scholarly journals Microsurgical anatomy of the extracranial-extradural origin of the posterior inferior cerebellar artery

1999 ◽  
Vol 7 (2) ◽  
pp. E2
Author(s):  
Andrew D. Fine ◽  
Alberto Cardoso ◽  
Albert L. Rhoton
Keyword(s):  
Soft Tissue ◽  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Microsurgical Anatomy ◽  
Common Variation ◽  
The Third ◽  
Cerebellar Artery ◽  
The Common ◽  
Bone Anomalies

Object The authors describe the microsurgical anatomy of the posterior inferior cerebellar artery (PICA) with an extradural origin and discuss its importance as a common variation. Methods The microsurgical anatomy of paired PICAs with an extradural origin were examined. Conclusions Five to 20% of PICAs have an extradural origin. In the case described, both PICAs arose extradurally from the third segment of the vertebral artery (VA). Both origins were less than 1 cm proximal to the site at which the VA penetrated the dura and neither PICA gave rise to extradural branches. Extradurally the PICAs coursed parallel to the VA and the C-1 nerve and the three structures penetrated the dura together. Intradurally, the PICAs remained lateral and posterior to the brainstem, whereas, in the common PICA configuration, the first segment of the PICA courses anterior to the medulla. Neither PICA sent branches to the anterior brainstem, which is commonly found in PICAs with an intradural origin. There were no soft-tissue or bone anomalies.

Microsurgical anatomy of the extracranial—extradural origin of the posterior inferior cerebellar artery

1999 ◽  
Vol 91 (4) ◽  
pp. 645-652 ◽  
Author(s):  
Andrew D. Fine ◽  
Alberto Cardoso ◽  
Albert L. Rhoton
Keyword(s):  
Soft Tissue ◽  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Microsurgical Anatomy ◽  
Content Type ◽  
The Third ◽  
Cerebellar Artery ◽  
The Common ◽  
Bone Anomalies ◽  
Fine Print

Object. The authors describe the microsurgical anatomy of the posterior inferior cerebellar artery (PICA) with an extradural origin and discuss its importance as a common variation.Methods. The microsurgical anatomy of paired PICAs with an extradural origin were examined.Conclusions. Five to 20% of PICAs have an extradural origin. In the case described, both PICAs arose extradurally from the third segment of the vertebral artery (VA). Both origins were less than 1 cm proximal to the site at which the VA penetrated the dura, and neither PICA gave rise to extradural branches. Extradurally, the PICAs coursed parallel to the VA and the C-1 nerve and the three structures penetrated the dura together. Intradurally, the PICAs remained lateral and posterior to the brainstem, whereas, in the common PICA configuration, the first segment of the PICA courses anterior to the medulla. Neither PICA sent branches to the anterior brainstem, which is commonly found in PICAs with an intradural origin. There were no soft-tissue or bone anomalies.

scholarly journals Neurosurgery (Neuro Interventional)

2015 ◽  
Vol 42 (S1) ◽  
pp. S43-S44
Author(s):  
JJ Shankar ◽  
L Hodgson
Keyword(s):  
Vertebral Artery ◽  
Retrospective Analysis ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
The Third ◽  
Cerebellar Artery ◽  
Incomplete Coverage ◽  
Negative Findings ◽  
The Right

Purpose: CTA is becoming the frontline modality to reveal aneurysms in patients with SAH. However, in about 20% of SAH patients no aneurysm is found. In these cases, intra-arterial DSA is still performed. Our aim was to evaluate whether negative findings on CTA can reliably exclude aneurysms in patients with acute SAH. Materials and Method: We conducted a retrospective analysis of all DSA performed from August 2010 to July 2014 in patients with various indications. We selected patient who presented with SAH and had a negative CTA. Findings of the CTA were compared with DSA. Results: 857 DSA were performed during the study period. 51(5.95%) patients with SAH and negative findings on CTA who underwent subsequent DSA were identified. Of these, only 3(5.9%) of patients had positive findings on the DSA. One patient had a posterior inferior cerebellar artery aneurysm on the DSA, not seen on CTA due to the incomplete coverage of the head. Second patient’ CTA did not show any evidence of aneurysm. DSA showed suspicious dissection of the right vertebral artery, potentially iatrogenic. The third patient’s DSA showed suspicious tiny protuberance from left ICA, possibly infundibulum. Conclusion: In patients with SAH, negative CTA findings are reliable in ruling out aneurysms in any pattern of SAH on CT.

Microsurgical Anatomy of the Posterior Inferior Cerebellar Artery

Neurosurgery ◽  
1982 ◽  
Vol 10 (2) ◽  
pp. 170-199 ◽  
Author(s):  
Richard J. Lister ◽  
Albert L. Rhoton ◽  
Toshiom Matsushima ◽  
David A. Peace
Keyword(s):  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Cerebellar Tonsil ◽  
Cortical Surface ◽  
Microsurgical Anatomy ◽  
Vagus Nerves ◽  
Adjacent Part ◽  
Tela Choroidea ◽  
Cerebellar Artery ◽  
Superior Pole

Abstract Fifty cerebellar hemispheres from 25 adult cadavers were examined. The posterior inferior cerebellar artery (PICA), by definition, arose from the vertebral artery. The vertebral artery was present in 49 and the PICA was present in 42 of the 50 hemispheres. Forty-one of the 42 PICAs arose as a single trunk and 1 arose as a duplicate trunk. The PICA was divided into five segments: the anterior medullary segment lay on the front of the medulla; the lateral medullary segment coursed beside the medulla and extended to the origin of the glossopharyngeal, vagal, and accessory nerves; the tonsillomedullary segment coursed around the caudal half of the cerebellar tonsil; the telovelotonsillar segment coursed in the cleft between the tela choroidea and the inferior medullary velum rostrally and the superior pole of the cerebellar tonsil caudally; and the cortical segment was distributed to the cerebellar surface. Thirty-seven of the 42 PICAs bifurcated into a medial and a lateral trunk. The medial trunk supplied the vermis and the adjacent part of the hemisphere, and the lateral trunk supplied the cortical surface of the tonsil and the hemisphere. The PICA gave off perforating, choroidal, and cortical arteries. The cortical arteries were divided into vermian, tonsillar, and hemispheric groups. Sixteen of the 42 PICAs passed between the rootlets of the accessory nerve, 10 passed between the rootlets of the vagus nerve, 13 passed between the vagus and the accessory nerves, 2 coursed rostral to the glossopharyngeal nerve, and 1 passed between the glossopharyngeal and the vagus nerves.

Surgical treatment for vertebral artery–posterior inferior cerebellar artery aneurysms: special reference to the importance of the cerebellomedullary fissure dissection

2013 ◽  
Vol 118 (2) ◽  
pp. 460-464 ◽  
Author(s):  
Masatou Kawashima ◽  
Yukinori Takase ◽  
Toshio Matsushima
Keyword(s):  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Neurological Deficits ◽  
Lateral Part ◽  
Microsurgical Anatomy ◽  
Aneurysm Surgery ◽  
Lesion Side ◽  
Cerebellar Artery ◽  
Cerebellomedullary Fissure ◽  
Pica Aneurysms

Object The cerebellomedullary fissure (CMF) is a space between the cerebellum and the medulla oblongata, which often adhere to each other. The purpose of the present study was to demonstrate the importance of the unilateral CMF dissection for clipping vertebral artery (VA)–posterior inferior cerebellar artery (PICA) aneurysms. Methods Five adult cadaveric specimens were studied after colored silicone was infused into the arteries and veins. The microsurgical anatomy of the CMF and the trans-CMF approach for VA-PICA aneurysm surgery were examined in stepwise dissections. In addition, 6 patients underwent surgery for VA-PICA saccular aneurysms (2 ruptured and 4 unruptured aneurysms) via posterolateral approaches, with wide opening of the unilateral CMF to obtain good visualization and a wide working space in the lateral part of the cerebellomedullary cistern. Clinical data including neurological and radiological findings and patient outcomes were analyzed in all 6 cases. Results In all cases, the aneurysm was successfully clipped and no permanent neurological deficits remained. The wide opening of the unilateral CMF on the lesion side made it possible to retract the inferolateral part of the cerebellum easily, provided a wide operative field in the cerebellomedullary cistern, and enabled successful clip placement without difficulty. Conclusions For safe and effective VA-PICA aneurysm surgery, it is very important to dissect the CMF on the lesion side as well as to remove the lateral part of the foramen magnum. Direct clip placement is very safe and useful in cases involving VA-PICA aneurysms.

Intracranial Vertebral Endarterectomy

Neurosurgery ◽  
1990 ◽  
Vol 26 (3) ◽  
pp. 465-471 ◽  
Author(s):  
James I. Ausman ◽  
Fernando G. Diaz ◽  
Balaji Sadasivan ◽  
Manuel Dujovny
Keyword(s):  
Vertebral Artery ◽  
Medical Therapy ◽  
Superficial Temporal Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Temporal Artery ◽  
Superior Cerebellar Artery ◽  
Focal Lesion ◽  
Cerebellar Infarction ◽  
Vertebrobasilar Insufficiency ◽  
Cerebellar Artery

Abstract Intracranial vertebral endarterectomy was performed on six patients with vertebrobasilar insufficiency in whom medical therapy failed. The patients underwent operations for stenotic plaque in the intracranial vertebral artery with the opposite vertebral artery being occluded, hypoplastic, or severely stenosed. In four of the patients, the stenosis was mainly proximal to the posterior inferior cerebellar artery (PICA). In this group, after endarterectomy, the vertebral artery was patent in two patients, and their symptoms resolved: in one patient the endarterectomy occluded, but the patient's symptoms improved; and in one patient the endarterectomy was unsuccessful, and he continued to have symptoms. In one patient, the plaque was at the origin of the PICA. The operation appeared technically to be successful, but the patient developed a cerebellar infarction and died. In one patient the stenosis was distal to the PICA. During endarterectomy, the plaque was found to invade the posterior wall of the vertebral artery. The vertebral artery was ligated, and the patient developed a Wallenburg syndrome. The results of superficial temporal artery to superior cerebellar artery anastomosis are better than those for intracranial vertebral endarterectomy for patients with symptomatic intracranial vertebral artery stenosis. The use of intracranial vertebral endarterectomy should be limited to patients who have disabling symptoms despite medical therapy, a focal lesion proximal to the PICA, and a patent posterior circulation collateral or bypass.

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