Dual Origin of Extradural Posterior Inferior Cerebellar Artery From Vertebral and Occipital Arteries: Anatomic Case Report

2015 ◽  
Vol 11 (4) ◽  
pp. 564-568 ◽  
Author(s):  
Ali Tayebi Meybodi ◽  
Michael T Lawton ◽  
Arnau Benet
Keyword(s):  
Vertebral Artery ◽  
Surgical Simulation ◽  
Posterior Inferior Cerebellar Artery ◽  
Craniovertebral Junction ◽  
Surgical Approaches ◽  
Occipital Artery ◽  
Direct Connection ◽  
Endovascular Interventions ◽  
Cerebellar Artery ◽  
Dual Origin

Abstract BACKGROUND Small anastomotic channels exist between the occipital artery (OA) and muscular branches of the vertebral artery; however, no direct connection has been reported between an extradural origin of the posterior inferior cerebellar artery (PICA) and the OA. OBJECTIVE To describe a rare anatomic connection between the extradural PICA and the OA. METHODS A far lateral exposure was completed on a cadaveric head prepared for surgical simulation. The course and branches of the OA were followed, and the relations to their immediate anatomic structures were studied. RESULTS The origin of the PICA was found at the second segment of the vertebral artery, between the C1 and C2 transverse foramina. There was a large anastomotic connection between the superficial descending branch of the occipital artery and the PICA 12 mm proximal to the dural entrance of the artery. CONCLUSION Awareness of the angioarchitecture of the suboccipital region and the existence of patent vertebrocarotid anastomotic connections is important to avoid complications during surgical or endovascular interventions. When present, a pre-existing OA-PICA anastomosis can be exploited to facilitate treatment in certain vascular pathologies (eg, vertebral artery aneurysms). Awareness of the existence of both an extradural origin of the PICA and a direct connection of this vessel with the OA is of great relevance to the muscular stage of surgical approaches to the posterior craniovertebral junction.

Vertebral Artery Disease

Neurosurgery ◽  
1981 ◽  
Vol 9 (5) ◽  
pp. 524-530 ◽  
Author(s):  
Michael B. Pritz ◽  
William F. Chandler ◽  
Glenn W. Kindt
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Medical Management ◽  
Posterior Inferior Cerebellar Artery ◽  
External Carotid Artery ◽  
The Other ◽  
External Carotid ◽  
Occipital Artery ◽  
Cerebellar Artery ◽  
Artery Disease

Abstract The neuroradiological evaluation, perioperative medical management, and microsurgical treatment of variously located vertebral artery lesions are presented. Four types of surgical procedures were undertaken: proximal vertebral artery to common carotid artery end-to-side anastomosis; external carotid artery to midcervical vertebral artery end-to-side anastomosis; external carotid artery to distal cervical vertebral artery end-to-end anastomosis; and occipital artery to posterior inferior cerebellar artery end-to-side anastomosis. Each case is used to demonstrate the evaluation and management involved, the type of and rationale for the surgical procedure selected, and the patency of the anastomosis performed. Two points are emphasized. One is that, after careful angiographic evaluation and improved perioperative medical management, lesions of the vertebral artery are indeed amenable to microsurgical intervention with relatively low risk to the patient. The other is that, whenever possible, anastomosis of the largest caliber of vessels with the least number of suture lines is the surgical treatment of choice.

scholarly journals Vertebral artery and posterior inferior cerebellar artery aneurysms: Results of microsurgical treatment of eighty patients

2019 ◽  
Vol 10 ◽  
pp. 227
Author(s):  
Yuri Pilipenko ◽  
Shalva Eliava ◽  
Dmitry Okishev ◽  
Elena Okisheva ◽  
Andronikos Spyrou
Keyword(s):  
Vertebral Artery ◽  
Vegetative State ◽  
Posterior Inferior Cerebellar Artery ◽  
Clinical Signs ◽  
Surgical Approaches ◽  
Microsurgical Treatment ◽  
Suboccipital Craniotomy ◽  
Cerebellar Artery ◽  
Angiographic Data ◽  
Pica Aneurysms

