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

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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Extremely tortuous superior cerebellar artery mimicking an aneurysm

Surgical Neurology International ◽

10.25259/sni_864_2021 ◽

2021 ◽

Vol 12 ◽

pp. 569

Author(s):

Megumi Matsuda ◽

Hideki Endo ◽

Kohei Ishikawa ◽

Ryota Nomura ◽

Tomoaki Ishizuka ◽

...

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Basilar Artery ◽

Vascular Lesions ◽

Superior Cerebellar Artery ◽

Case Description ◽

Unruptured Cerebral Aneurysm ◽

Cerebellar Artery ◽

The Right ◽

Angiography Catheter

Background: An extremely tortuous superior cerebellar artery is a rare anomaly. We report a case of an extremely tortuous superior cerebellar artery mimicking an aneurysm. Case Description: A 77-year-old woman was initially diagnosed with unruptured cerebral aneurysm at the right basilar artery-superior cerebellar artery junction by magnetic resonance angiography. Catheter angiogram revealed that there was no apparent aneurysm at the basilar artery-superior cerebellar artery junction and the lesion was actually an extremely tortuous superior cerebellar artery. Conclusion: Although an extremely tortuous superior cerebellar artery is rare, it should be considered when examining other vascular lesions.

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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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Direct puncture of the V3 segment of the vertebral artery in acute basilar artery stroke: an alternative approach in desperate circumstances

BMJ Case Reports ◽

10.1136/bcr-2019-231335 ◽

2019 ◽

Vol 12 (8) ◽

pp. e231335 ◽

Cited By ~ 1

Author(s):

Sean Thomas O’Reilly ◽

Ian Rennie ◽

Jim McIlmoyle ◽

Graham Smyth

Keyword(s):

Vertebral Artery ◽

Basilar Artery ◽

Posterior Inferior Cerebellar Artery ◽

Left Vertebral Artery ◽

Basilar Artery Thrombosis ◽

Direct Puncture ◽

Alternative Approach ◽

Cerebellar Artery ◽

First Pass ◽

The Right

A patient in his mid-40s presented with acute basilar artery thrombosis 7 hours postsymptom onset. Initial attempts to perform mechanical thrombectomy (MT) via the femoral and radial arterial approaches were unsuccessful as the left vertebral artery (VA) was occluded at its origin and the right VA terminated in the posterior inferior cerebellar artery territory, without contribution to the basilar system. MT was thus performed following ultrasound-guided direct arterial puncture of the left VA in its V3 segment, with antegrade advancement of a 4 French radial access sheath. First pass thrombolyisis in cerebral infarction (TICI) 3 recanalisation achieved with a 6 mm Solitaire stent retriever and concurrent aspiration on the 4 French sheath. Vertebral closure achieved with manual compression.

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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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Management of a double basilar tip aneurysm

Romanian Neurosurgery ◽

10.33962/roneuro-2021-004 ◽

2021 ◽

pp. 25-28

Author(s):

A. Chiriac ◽

N. Dobrin ◽

Georgiana Ion ◽

I. Poeata

Keyword(s):

Basilar Artery ◽

Case Reports ◽

Superior Cerebellar Artery ◽

Appropriate Treatment ◽

Cerebellar Artery ◽

Basilar Tip Aneurysm

Complex basilar tip aneurysms are still challenging to secure with coils or stent-assisted coiling. Double aneurysms at the basilar bifurcation and the basilar artery-superior cerebellar artery are a rare particular situation that usually requires more appropriate treatment. This case reports details of our experience with a double basilar tip aneurysm treated in two steps by coiling repair and stent-assisted coiling.

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Revascularization of the upper posterior circulation with the anterior temporal artery: an anatomical feasibility study

Journal of Neurosurgery ◽

10.3171/2017.3.jns162865 ◽

2018 ◽

Vol 129 (1) ◽

pp. 121-127 ◽

Cited By ~ 1

Author(s):

Ali Tayebi Meybodi ◽

Michael T. Lawton ◽

Dylan Griswold ◽

Pooneh Mokhtari ◽

Andre Payman ◽

...

Keyword(s):

Basilar Artery ◽

Posterior Cerebral Artery ◽

Temporal Artery ◽

Posterior Circulation ◽

Superior Cerebellar Artery ◽

Middle Temporal ◽

Cerebellar Artery ◽

Orbitozygomatic Approach ◽

Basal Cisterns

OBJECTIVEIn various disease processes, including unclippable aneurysms, a bypass to the upper posterior circulation (UPC) including the superior cerebellar artery (SCA) and posterior cerebral artery (PCA) may be needed. Various revascularization options exist, but the role of intracranial (IC) donors has not been scrutinized. The objective of this study was to evaluate the anatomical feasibility of utilizing the anterior temporal artery (ATA) for revascularization of the UPC.METHODSATA-SCA and ATA-PCA bypasses were performed on 14 cadaver specimens. After performing an orbitozygomatic craniotomy and opening the basal cisterns, the ATA was divided at the M3-M4 junction and mobilized to the crural cistern to complete an end-to-side bypass to the SCA and PCA. The length of the recipient artery between the anastomosis and origin was measured.RESULTSSeventeen ATAs were found. Successful anastomosis was performed in 14 (82%) of the ATAs. The anastomosis point on the PCA was 14.2 mm from its origin on the basilar artery. The SCA anastomosis point was 10.1 mm from its origin. Three ATAs did not reach the UPC region due to a common opercular origin with the middle temporal artery. The ATA-SCA bypass was also applied to the management of an incompletely coiled SCA aneurysm.CONCLUSIONSThe ATA is a promising IC donor for UPC revascularization. The ATA is exposed en route to the proximal SCA and PCA through the pterional-orbitozygomatic approach. Also, the end-to-side anastomosis provides an efficient and straightforward bypass without the need to harvest a graft or perform multiple or difficult anastomoses.

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Combined Endovascular and Microsurgical Management of a Tentorial Arteriovenous Malformation in a Hybrid Neurovascular Operating Room: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opab142 ◽

2021 ◽

Author(s):

Gregory Glauser ◽

Donald K E Detchou ◽

John Arena ◽

Omar Choudhri

Keyword(s):

Operating Room ◽

University Of Pennsylvania ◽

Superior Cerebellar Artery ