Three-dimensional CT angiography for the surgical management of the vertebral artery-posterior inferior cerebellar artery aneurysms

Object The vertebral artery (VA) often takes a protrusive course posterolaterally over the posterior arch of the atlas. In this study, the authors attempted to quantify this posterolateral protrusion of the VA. Methods Three-dimensional CT angiography images obtained for various cranial or cervical diseases in 140 patients were reviewed and evaluated. Seven patients were excluded for various reasons. To quantify the protrusive course of the VA, the diameter of the VA and 4 parameters were measured in images of the C1–VA complex obtained in the remaining 133 patients. The authors also checked for anomalies and anatomical variations. Results When there was no dominant side, mean distances from the most protrusive part of the VA to the posterior arch of the atlas were 6.73 ± 2.35 mm (right) and 6.8 ± 2.15 mm (left). When the left side of the VA was dominant, the distance on the left side (8.46 ± 2.00 mm) was significantly larger than that of the right side (6.64 ± 2.0 mm). When compared by age group (≤ 30 years, 31–60 years, and ≥ 61 years), there were no significant differences in the extent of the protrusion. When there was no dominant side, the mean distances from the most protrusive part of the VA to the midline were 30.73 ± 2.51 mm (right side) and 30.79 ± 2.47 mm (left side). When the left side of the VA was dominant, the distance on the left side (32.68 ± 2.03 mm) was significantly larger than that on the right side (29.87 ± 2.53 mm). The distance from the midline to the intersection of the VA and inner cortex of the posterior arch of the atlas was ~ 12 mm, irrespective of the side of VA dominance. The distance from the midline to the intersection of the VA and outer cortex of the posterior arch was ~ 20 mm on both sides. Anatomical variations and anomalies were found as follows: bony bridge formation over the groove for the VA on the posterior arch of C-1 (9.3%), an extracranial origin of the posterior inferior cerebellar artery (8.2%), and a VA passing beneath the posterior arch of the atlas (1.8%). Conclusions There may be significant variation in the location and branches of the VA that may place the vessel at risk during surgical intervention. If concern is noted about the vulnerability of the VA or its branches during surgery, preoperative evaluation by CT angiography should be considered.

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Posterior inferior cerebellar artery with an extradural origin from the V3 segment: higher incidence on the nondominant vertebral artery

Journal of Neurosurgery Spine ◽

10.3171/2017.5.spine161286 ◽

2018 ◽

Vol 28 (2) ◽

pp. 154-159 ◽

Cited By ~ 3

Author(s):

Taiki Isaji ◽

Muneyoshi Yasuda ◽

Reo Kawaguchi ◽

Masahiro Aoyama ◽

Aichi Niwa ◽

...

Keyword(s):

Vertebral Artery ◽

Posterior Inferior Cerebellar Artery ◽

Three Dimensional ◽

Ct Scanning ◽

Anatomical Variations ◽

Craniovertebral Junction ◽

Ponticulus Posticus ◽

Cerebellar Artery ◽

3D Ct Angiography ◽

Relationship Of

OBJECTIVEThe posterior inferior cerebellar artery (PICA) and the vertebral artery (VA) often exhibit anatomical variations at the craniovertebral junction (CVJ). An example of this is the PICA originating extradurally from the V3 segment of the VA. To date, some cadaveric investigations have been reported, but the incidence and relationship of this variation to the VA and the atlas as observed on clinical imaging have not been discussed. This study evaluated the prevalence of PICAs originating from the V3 on CT scanning. Other variations of the atlas and VA were also analyzed.METHODSCT images from a series of 153 patients who underwent 3D CT angiography (CTA) were analyzed, and variations of the PICA, VA, and atlas were investigated.RESULTSA total of 142 patients (284 sides) were analyzed; 11 patients (7.2%) were excluded due to poor image quality. The most common VA variation was the PICA originating from V3 (9.5% of 284 sides), which was more frequently observed on the nondominant VA than the dominant VA (22.5% vs 6.25%, p = 0.0005). A VA with a PICA end was identified in 4 sides (1.4%), which is the same incidence as observed in the persistent first intersegmental VA (1.4%). VA fenestration was only found in 1 side (0.35%). Regarding the atlas, ponticulus posticus was observed in 24 sides (8.5%). There was no relationship between the incidence of ponticulus posticus and the variations of the VA.CONCLUSIONSA PICA originating from V3 was the most common VA variation at the CVJ and was more common on the nondominant VA. Three-dimensional CTA is useful for the evaluation of this variance. Surgeons should be mindful of this variation during operations.

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Subarachnoid Hemorrhage Due to Ruptured Intracranial Aneurysm Arising from a Vertebral Artery-Bihemispheric Posterior Inferior Cerebellar Artery Bifurcation

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_285_17 ◽

2017 ◽

Vol 08 (04) ◽

pp. 654-656 ◽

Cited By ~ 1

Author(s):

Yasushi Ogasawara ◽

Hiroshi Kashimura ◽

Kenta Aso ◽

Hiroaki Saura

Keyword(s):

Subarachnoid Hemorrhage ◽

Vertebral Artery ◽

Posterior Inferior Cerebellar Artery ◽

Three Dimensional ◽

Distal Portion ◽

Ruptured Intracranial Aneurysm ◽

Cerebellar Artery ◽

Complications Of Surgery ◽

Subsequent Loss ◽

The Right

ABSTRACTAlthough the anatomy of the posterior inferior cerebellar artery (PICA) is highly variable, a solitary PICA supplying both hemispheres of the cerebellum is rare. A 76-year-old woman presented with severe headache and subsequent loss of consciousness and was admitted to our hospital. Initial computed tomography showed subarachnoid hemorrhage. Three-dimensional digital subtraction angiography revealed a saccular aneurysm arising from the right vertebral artery (VA)-PICA bifurcation. The PICA branching from the right VA was enlarged, tortuous, and crossed the midline to supply both cerebellar hemispheres. This right PICA was interpreted as a bihemispheric PICA. Recognizing this variant preoperatively could help prevent complications of surgery. Careful follow-up studies are necessary in cases with bihemispheric PICA to monitor for the development of aneurysm at the junction between the bihemispheric PICA and the VA or the distal portion of the bihemispheric PICA.

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Stent-assisted coiling in treating hemorrhagic vertebral artery dissecting aneurysms involving posterior inferior cerebellar artery: a case report

Academic Journal of Second Military Medical University ◽

10.3724/sp.j.1008.2014.01407 ◽

2014 ◽

Vol 35 (12) ◽

pp. 1407

Author(s):

Lin-sun DAI ◽

Bao-qiang LIAN ◽

Li-sheng HE ◽

De-zhi KANG

Keyword(s):

Case Report ◽

Vertebral Artery ◽

Posterior Inferior Cerebellar Artery ◽

Cerebellar Artery ◽

Dissecting Aneurysms

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How I do it? Posterior inferior cerebellar artery-intracranial vertebral artery reimplantation bypass and trapping of dissecting aneurysm involving the proximal posterior inferior cerebellar artery

Acta Neurochirurgica ◽

10.1007/s00701-021-04918-9 ◽

2021 ◽

Author(s):

Zixiao Yang ◽

Jianping Song ◽

Peiliang Li ◽

Wei Zhu

Keyword(s):

Vertebral Artery ◽

Posterior Inferior Cerebellar Artery ◽

Dissecting Aneurysm ◽

Cerebellar Artery

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Staged, Combined Management of Ruptured Vertebral Artery Dissecting Aneurysms Involving the Posterior Inferior Cerebellar Artery: Report of 4 Cases and Review of the Literature

World Neurosurgery ◽

10.1016/j.wneu.2019.05.146 ◽

2019 ◽

Vol 128 ◽

pp. 444-447

Author(s):

You-Sub Kim ◽

Tae-Sun Kim ◽

In-Chul Yang ◽

Sung-Pil Joo

Keyword(s):

Vertebral Artery ◽

Posterior Inferior Cerebellar Artery ◽

Review Of The Literature ◽

Cerebellar Artery ◽

Dissecting Aneurysms

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Intracranial Vertebral Endarterectomy

Neurosurgery ◽

10.1227/00006123-199003000-00014 ◽

1990 ◽

Vol 26 (3) ◽

pp. 465-471 ◽

Cited By ~ 22

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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