Microsurgical Anatomy of the Superior Cerebellar Artery

ABSTRACT The increasing use of microsurgical decompression for trigeminal neuralgia has created a need for more detailed anatomical information about the approach. To define better this anatomy, 10 cerebellar specimens obtained at autopsy were examined, and intraoperative findings in 30 patients with trigeminal neuralgia were analyzed. Since the infratentorial subdural space on the tentorial cerebellar surface is exposed to explore the trigeminal nerve in the infratentorial lateral supracerebellar approach, attention was directed to the following: the anterolateral margin of the cerebellar hemisphere, bridging veins on the tentorial surface, superior petrosal veins, and relationships between blood vessels and the trigeminal nerve. The lateral mesencephalic segment of the superior cerebellar artery at or near the bifurcation often compressed the nerve laterally at more than one point. With this approach, the relationship of the superior cerebellar artery to the nerve could be observed from the medial side of the tentorial surface. The infratentorial lateral supracerebellar approach is discussed and compared to Dandy's cerebellar route.

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Microsurgical anatomy of the superior cerebellar artery

Neurosurgery ◽

10.1097/00006123-198001000-00002 ◽

1980 ◽

Vol 6 (1) ◽

pp. 10???28 ◽

Cited By ~ 14

Author(s):

D G Hardy ◽

D A Peace ◽

A L Rhoton

Keyword(s):

Superior Cerebellar Artery ◽

Microsurgical Anatomy ◽

Cerebellar Artery

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On the Surgical Implications of Peritrigeminal Perforating Vessels in Microvascular Decompression

Operative Neurosurgery ◽

10.1093/ons/opy325 ◽

2018 ◽

Vol 17 (2) ◽

pp. 193-201 ◽

Cited By ~ 1

Author(s):

Paolo di Russo ◽

Tao Xu ◽

Michael A Cohen ◽

Paolo Perrini ◽

Philip E Stieg ◽

...

Keyword(s):

Microvascular Decompression ◽

Cerebellopontine Angle ◽

Superior Cerebellar Artery ◽

Anterior Inferior Cerebellar Artery ◽

Type I ◽

Microsurgical Anatomy ◽

Type Ii ◽

Parent Vessel ◽

Cerebellar Artery ◽

Trigeminal Root

Abstract BACKGROUND Perforating branches arising from the superior cerebellar artery (SCA) or anterior inferior cerebellar artery (AICA) that pierces the brainstem within 5 mm of the trigeminal root may limit offending vessel transposition during microvascular decompression for trigeminal neuralgia. OBJECTIVE To investigate the microsurgical anatomy of peritrigeminal perforators and evaluate their effect on the mobility of the SCA and AICA. Additionally, we propose strategies for mitigating the potential complications caused by the presence of short peritrigeminal perforators. METHODS Retrosigmoid approaches and exposure of the upper cerebellopontine angle were performed on 11 cadaveric heads (22 sides). The number, origin, and course of perforators were recorded and each was classified as either type I, short straight (<3 mm); type II, long straight perforators (>3 mm); or type III, long circumflex (>3 mm). Transposition of each SCA and AICA away from trigeminal nerve was performed, and degree of mobilization was evaluated and graded. RESULTS A total of 123 perforators were identified, of which 44 were considered peritrigeminal. Of these, 19 arose from the AICA, 18 from the SCA, and 7 from the basilar artery. Type I peritrigeminal perforators were the most common at 77.3%. Transposition or interposition of the parent vessel was not possible in 8 (47.1%) instances. CONCLUSION Identification of inhibiting perforators is essential before performing microvascular decompression to avoid ischemic injury to the brainstem. The presence of type I perforators may necessitate extensive arachnoid dissection and use of an interpositioning technique with minimal repositioning of the offending vessel.

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Microsurgical anatomy of the pineal region

Journal of Neurosurgery ◽

10.3171/jns.1980.53.2.0205 ◽

1980 ◽

Vol 53 (2) ◽

pp. 205-221 ◽

Cited By ~ 68

Author(s):

Isao Yamamoto ◽

Naoki Kageyama

Keyword(s):

Cranial Nerves ◽

Pineal Region ◽

Superior Cerebellar Artery ◽

Cerebral Vein ◽

Microsurgical Anatomy ◽

Content Type ◽

Cerebellar Artery ◽

Bridging Vein ◽

Tentorial Notch ◽

Relationship Of

✓ Thirty cadaver brains were examined under × 6 to 16 magnification in order to define the microsurgical anatomy of the pineal region, particularly the relationship of the pineal body, posterior cerebral artery, superior cerebellar artery, vein of Galen, basal vein of Rosenthal, internal cerebral vein, straight sinus, bridging vein, the size of the tentorial notch, and the third and the fourth cranial nerves. The infratentorial and supratentorial approaches to the pineal region are compared from the viewpoint of microsurgical anatomy.

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Segmental anatomy of cerebellar arteries: a proposed nomenclature

Journal of Neurosurgery ◽

10.3171/2011.3.jns101413 ◽

2011 ◽

Vol 115 (2) ◽

pp. 387-397 ◽

Cited By ~ 30

Author(s):

Ana Rodríguez-Hernández ◽

Albert L. Rhoton ◽

Michael T. Lawton

Keyword(s):

Cerebral Arteries ◽

Posterior Inferior Cerebellar Artery ◽

Superior Cerebellar Artery ◽

Anterior Inferior Cerebellar Artery ◽

Microsurgical Anatomy ◽

Numbering System ◽

Segmental Anatomy ◽

Cerebellar Artery ◽

Intracranial Arteries

Object The conceptual division of intracranial arteries into segments provides a better understanding of their courses and a useful working vocabulary. Segmental anatomy of cerebral arteries is commonly cited by a numerical nomenclature, but an analogous nomenclature for cerebellar arteries has not been described. In this report, the microsurgical anatomy of the cerebellar arteries is reviewed, and a numbering system for cerebellar arteries is proposed. Methods Cerebellar arteries were designated by the first letter of the artery's name in lowercase letters, distinguishing them from cerebral arteries with the same first letter of the artery's name. Segmental anatomy was numbered in ascending order from proximal to distal segments. Results The superior cerebellar artery was divided into 4 segments: s1, anterior pontomesencephalic segment; s2, lateral pontomesencephalic segment; s3, cerebellomesencephalic segment; and s4, cortical segment. The anterior inferior cerebellar artery was divided into 4 segments: a1, anterior pontine segment; a2, lateral pontine segment; a3, flocculopeduncular segment; and a4, cortical segment. The posterior inferior cerebellar artery was divided into 5 segments: p1, anterior medullary segment; p2, lateral medullary segment; p3, tonsillomedullary segment; p4, telovelotonsillar segment; and p5, cortical segment. Conclusions The proposed nomenclature for segmental anatomy of cerebellar artery complements established nomenclature for segmental anatomy of cerebral arteries. This nomenclature is simple, easy to learn, and practical. The nomenclature localizes distal cerebellar artery aneurysms and also localizes an anastomosis or describes a graft's connections to donor and recipient arteries. These applications of the proposed nomenclature with cerebellar arteries mimic the applications of the established nomenclature with cerebral arteries.

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Microsurgical Anatomy and Territories of Perfusion of the Superior Cerebellar Artery

Cerebellar Infarct. Midline Tumors. Minimally Invasive Endoscopic Neurosurgery (MIEN) - Advances in Neurosurgery ◽

10.1007/978-3-642-78801-7_2 ◽

1994 ◽

pp. 5-10

Author(s):

S. Hussein ◽

D. Woischneck ◽

S. Schulze

Keyword(s):

Superior Cerebellar Artery ◽

Microsurgical Anatomy ◽

Cerebellar Artery

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The oculomotor-tentorial triangle. Part 1: microsurgical anatomy and techniques to enhance exposure

Journal of Neurosurgery ◽

10.3171/2018.1.jns173139 ◽

2019 ◽

Vol 130 (5) ◽

pp. 1426-1434 ◽

Cited By ~ 3

Author(s):

Ali Tayebi Meybodi ◽

Sirin Gandhi ◽

Justin Mascitelli ◽

Baran Bozkurt ◽

Gyang Bot ◽

...

