Preserved Simple and Impaired Compound Movement After Infarction in the Territory of the Superior Cerebellar Artery

ABSTRACT:A patient with an infarct in the distribution of the right superior cerebellar artery was studied with regard to his ability to make simple movements (visually triggered, self-terminated ballistic wrist movements), and compound movements (reaching to a visual target and precision pinch of a seen object). Movements on the right side of the body alone were affected. Control movements were made by the normal left upper extremity. Wrist movement on the right side was normal in reaction time, direction, peak velocity, and end-point position control ascompared to the left. By contrast, both reaching and pinching movements on the right were impaired. Reaching movements showed marked decomposition of the compound elbow-shoulder movement into seriatim simple movements madealternately at elbow and shoulder. Pinching movements were not made, and instead winkling movements (a movement of index alone) were substituted. These results are compared to similar results of controlled inactivation of the cerebellar dentate nucleus in monkeys. We conclude that one function of the cerebellum may be to combine elements in the movement repertoires of downstream movement generators. When that ability is lost, a strategy may be voluntarily adopted of using the preserved simple movements in place of the impaired compound movements.

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Thrombectomy in posterior circulation stroke through persistent primitive trigeminal artery: A case report

Interventional Neuroradiology ◽

10.1177/1591019915609122 ◽

2015 ◽

Vol 21 (6) ◽

pp. 715-718 ◽

Cited By ~ 5

Author(s):

MJHL Mulder ◽

GJ Lycklama à Nijeholt ◽

W Dinkelaar ◽

TPW de Rooij ◽

ACGM van Es ◽

...

Keyword(s):

Posterior Circulation ◽

Superior Cerebellar Artery ◽

Trigeminal Artery ◽

Left Hand ◽

Persistent Primitive Trigeminal Artery ◽

Cerebellar Artery ◽

Intervention Patient ◽

Primitive Trigeminal Artery ◽

The Right ◽

Neurovascular Anatomy

We describe a case of intra-arterial treatment (IAT) of acute posterior circulation occlusion in a patient with a persistent primitive trigeminal artery (PPTA). The patient presented with an acute left sided hemiparesis and loss of consciousness (Glasgow coma score of 5). Computed tomography angiography showed an acute occlusion of the right internal carotid artery (ICA), the PPTA, distal basilar artery (BA), right posterior cerebral artery (PCA), and right superior cerebellar artery (SCA). Stent-retriever assisted thrombectomy was not considered possible through the hypoplastic proximal BA. After passage of the proximal ICA occlusion, the right PCA and SCA were recanalized through the PPTA, with a single thrombectomy procedure. Ten days after intervention patient was discharged scoring optimal EMV with only a mild facial and left hand paresis remaining. PPTA is a persistent embryological carotid–basilar connection. Knowledge of existing (embryonic) variants in neurovascular anatomy is essential when planning and performing acute neurointerventional procedures.

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Extreme Lateral Supracerebellar Infratentorial Approach to the Lateral Midbrain

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1669981 ◽

2018 ◽

Vol 79 (S 05) ◽

pp. S415-S417

Author(s):

M. Kalani ◽

William Couldwell

Keyword(s):

Cranial Nerves ◽

Sudden Onset ◽

Superior Cerebellar Artery ◽

Entry Zone ◽

Cerebellar Artery ◽

Sensory Disturbances ◽

History Of ◽

Supracerebellar Infratentorial Approach ◽

The Right ◽

Piecemeal Resection

This video illustrates the case of a 52-year-old man with a history of multiple bleeds from a lateral midbrain cerebral cavernous malformation, who presented with sudden-onset headache, gait instability, and left-sided motor and sensory disturbances. This lesion was eccentric to the right side and was located in the dorsolateral brainstem. Therefore, the lesion was approached via a right-sided extreme lateral supracerebellar infratentorial (exSCIT) craniotomy with monitoring of the cranial nerves. This video demonstrates the utility of the exSCIT for resection of dorsolateral brainstem lesions and how this approach gives the surgeon ready access to the supracerebellar space, and cerebellopontine angle cistern. The lateral mesencephalic safe entry zone can be accessed from this approach; it is identified by the intersection of branches of the superior cerebellar artery and the fourth cranial nerve with the vein of the lateral mesencephalic sulcus. The technique of piecemeal resection of the lesion from the brainstem is presented. Careful patient selection and respect for normal anatomy are of paramount importance in obtaining excellent outcomes in operations within or adjacent to the brainstem.The link to the video can be found at: https://youtu.be/aIw-O2Ryleg.

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Retrosigmoid Craniotomy for the Removal of Left Sided Tentorial and Posterior Fossa Meningioma Combined with Microvascular Decompression for Hemifacial Spasm

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1675167 ◽

2018 ◽

Vol 80 (S 03) ◽

pp. S294-S295

Author(s):

Yu-Wen Cheng ◽

Chun-Yu Cheng ◽

Zeeshan Qazi ◽

Laligam N. Sekhar

Keyword(s):

Facial Nerve ◽

Hemifacial Spasm ◽

Microvascular Decompression ◽

Preoperative Imaging ◽

Superior Cerebellar Artery ◽

Anterior Inferior Cerebellar Artery ◽

Root Exit Zone ◽

Tentorial Meningioma ◽

Cerebellar Artery ◽

The Right

This 68-year-old woman presented with repeated episodes of bilateral hemifacial spasm with headache for 5 years and with recent progression of left sided symptoms. Preoperative imaging showed a left sided tentorial meningioma with brain stem and cerebellar compression. Left facial nerve was compressed by the vertebral artery (VA) and the right facial nerve by the anterior inferior cerebellar artery (AICA). This patient underwent left side retrosigmoid craniotomy and mastoidectomy. The cisterna magna was drained to relax the brain. The tumor was very firm, attached to the tentorium and had medial and lateral lobules. The superior cerebellar artery was adherent to the lateral lobule of the tumor and dissected away. The tumor was detached from its tentorial base; we first removed the lateral lobule. Following this, the medial lobule was also completely dissected and removed. The root exit zone of cranial nerve (CN) VII was dissected and exposed. The compression was caused both by a prominent VA and AICA. Initially, the several pieces of Teflon felt were placed for the decompression. Then vertebropexy was performed by using 8–0 nylon suture placed through the VA media to the clival dura. A further piece of Teflon felt was placed between cerebellopontine angle region and AICA. Her hemifacial spasm resolved postoperatively, and she discharged home 1 week later. Postoperative imaging showed complete tumor removal and decompression of left CN VII. This video shows the complex surgery of microsurgical resection of a large tentorial meningioma and microvascular decompression with a vertebropexy procedure.The link to the video can be found at: https://youtu.be/N5aHN9CRJeM.

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Traumatic false aneurysm of the superior cerebellar artery simulating posterior fossa tumor

Journal of Neurosurgery ◽

10.3171/jns.1977.46.3.0377 ◽

1977 ◽

Vol 46 (3) ◽

pp. 377-380 ◽

Cited By ~ 17

Author(s):

H. Howard Cockrill ◽

John P. Jimenez ◽

John A. Goree

Keyword(s):

Posterior Fossa ◽

False Aneurysm ◽

Superior Cerebellar Artery ◽

Content Type ◽

Specific Diagnosis ◽

Cerebellar Artery ◽

Brain Scan ◽

The Right ◽

Angiographic Findings ◽

Fine Print

✓ An example of traumatic false aneurysm of the right superior cerebellar artery is described. The chronicity of the clinical picture and a positive brain scan strongly suggested a posterior fossa neoplasm; however, the angiographic findings permitted a specific diagnosis to be made.

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GIANT FUSIFORM ANEURYSM ARISING FROM FENESTRATED POSTERIOR CEREBRAL ARTERY AND BASILAR TIP VARIATION

Neurosurgery ◽

10.1227/01.neu.0000338431.70709.81 ◽

2009 ◽

Vol 64 (3) ◽

pp. E564-E565 ◽

Cited By ~ 6

Author(s):

Marco A. Zanini ◽

Vitor M. Pereira ◽

Mauricio Jory ◽

José G.M.P. Caldas

Keyword(s):

Cerebral Artery ◽

Posterior Cerebral Artery ◽

Superior Cerebellar Artery ◽

Fusiform Aneurysm ◽

Parent Vessel ◽

Vessel Occlusion ◽

Cerebellar Artery ◽

Parent Vessel Occlusion ◽

The Right ◽

Double Origin

Abstract OBJECTIVE A giant fusiform aneurysm in the posterior cerebral artery (PCA) is rare, as is fenestration of the PCA and basilar apex variation. We describe the angiographic and surgical findings of a giant fusiform aneurysm in the P1–P2 PCA segment associated with PCA bilateral fenestration and superior cerebellar artery double origin. CLINICAL PRESENTATION A 26-year-old woman presented with a 2-month history of visual blurring. Digital subtraction angiography showed a giant (2.5 cm) fusiform PCA aneurysm in the right P1–P2 segment. The 3-dimensional view showed a caudal fusion pattern from the upper portion of the basilar artery associated with a bilateral long fenestration of the P1 and P2 segments and superior cerebellar artery double origin. INTERVENTION Surgical trapping of the right P1–P2 segment, including the posterior communicating artery, was performed by a pretemporal approach. Angiograms performed 3 and 13 months after surgery showed complete aneurysm exclusion, and the PCA was permeated and filled the PCA territory. Clinical follow-up at 14 months showed the patient with no deficits and a return to normal life. CONCLUSION To our knowledge, this is the first report of a giant fusiform aneurysm of the PCA associated with P1–P2 segment fenestration and other variations of the basilar apex (bilateral superior cerebellar artery duplication and caudal fusion). Comprehension of the embryology and anatomy of the PCA and its related vessels and branches is fundamental to the decision-making process for a PCA aneurysm, especially when parent vessel occlusion is planned.

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Flow diversion and microvascular plug occlusion for the treatment of a complex unruptured basilar/superior cerebellar artery aneurysm: case report

Journal of Neurosurgery ◽

10.3171/2018.1.jns172465 ◽

2019 ◽

Vol 130 (6) ◽

pp. 1978-1983 ◽

Cited By ~ 1

Author(s):

Jan-Karl Burkhardt ◽

Howard A. Riina ◽

Omar Tanweer ◽

Peyman Shirani ◽

Eytan Raz ◽

...

Keyword(s):

Case Report ◽

Treatment Options ◽

Artery Aneurysm ◽

Mass Effect ◽

Superior Cerebellar Artery ◽

Cerebellar Artery ◽

Endovascular Approach ◽

Aneurysm Occlusion ◽

The Right

The authors present the unusual case of a complex unruptured basilar artery terminus (BAT) aneurysm in a 42-year-old symptomatic female patient presenting with symptoms of mass effect. Due to the fusiform incorporation of both the BAT and left superior cerebellar artery (SCA) origin, simple surgical or endovascular treatment options were not feasible in this case. A 2-staged (combined deconstructive/reconstructive) procedure was successfully performed: first occluding the left SCA with a Pipeline embolization device (PED) coupled to a microvascular plug (MVP) in the absence of antiplatelet coverage, followed by reconstruction of the BAT by deploying a second PED from the right SCA into the basilar trunk. Six-month follow-up angiography confirmed uneventful aneurysm occlusion. The patient recovered well from her neurological symptoms. This case report illustrates the successful use of a combined staged deconstructive/reconstructive endovascular approach utilizing 2 endoluminal tools, PED and MVP, to reconstruct the BAT and occlude a complex aneurysm.

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Case Report: Endovascular Treatment of a Giant Distal PICA Aneurysm in Association With a Cerebellar AVM: A Report on Treatment Considerations and a Literature Review

Frontiers in Neurology ◽

10.3389/fneur.2020.611377 ◽

2020 ◽

Vol 11 ◽

Author(s):

Hassan A. Khayat ◽

Christine M. Hawkes ◽

Almunder R. Algird

Keyword(s):

Posterior Inferior Cerebellar Artery ◽

Superior Cerebellar Artery ◽

Management Approach ◽

Parent Vessel ◽

Cerebral Angiogram ◽

First Case ◽

Cerebellar Artery ◽

Risk Of Rupture ◽

The Right ◽

Pica Aneurysms

Background: Distal posterior inferior cerebellar artery (PICA) aneurysms are uncommon intracranial vascular lesions. The coincidence of these aneurysms and Arteriovenous malformation (AVM) is even more rare. Since 1956, a total of 57 cases of distal PICA aneurysms associated with AVM have been reported with clear and adequate description. None of these reports describe a giant prenidal aneurysm at this particular location. The paucity of natural history data as well as lack of consensus about treatment strategies in such cases present a significant challenge that requires an individualized management approach.Case Description: A 68-year-old male presented with recurrent episodes of nausea and vomiting precipitated by physical exertion and change of head position. An MRI of the brain demonstrated a giant partially thrombosed right posterior inferior cerebellar artery (PICA) aneurysm with mass effect on the floor of the fourth ventricle. A conventional cerebral angiogram revealed a giant (3.1 x 3.1 x 2.8cm) distal right PICA pre-nidal aneurysm with two smaller distal PICA aneurysms. An AVM (Spetzler-Martin Grade 1) supplied by the right PICA as well as the right superior cerebellar artery (SCA) was also identified on cerebral angiography (not seen on an MRI). Endovascular coil embolization with parent vessel sacrifice was performed to occlude the giant aneurysm. Due to the asymptomatic nature, low risk of rupture, and the patient's age, AVM treatment was deferred.Conclusion: This paper presents the first case of a giant PICA aneurysm associated with cerebellar AVM. For PICA aneurysm-AVM complexes, meticulous evaluation of the morphology, associated anatomy, and comparative risk analysis for both lesions are key for treatment planning. Distal PICA aneurysms can be treated safely with parent vessel occlusion, particularly in the case of prenidal aneurysms.

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Morphological Characteristics of the Superior Cerebellar Artery/ Морфолошки Карактеристики На Горната Церебеларна Артерија

PRILOZI ◽

10.1515/prilozi-2015-0032 ◽

2015 ◽

Vol 36 (1) ◽

pp. 80-84

Author(s):

Ace Dodevski ◽

Dobrila Tosovska Lazarova ◽

Julija Zhivadinovik ◽

Menka Lazareska ◽

Elizabeta Stojovska-Jovanovska

Keyword(s):

Basilar Artery ◽

Morphological Characteristics ◽

Clinical Work ◽

Daily Basis ◽

Superior Cerebellar Artery ◽

Adult Type ◽

New Techniques ◽

Cerebellar Artery ◽

The Right ◽

The University

Abstract With the introduction of new techniques in diagnostic and interventional radiology and progress in micro neurosurgery, accurate knowledge of the brain blood vessels is essential for daily clinical work. The aim of this study was to describe the morphological characteristics of the superior cerebellar artery and to emphasize their clinical significance. In this study we examined radiographs of 109 patients who had CT angiography at the University Clinic for Radiology in Skopje, R. Macedonia. This study included 49 females and 60 males, ranging in age from 27 to 83 years; mean age 57.4 ± 11.8 years. In 105 patients SCA arose from the basilar artery on both sides as a single vessel. In two patients SCA arose as a duplicate trunk from the basilar artery. We found unilateral duplication on the right SCA in one patient, and bilateral duplication in one patient. In two patients was noticed origin of the SCA from PCA as a single trunk from adult type of the PCA. Through knowledge of the anatomy and variations of SCA is important for clinicians as well as basic scientists who deal with problems related to intracranial vasculature in daily basis for save performance of diagnostic and interventional procedures.

