scholarly journals Radiological anatomy of the intracranial vertebral artery in a select South African cohort of patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
B. R. Omotoso ◽  
R. Harrichandparsad ◽  
K. S. Satyapal ◽  
I. G. Moodley ◽  
L. Lazarus
Keyword(s):  
Vertebral Artery ◽  
South African ◽  
Anatomical Variation ◽  
Posterior Inferior Cerebellar Artery ◽  
Vascular Diseases ◽  
Retrospective Chart Review ◽  
Anatomical Variations ◽  
Neurological Complications ◽  
Radiological Anatomy ◽  
Total Prevalence

AbstractThe intracranial segment of the vertebral artery (VA) is the unique part of the artery where the two VAs join to form a single vascular channel, viz. the basilar artery. In addition to this typical description, anatomical variations have been described; the presence of anatomical variation has been associated with some pathological processes, neurological complications, and the risk of vascular diseases in the posterior circulatory territory. We evaluated the typical anatomical features and variations of the VA4 component of the VA in a South African population to provide useful data on the prevalence of variation and morphometry of the distal VA. The study is an observational, retrospective chart review of 554 consecutive South African patients (Black, Indian, and Caucasian) who had been examined with multidetector computed tomography angiography (MDCTA) from January 2009 to September 2019. We observed various anatomical variations in the VA4 segment of the VA. We report the incidence of VA hypoplasia, hypoplastic terminal VA, and atresia. Fenestration and duplicate posterior inferior cerebellar artery (PICA) origin were also observed. The left intracranial VA was significantly larger than the right. Our study shows that anatomical variation of the intracranial VA is common in the population studied, with a total prevalence of 36.5%. Understanding the patterns of anatomical variations of the VAs will contribute significantly to the interpretation of ischemic areas and diagnosis of various diseases in the posterior circulatory territory.

Anatomical Variations and Dimension of the Intracranial Vertebral Artery: Evaluation With Multidetector Computed Tomography Angiography

2021 ◽  
Author(s):  
Bukola Omotoso ◽  
Rohen Harrichandparsad ◽  
Kapil Satyapal ◽  
Indheresan Moodley ◽  
Lelika Lazarus
Keyword(s):  
Computed Tomography ◽  
Vertebral Artery ◽  
Multidetector Computed Tomography ◽  
South African ◽  
Basilar Artery ◽  
Computed Tomography Angiography ◽  
Anatomical Variation ◽  
Posterior Inferior Cerebellar Artery ◽  
Anatomical Variations ◽  
Multidetector Computed Tomography Angiography

Abstract The intracranial segment of the vertebral artery (VA) is the unique part of the artery where the two VAs join to form a single vascular channel, viz. the basilar artery. In addition to this typical description, anatomical variations have been described; the presence of anatomical variation has been associated with some pathological processes, neurological complications, and the risk of vascular diseases in the posterior circulatory territory. We evaluated the typical anatomical features and variations of the VA4 component of the VA in a South African population to provide useful data on the prevalence of variation and morphometry of the distal VA. The study is an observational, retrospective chart review of 554 consecutive South African patients (Black, Indian, and White) who had been examined with multidetector computed tomography angiography (MDCTA) from January 2009 to September 2019. We observed various anatomical variations in the VA4 segment of the VA. We report the incidence of VA hypoplasia, hypoplastic terminal VA, and atresia. Fenestration and duplicate posterior inferior cerebellar artery (PICA) origin were also observed. The left intracranial VA was significantly larger than the right. Our study shows that anatomical variation of the intracranial VA is common in the population studied, with a total prevalence of 36.5%. Imaging of the entire course of the VA from the origin to the point of convergence to form the basilar artery may be necessary to decide a treatment strategy for interventions in the vicinity of the VA.

scholarly journals An anatomical investigation of the proximal vertebral arteries (V1, V2) in a select South African population

2021 ◽  
Author(s):  
B. R. Omotoso ◽  
R. Harrichandparsad ◽  
I. G. Moodley ◽  
K. S. Satyapal ◽  
L. Lazarus
Keyword(s):  
South African ◽  
Anatomical Variation ◽  
Retrospective Chart Review ◽  
Anatomical Variations ◽  
Arterial Injury ◽  
Vascular Complication ◽  
African Population ◽  
South African Population ◽  
Transverse Foramen ◽  
Cervical Spine Surgery

Abstract Introduction The most common type of vascular complication during cervical spine surgery is the vertebral artery (VA) injury. The presence of anatomical variation in the artery's morphology has been a significant factor for arterial injury during surgery. Therefore, physicians planning interventions in the craniospinal region need to be aware of the extents of variations. In addition to vascular injury, anatomical variations can predispose to some pathologies in the posterior circulation territory. To provide useful data to interventional radiologists, anatomists, and surgeons, we evaluated the anatomical features of the V1 and V2 segments of the VA in a South African population. Materials and methods The study is an observational, retrospective chart review of 554 consecutive South African patients (Black, Indian and White) who had undergone computed tomography angiography (CTA) from January 2009 to September 2019. Results The VA exhibited morphological variation in its course. We report the incidence of variant origin of the left VA, all from the aortic arch. Variation in the level of entry into the transverse foramen ranged between C7 and C3. A left dominant pattern was observed; we also report on hypoplasia of the VA. In addition, we report incidence of VA tortuosity at V1, V2 to be 76.6% and 32.1%, respectively. Conclusions The baseline data established in this study regarding the diameter, variant origin, and level of entry into the transverse foramen will assist neurosurgeons and interventional radiologists in interpreting, diagnosing, and planning and executing various vascular procedures and treatment of pathology in the vicinity of the VA.

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.

Calcaneal Osteotomy Safe Zone to Prevent Neurological Damage: Fact or Fiction?

2018 ◽  
Vol 12 (1) ◽  
pp. 34-38
Author(s):  
Bradley Wills ◽  
Sung Ro Lee ◽  
Parke William Hudson ◽  
Bahman SahraNavard ◽  
Cesar de Cesar Netto ◽  
...  
Keyword(s):  
Nerve Injury ◽  
Anatomical Variation ◽  
Retrospective Chart Review ◽  
Plantar Fascia ◽  
Neurological Complications ◽  
Safe Zone ◽  
Reference Line ◽  
Calcaneal Osteotomy ◽  
Significant Difference ◽  
Osteotomy Line

Background. Calcaneal osteotomy is a commonly used surgical option for the correction of hindfoot malalignment. A previous cadaveric study described a neurological “safe zone” for calcaneal osteotomy. We performed a retrospective chart review to evaluate the presence of neurological injuries following calcaneal osteotomies and the location of the osteotomy in relation to the reported safe zone. Methods. In this retrospective study, we reviewed charts of patients who underwent calcaneal osteotomy at our institution from 2011 to 2015. All immediate postoperative radiographs were examined and the shortest distance between the calcaneal osteotomy line and a reference line connecting the posterior superior apex of the calcaneal tuberosity to the origin of the plantar fascia was measured. If the osteotomy line was positioned within an area 11.2 mm anterior to the reference line, it was considered to be inside the neurological safe zone. We correlated the positioning of the osteotomy with the presence of postoperative neurological complications. Results. We identified 179 calcaneal osteotomy cases. Of the 174 (97.2%) nerve injury-free cases, 62.6% (109/174) were performed inside the defined “safe zone” while 37.4% (65/174) outside. A total of 5 (2.8%) nerve complications were identified: 3 (60%) were inside the safe zone and 2 (40%) outside the safe zone. Osteotomies outside the safe zone had a 1.114 relative risk of nerve injury with a 95% CI of 0.191 to 6.500 and showed no statistically significant difference ( P = .9042). Conclusion. Our findings suggest that the clinical “safe zone” in calcaneal osteotomies may not actually exist, likely because of wide anatomical variation of the implicated nerves, as described in prior studies. Patients should be properly counseled preoperatively on the low, but seemingly fixed, risk of nerve injury before undergoing calcaneal osteotomy. Levels of Evidence: Level III: Retrospective comparative study

Posterolateral protrusion of the vertebral artery over the posterior arch of the atlas: quantitative anatomical study using three-dimensional computed tomography angiography

2008 ◽  
Vol 9 (2) ◽  
pp. 167-174 ◽  
Author(s):  
Satoshi Yamaguchi ◽  
Kuniki Eguchi ◽  
Yoshihiro Kiura ◽  
Masaaki Takeda ◽  
Kaoru Kurisu
Keyword(s):  
Vertebral Artery ◽  
Ct Angiography ◽  
Preoperative Evaluation ◽  
Posterior Inferior Cerebellar Artery ◽  
Three Dimensional ◽  
Anatomical Variations ◽  
Posterior Arch ◽  
Outer Cortex ◽  
The Right ◽  
Dominant Side

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.

scholarly journals Treatment of posterior circulation fusiform aneurysms

2020 ◽  
pp. 1-7
Author(s):  
Ephraim W. Church ◽  
Mark G. Bigder ◽  
Eric S. Sussman ◽  
Santosh E. Gummidipundi ◽  
Summer S. Han ◽  
...  
Keyword(s):  
Neurological Complication ◽  
Posterior Inferior Cerebellar Artery ◽  
Retrospective Chart Review ◽  
Neurological Complications ◽  
Posterior Circulation ◽  
Flow Diversion ◽  
Interdisciplinary Treatment ◽  
Complication Rates ◽  
The Difference

OBJECTIVEPerforator arteries, the absence of an aneurysm discrete neck, and the often-extensive nature of posterior circulation fusiform aneurysms present treatment challenges. There have been advances in microsurgical and endovascular approaches, including flow diversion, and the authors sought to review these treatments in a long-term series at their neurovascular referral center.METHODSThe authors performed a retrospective chart review from 1990 to 2018. Primary outcomes were modified Rankin Scale (mRS) scores and Glasgow Outcome Scale (GOS) scores at follow-up. The authors also examined neurological complication rates. Using regression techniques, they reviewed independent and dependent variables, including presenting features, aneurysm location and size, surgical approach, and pretreatment and posttreatment thrombosis.RESULTSEighty-four patients met the inclusion criteria. Their mean age was 53 years, and 49 (58%) were female. Forty-one (49%) patients presented with subarachnoid hemorrhage. Aneurysms were located on the vertebral artery (VA) or posterior inferior cerebellar artery (PICA) in 50 (60%) patients, basilar artery (BA) or vertebrobasilar junction (VBJ) in 22 (26%), and posterior cerebral artery (PCA) in 12 (14%). Thirty-one (37%) patients were treated with microsurgical and 53 (63%) with endovascular approaches. Six aneurysms were treated with endovascular flow diversion. The authors found moderate disability or better (mRS score ≤ 3) in 85% of the patients at a mean 14-month follow-up. The GOS score was ≥ 4 in 82% of the patients. The overall neurological complication rate was 12%. In the regression analysis, patients with VA or PICA aneurysms had better functional outcomes than the other groups (p < 0.001). Endovascular strategies were associated with better outcomes for BA-VBJ aneurysms (p < 0.01), but microsurgery was associated with better outcomes for VA-PICA and PCA aneurysms (p < 0.05). There were no other significant associations between patient, aneurysm characteristics, or treatment features and neurological complications (p > 0.05). Patients treated with flow diversion had more complications than those who underwent other endovascular and microsurgical strategies, but the difference was not significant in regression models.CONCLUSIONSPosterior circulation fusiform aneurysms remain a challenging aneurysm subtype, but an interdisciplinary treatment approach can result in good outcomes. While flow diversion is a useful addition to the armamentarium, traditional endovascular and microsurgical techniques continue to offer effective options.

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

2018 ◽  
Vol 28 (2) ◽  
pp. 154-159 ◽  
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.

scholarly journals Recurrent artery of Heubner - morphological variations

2013 ◽  
Vol 19 (3) ◽  
pp. 141-146 ◽  
Author(s):  
Cr.P. Dimitriu ◽  
D.M. Iliescu ◽  
P. Bordei ◽  
I. Bulbuc
Keyword(s):  
Anterior Part ◽  
Anatomical Variation ◽  
Vascular Anatomy ◽  
Internal Capsule ◽  
Anatomical Variations ◽  
Neurological Complications ◽  
Circle Of Willis ◽  
Anterior Communicating Artery ◽  
Neurosurgical Procedures ◽  
Anterior Portion

Abstract Recurrent artery of Heubner (RAH) is the largest and most constant perforating branch of anterior cerebral artery. It supplies blood to the medial portion of the orbitofrontal cortex, the anterior portion of the caudate nucleus, the anterior third of the putamen, the external segment of the globus pallidus, and the anterior crus of the internal capsule The anatomical variation of RAH is related to its traject, number, presence, or absence, and the diverse origin from ACA is of considerable clinical impact mainly from the point of view of the surgical procedures involving the anterior portion of the circle of Willis or the topographically related structures. The present study aimed to demonstrate vascular anatomy of this RAH and its variation. The study included 60 human cadaveric brains fixed in the formalin and examined under operating microscope. 22 freshly harvested human cadaveric brains, injected with a polymer (Technovit 7143), a partial coroded and also we have consulted 30 digital subtraction angiograms. We have evaluated the origin, traject and caliber of recurrent artery of Heubner, our results were compared with other anatomical studies published. The most obvious finding was the great variability of its origin but in 91% of the cases it was in the range of 2mm around anterior communicating artery, that could be harmed during aneurismal clipping. The RAH is commonly arising from ACA-ACoA junction. This portion of the circle of Willis is the place of many anatomical variations and malformations. The vessel can be absent, single, or multiple, and its diameter is highly variable. The awareness of these distinct anatomical and morphometric variations of the RAH is essential in planning the neurosurgical procedures in the anterior part of the circle of Willis to avoid the unexpected neurological complications.

scholarly journals Anatomical variations of posterior inferior cerebellar artery (PICA) on digital subtraction angiography (DSA)

2021 ◽  
Vol 7 (1) ◽  
pp. 54-60
Author(s):  
Dileep Reddy Ayapaneni ◽  
Surekha Srikonda ◽  
Krishna Teja Nerella ◽  
Latha P. Reddy
Keyword(s):  
Vertebral Artery ◽  
Digital Subtraction Angiography ◽  
Posterior Inferior Cerebellar Artery ◽  
Age Groups ◽  
Anatomical Variations ◽  
Distal Segment ◽  
Craniovertebral Junction ◽  
Digital Subtraction ◽  
Anatomic Variations ◽  
Cerebellar Artery

Introduction: The posterior inferior cerebellar artery (PICA) often exhibits anatomical variations at the craniovertebral junction. Few studies investigated variations of the posterior inferior cerebellar artery, and the prevalence of other variations has not been reported. The study aimed to identify variations of the posterior inferior cerebral artery using cerebral Digital Subtraction Angiography (DSA). Method: 50 patients underwent 64-slice cerebral Digital Subtraction Angiography. Four types of variations were observed. Results: Out of a total of 50 patients, 23 (46%) were males and 27 (54%) females (all age groups). Our study has shown the utility of the 2 sequences - fluoroscopy and cine. All 2 sequences have their significance in evaluating anatomical variations in PICA. Only 20% of the 50 patients had all the posterior inferior cerebellar artery without anatomical variations. Anatomic variations commonly involve the distal segment of the vertebral artery (VA). Most of them are seen arising from the C1, C2, and both C1 and C2 origins. Anatomic variations involve arising from the C1 origin in 9 patients, C2 origin in 11 patients, C1 & C2 origin in 8 patients, and other variations observed in 12 patients. Conclusion: Variations of the posterior inferior cerebellar artery can be easily evaluated by cerebral Digital Subtraction Angiography (CDSA). Recognizing and reporting them at cerebral CDSA may be clinically important. Surgeons should be mindful of this variation during operations.

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