in 42.3% of specimens, from the A1–A2 junction in 25.7%, and from A1 in 20%. Results Five types and 14 subtypes of the RAH were identified, determined based on vessel origin and number. In its course, the RAH gave 1–12 branches, and the terminal part most frequently penetrated into the brain through the anterior perforated substance at the level of the sphenoid segment of the middle cerebral artery. The specimens with a single RAH fenestration, abnormal double RAH anastomosis, and unusual RAH origin and relationship to the surrounding vessels represented new data. Conclusions The authors' observations of common anatomical variations in the number and origin of the RAH, as well as its abnormalities, may assist neuroradiologists in the interpretation of diagnostic test results and neurosurgeons in performing procedures in the anterior cerebral circulation.

E-092 azygous anterior cerebral artery aneurysms

2015 ◽  
Vol 7 (Suppl 1) ◽  
pp. A81.2-A82
Author(s):  
A Nicholson ◽  
D Cooke ◽  
M Amans ◽  
F Settecase ◽  
S Hetts ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Azygous Anterior Cerebral Artery

Ruptured aneurysm on a double origin of the posterior inferior cerebellar artery: a pathological entity in an anatomical variation

2002 ◽  
Vol 96 (1) ◽  
pp. 127-131 ◽  
Author(s):  
Anne Pasco ◽  
Francine Thouveny ◽  
Xavier Papon ◽  
Jean-Yves Tanguy ◽  
Philippe Mercier ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Anatomical Variation ◽  
Posterior Inferior Cerebellar Artery ◽  
Anatomical Variations ◽  
Content Type ◽  
Small Branch ◽  
Cerebellar Artery ◽  
Fourth Segment ◽  
Double Origin ◽  
Fine Print

✓ The posterior inferior cerebellar artery (PICA) is known to be very variable, and some of its anatomical variations can explain ischemic complications that occur during endovascular treatment of aneurysms. The authors report two cases of anatomical variation of the PICA that they have called its double origin, one of which gave rise to an aneurysm. The first patient was a 36-year-old man who presented with a subarachnoid hemorrhage related to the rupture of a PICA aneurysm. The aneurysm was treated by the endovascular route. Selective and superselective studies showed that the PICA origin was low on the fourth segment of the vertebral artery (VA). The aneurysm was located on an anastomosis between the PICA and a small upper arterial branch originating from the VA. Embolization was performed through the small branch with no problem, but a lateral medullary infarct followed, probably due to occlusion of the perforating vessels. The same anatomical variation was incidentally discovered in the second patient. To the authors' knowledge, neither this anatomical variation of the PICA nor the aneurysm's topography have been previously described angiographically. This highlights the role of angiography in pretreatment evaluation of aneurysms especially when perforating vessels or small accessory branches that are poorly visualized on angiographic studies are concerned, as in the territory of the PICA. Anatomy is sometimes unpredictable, and the surgeon must be very careful when confronted with these variations because they are potentially dangerous for endovascular treatment.

scholarly journals Surgical microanatomy of the occipital artery for suboccipital muscle dissection and intracranial artery reconstruction

2019 ◽  
Vol 10 ◽  
pp. 127
Author(s):  
Yuto Hatano ◽  
Nakao Ota ◽  
Kosumo Noda ◽  
Yasuaki Okada ◽  
Yosuke Suzuki ◽  
...  
Keyword(s):  
Anatomic Variation ◽  
Superficial Temporal Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Temporal Artery ◽  
Occipital Artery ◽  
Cerebellar Artery ◽  
Preoperative Ct ◽  
Running Pattern ◽  
Enhanced Computed Tomography ◽  
Artery Reconstruction

Background: The occipital artery (OA) is an important donor artery for posterior fossa revascularization. Harvesting the OA is difficult in comparison to the superficial temporal artery because the OA runs between suboccipital muscles. Anatomical knowledge of the suboccipital muscles and OA is essential for harvesting the OA during elevation of the splenius capitis muscle (SPL) for reconstruction of the posterior inferior cerebellar artery. We analyzed the running pattern of the OA and its anatomic variations using preoperative and intraoperative findings. Methods: From April 2012 to March 2018, we surgically treated 162 patients with suboccipital muscle dissection by OA dissection using the lateral suboccipital approach. The running pattern and relationship between the suboccipital muscles and OA were retrospectively analyzed using the operation video and preoperative enhanced computed tomography (CT) images. The anatomic variation in the running pattern of the OA was classified into two types: lateral type, running lateral to the muscle and medial type, running medial to the longissimus capitis muscle (LNG). Results: The medial pattern was observed in 107 (66%) patients and the lateral pattern in 54 (33.3%); 1 (0.6%) patient had the OA running between the LNGs. Conclusion: Preoperative CT is effective in determining the running course of the OA, which is important for safely harvesting the OA during SPL elevation. There is a risk of causing OA injury in patients with the lateral pattern. This is the first report showing that the OA rarely runs in between the LNGs.

scholarly journals Pericallosal berry aneurysm associated with azygous anterior cerebral artery – a case report

2021 ◽  
Vol 19 (3) ◽  
pp. 259-261
Author(s):  
Berrin Erok ◽  
◽  
Nu Nu Win ◽  
Sertaç Tatar ◽  
◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Anterior Segment ◽  
Radiology Department ◽  
Rare Occurrence ◽  
History Of ◽  
Aneurysm Development ◽  
Azygous Anterior Cerebral Artery ◽  
Interventional Radiology Department

Introduction. Azygos anterior cerebral artery is a rare variant of the anterior segment of the circle of Willis caused by an unusual fusion of the normally paired A2 segments of the anterior cerebral artery (ACA). Despite its rare occurrence, it is associated with various vascular and structural cerebral abnormalities, particularly berry aneurysms. Aim. We aimed to present a case of a 41-year-old female patient who presented to our neurology department with complaints of headache. Description of the case. She had a positive paternal history of aneurysmal subarachnoid hemorrhage. Magnetic resonance angiography (MRA) of her brain revealed an azygos ACA (bifurcating into two pericallosal arteries) which was associated with a saccular aneurysm at its bifurcation point. She was referred to the interventional radiology department for preventive endovascular treatment. Conclusion. Azygos ACA carries a high risk of aneurysm development and its occlusion can potentially compromise blood supply to both cerebral hemispheres. It is therefore crucial for clinicians to be aware of its significance and to report its presence in angiographic studies.

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