Keyword(s):

Temporal Lobe ◽

Posterior Cerebral Artery ◽

Oculomotor Nerve ◽

Posterior Circulation ◽

Vascular Lesions ◽

Superior Cerebellar Artery ◽

Microsurgical Anatomy ◽

Cavernous Malformations ◽

Anatomical Features ◽

Cerebellar Artery

OBJECTIVEAccess to the ventrolateral pontomesencephalic area may be required for resecting cavernous malformations, performing revascularization of the upper posterior circulation, and treating vascular lesions such as aneurysms. However, such access is challenging because of nearby eloquent structures. Commonly used corridors to this surgical area include the optico-carotid, supracarotid, and carotid-oculomotor triangles. However, the window lateral to the oculomotor nerve can also be used and has not been studied. The authors describe the anatomical window formed between the oculomotor nerve and the medial tentorial edge (the oculomotor-tentorial triangle [OTT]) to the ventrolateral pontomesencephalic area, and assess techniques to expand it.METHODSFour cadaveric heads (8 sides) underwent orbitozygomatic craniotomy. The OTT was exposed via a pretemporal approach. The contents of the OTT were determined and their anatomical features were recorded. Also, dimensions of the brainstem surface exposed lateral and inferior to the oculomotor nerve were measured. Measurements were repeated after completing a transcavernous approach (TcA), and after resection of temporal lobe uncus (UnR).RESULTSThe s1 segment and proximal s2 segment of the superior cerebellar artery (SCA) and P2A segment of the posterior cerebral artery (PCA) were the main contents of the OTT, with average exposed lengths of 6.4 ± 1.3 mm and 5.5 ± 1.6 mm for the SCA and PCA, respectively. The exposed length of the SCA increased to 9.6 ± 2.7 mm after TcA (p = 0.002), and reached 11.6 ± 2.4 mm following UnR (p = 0.004). The exposed PCA length increased to 6.2 ± 1.6 mm after TcA (p = 0.04), and reached 10.4 ± 1.8 mm following UnR (p < 0.001). The brainstem surface was exposed 7.1 ± 0.5 mm inferior and 5.6 ± 0.9 mm lateral to the oculomotor nerve initially. The exposure inferior to the oculomotor nerve increased to 9.3 ± 1.7 mm after TcA (p = 0.003), and to 9.9 ± 2.5 mm after UnR (p = 0.21). The exposure lateral to the oculomotor nerve increased to 8.0 ± 1.7 mm after TcA (p = 0.001), and to 10.4 ± 2.4 mm after UnR (p = 0.002).CONCLUSIONSThe OTT is an anatomical window that provides generous access to the upper ventrolateral pontomesencephalic area, s1- and s2-SCA, and P2A-PCA. This window may be efficiently used to address various pathologies in the region and is considerably expandable by TcA and/or UnR.

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Microsurgical anatomy of the choroidal arteries Fourth ventricle and cerebellopontine angles

Journal of Neurosurgery ◽

10.3171/jns.1980.52.4.0504 ◽

1980 ◽

Vol 52 (4) ◽

pp. 504-524 ◽

Cited By ~ 59

Author(s):

Kiyotaka Fujii ◽

Carla Lenkey ◽

Albert L. Rhoton

Keyword(s):

Choroid Plexus ◽

Fourth Ventricle ◽

Cerebellopontine Angle ◽

Posterior Inferior Cerebellar Artery ◽

Superior Cerebellar Artery ◽

Anterior Inferior Cerebellar Artery ◽

Microsurgical Anatomy ◽

Lateral Recess ◽

Lateral Segment ◽

Cerebellar Artery

✓ The microsurgical anatomy of the arteries supplying the choroid plexus in the fourth ventricle and cerebellopontine angles was examined under × 3 to × 20 magnification in brains from 25 adult cadavers. In the most common pattern, the branches of the anterior inferior cerebellar artery (AICA) supplied the portion of the choroid plexus in the cerebellopontine angle and adjacent part of the lateral recess of the fourth ventricle, and the posterior inferior cerebellar artery (PICA) supplied the choroid plexus in the roof and medial part of the lateral recess of the fourth ventricle. The superior cerebellar artery (SCA) gave rise to a choroidal branch in only one brain. The choroid plexus on each side of the midline was divided into a medial and a lateral segment. Each segment was considered two parts to facilitate the description of its blood supply. The medial segment, located in the roof of the fourth ventricle, was divided into a rostral or nodular part, and a caudal or tonsillar part. The lateral segment, located in the lateral recess of the fourth ventricle and cerebellopontine angle, was separated into a medial or peduncular part, and a lateral or floccular part. The AICA most commonly supplied all the floccular part and the lateral portion of the peduncular part, and the PICA most commonly supplied all of the tonsillar and nodular parts, and the medial portion of the peduncular part.

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