Background: The choice of surgical approaches and options for the microsurgical vertebral artery (VA) and posterior inferior cerebellar artery (PICA) aneurysms repair remains controversial. Methods: A retrospective analysis of the clinical, surgical, and angiographic data of 80 patients with VA and PICA aneurysms treated from 2012 to 2018 was performed. Results: The aneurysms were saccular in 50 cases (62.5%) and fusiform in 30 cases (37.5%). The median suboccipital craniotomy was the most common approach (73.8%). Retrosigmoid craniotomy was performed in 25% of patients. There were the following types of microsurgical operations: neck clipping (61.25%), clipping with the artery lumen formation (13.75%), trapping (10%), proximal clipping (5%), and deconstruction with anastomosis (10%). Fifty-seven (71.3%) patients were discharged without worsening of the clinical signs after surgery. The most common postoperative neurological disorder was palsy of IX and X cranial nerve revealed in 14 (17.5%) patients. No fatal outcomes or patients in vegetative state were identified. The complete occlusion of PICA and VA aneurysms according angiography was in 77 (96.3%) cases. Conclusion: Microsurgical treatment is an effective method for VA and PICA aneurysms. The majority of VA and PICA aneurysms do not require complex basal approaches. A thorough preoperative planning, reconstructive clipping techniques, and anastomoses creation, as well as patient selection based on the established algorithms and consultations with endovascular surgeons, may reduce the number of complications and increase the rate of complete microsurgical occlusion in VA and PICA aneurysms.

Vertebral artery–posterior inferior cerebellar artery bypass using a radial artery graft for hemorrhagic dissecting vertebral artery aneurysms: surgical technique and report of 2 cases

2011 ◽  
Vol 114 (4) ◽  
pp. 1074-1079 ◽  
Author(s):  
Marcus Czabanka ◽  
Muhammad Ali ◽  
Peter Schmiedek ◽  
Peter Vajkoczy ◽  
Michael T. Lawton
Keyword(s):  
Vertebral Artery ◽  
Radial Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Occipital Artery ◽  
Radial Artery Graft ◽  
Interposition Graft ◽  
Endovascular Occlusion ◽  
Artery Graft ◽  
Cerebellar Artery ◽  
Far Lateral Approach

Endovascular occlusion of hemorrhagic dissecting aneurysms of the vertebral artery (VA) is not possible when the posterior inferior cerebellar artery (PICA) originates from the dissecting aneurysm or when the contralateral VA provides inadequate collateral blood flow to the distal basilar circulation. The authors introduce a VA-PICA bypass with radial artery interposition graft and aneurysm trapping as an alternative approach and describe 2 cases in which this bypass was used to treat hemorrhagic dissecting VA aneurysms. The VA-PICA bypass is performed via a standard far lateral approach. An end-to-side anastomosis between the radial artery graft and the PICA at the level of the caudal loop is performed first, and an end-to-side anastomosis is performed between the V3 segment and the proximal end of the radial artery graft. A 56-year-old woman harbored a hemorrhagic dissecting VA aneurysm incorporating the origin of the PICA. Endovascular treatment failed, with aneurysm refilling on follow-up angiography. A 65-year-old man had a hemorrhagic dissecting VA aneurysm and a hypoplastic contralateral VA. Both patients were treated with the VA-PICA bypass and aneurysm trapping, with adequate filling of the PICA territory in the first patient and both the PICA territory and the basilar circulation in the second patient. Vertebral artery–PICA bypass with radial artery interposition graft and subsequent trapping of the dissected VA segment is an alternative to occipital artery–PICA and PICA-PICA bypass for the treatment of hemorrhagic dissecting VA aneurysms that are not suitable for endovascular occlusion.

Superficial temporal and occipital artery bypass pedicles to superior, anterior inferior, and posterior inferior cerebellar arteries for vertebrobasilar insufficiency

1990 ◽  
Vol 72 (4) ◽  
pp. 554-558 ◽  
Author(s):  
James I. Ausman ◽  
Fernando G. Diaz ◽  
Dante F. Vacca ◽  
Balaji Sadasivan
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Superficial Temporal Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Occipital Artery ◽  
Vertebrobasilar Insufficiency ◽  
Cerebellar Artery ◽  
Artery Disease