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A Case of Dentatotomy for Pain and Spasticity and Systematic Review

Stereotactic and Functional Neurosurgery ◽

10.1159/000516423 ◽

2021 ◽

pp. 1-5

Author(s):

Francisco Alberto Villegas-López ◽

Armando Armas-Salazar ◽

Jesús Q. Beltrán ◽

Noé Téllez-León ◽

Ana Arellano-Alcántara ◽

...

Keyword(s):

Dentate Nucleus ◽

Cervical Spinal Cord ◽

Lower Extremities ◽

Progressive Increase ◽

Spastic Diplegia ◽

Surgical Interventions ◽

Cord Injury ◽

Intraoperative Electrophysiological Monitoring ◽

Cerebellar Dentate Nucleus ◽

The Right

Background: Surgical interventions for spasticity aim to improve motor function and pain in cases that are refractory to medical treatment. Ablation of the cerebellar dentate nucleus (dentatotomy) may be a useful alternative. Case Report: A 55-year-old male patient with spasticity, secondary to a traumatic cervical spinal cord injury with quadriparesis, had bilateral lumbar DREZotomy with an improvement that lasted for 6 years. Ten years after the DREZotomy, a progressive increased spasticity manifested as spastic diplegia (Ashworth 4) and spontaneous muscle painful spasms (Penn 4), as well as spasticity in the upper extremities, predominantly on the right side (Ashworth 3). A right radio frequency dentatotomy was performed with intraoperative electrophysiological monitoring. Spasticity scales were applied at the following times: preoperative and at 1 and 8 months after surgery. During the first month, the patient presented a clear decrease in spasticity ipsilateral to the side of lesioning (Ashworth 1) and of painful spasms in the lower extremities (Penn 1). After 8 months, spasticity ipsilateral to the injury decreased even more to Ashworth (0), but a progressive increase in muscle spasms of lower extremities was observed (Penn 2). Conclusion: Stereotactic dentatotomy may be an effective surgical alternative for management of spasticity associated with painful spasms in selected patients.

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Fusiform superior cerebellar artery aneurysm treated with flow diversion: A case report

Surgical Neurology International ◽

10.25259/sni_556_2020 ◽

2020 ◽

Vol 11 ◽

pp. 330

Author(s):

Yafell Serulle ◽

Deepak Khatri ◽

Jada Fletcher ◽

Anna Pappas ◽

Audrey Heidbreder ◽

...

Keyword(s):

Artery Aneurysm ◽

Flow Diversion ◽

Superior Cerebellar Artery ◽

Parent Artery ◽

Fusiform Aneurysm ◽

Parent Vessel ◽

Pipeline Embolization Device ◽

Head Ct ◽

Cerebellar Artery ◽

The Right

Background: Fusiform aneurysms of the distal superior cerebellar artery are rare and challenging to treat. Due to the rarity of these lesions, there is little consensus regarding their management. Treatment options have traditionally included parent artery sacrifice with either an endovascular approach or microsurgical clipping. Given the small diameter of the superior cerebellar artery, flow diversion has not been typically considered as a viable treatment option for these aneurysms. Case Description: A 67-year-old female presented complaining of severe sudden onset headache. Noncontrast head CT demonstrated no intracranial hemorrhage. Head CT angiogram demonstrated a 4.2 mm fusiform aneurysm in the distal right superior cerebellar artery. The patient underwent treatment with the Pipeline embolization device which was deployed in the right superior cerebellar artery covering the aneurysm. Six-month posttreatment follow-up angiogram demonstrated resolution of the aneurysm with patency of the parent vessel. Conclusion: To the best of our knowledge, this is the first report of a distal superior cerebellar artery aneurysm treated with the Pipeline embolization device. The use of a Pipeline stent to create flow diversion should be considered in a case of a fusiform aneurysm of the right superior cerebellar artery. Treatment with flow diversion may allow for the treatment of the aneurysm while preserving patency of the parent vessel.

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