✓ Eighty-three patients underwent 85 intracranial to extracranial pedicle bypass anastomosis procedures to the posterior circulation. There were 15 patients with occipital artery (OA) to posterior inferior cerebellar artery (PICA) anastomosis, 20 patients with OA to anterior inferior cerebellar artery (AICA) anastomosis, and 50 patients with superficial temporal artery (STA) to superior cerebellar artery (SCA) anastomosis. All patients had transient ischemic attacks (TIA's) suggestive of vertebrobasilar ischemia. Twenty-seven patients had crescendo TIA's or stroke in evolution and were considered to be clinically unstable. All patients had severe bilateral distal vertebral artery or basilar artery disease. Twenty-two patients had bilateral vertebral artery occlusion and three had basilar artery occlusion. In this series, 69% had complete resolution of symptoms; the mortality rate was 8.4% and the morbidity rate 13.3%. Clinically stable patients did better than unstable patients. The STA-SCA anastomosis was well tolerated and technically less demanding than the OA-PICA or OA-AICA anastomosis procedures. Patients with symptomatic severe bilateral vertebral or basilar artery disease have a grave prognosis and the option of a surgical arterial pedicle revascularization procedure should be offered to them.

scholarly journals Surgical removal using V3-radial artery graft-V4 bypass and occipital artery-posterior inferior cerebellar artery bypass for a giant thrombosed aneurysm of vertebral artery compressing brain stem: Case report

2019 ◽  
Vol 10 ◽  
pp. 220
Author(s):  
Sho Tsunoda ◽  
Tomohiro Inoue ◽  
Kazuaki Naemura ◽  
Atsuya Akabane
Keyword(s):  
Blood Flow ◽  
Vertebral Artery ◽  
Brain Stem ◽  
Radial Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Occipital Artery ◽  
Radial Artery Graft ◽  
Muscle Testing ◽  
Artery Graft ◽  
Cerebellar Artery

Background: Giant thrombosed vertebral artery aneurysms (GTVAs) are difficult disease to treat. Here, we are reporting a case of GTVA successfully treated with excluding the pathological segment and restoring the anterograde blood flow of the parent artery, highlighting the reliable surgical procedure. Case Description: A 55-year-old man with a left GTVA complained of right hemiparesis (manual muscle testing 4/5) represented by hand clumsiness and gait disturbance, in addition to severe left-sided dysesthesia, was referred to our hospital. The posterior inferior cerebellar artery (PICA) was incorporated into the GTVA segment, and the contralateral vertebral artery showed atherosclerotic change. Thus, we decided to treat the aneurysm with aneurysm trapping and thrombectomy, in conjunction with V3-radial artery graft (RAG)-V4 bypass and occipital artery (OA)-PICA bypass through a suboccipital transcondylar approach. The distal end of the dilated segment was meandering and deflecting outwardly to the vicinity of the internal auditory canal and was stretched in an axial direction. Thus, the V4 stump can be transposed to the triangle space made by the medulla, lower cranial nerves, and sigmoid sinus, and we could perform a safe and reliable anastomosis through the corridor. After the surgery, the compression of the brain stem was released, and right hemiparesis was improved completely after rehabilitation. The patient was discharged with a modified Rankin Scale score of 1. Conclusion: Trapping of the aneurysm and thrombectomy are the most radical treatment for GTVA, and if possible, reconstruction of anterograde blood flow with V3-RAG-V4 bypass and OA-PICA bypass is desirable.

Preoperative Considerations in Occipital Artery-high-riding Posterior Inferior Cerebellar Artery Bypass: A Report of Two Cases and a Literature Review

2019 ◽  
Vol 80 (05) ◽  
pp. 399-403
Author(s):  
Yeong-Jin Kim ◽  
Jae-Young Kim ◽  
Yong-Hwan Cho ◽  
You-Sub Kim ◽  
Tae-Sun Kim ◽  
...  
Keyword(s):  
Literature Review ◽  
Vertebral Artery ◽  
Skull Base ◽  
Artery Bypass ◽  
Posterior Inferior Cerebellar Artery ◽  
Occipital Artery ◽  
Anatomical Features ◽  
Significant Challenge ◽  
Cerebellar Artery ◽  
Technical Considerations

AbstractNonsaccular vertebral artery aneurysms involving the posterior inferior cerebellar artery (PICA) are rare. Treatment is considered a significant challenge because of their angiographic and anatomical features, especially in high-riding PICA. Therefore, meticulous preoperative angiographic and anatomical evaluation is necessary. Moreover, consideration of the distance between the cerebellar skull base and caudal loop of the PICA is important. We present two cases of occipital artery-high-riding PICA bypass and discuss important preoperative technical considerations.

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.

Sign in / Sign up

Export Citation Format

Share Document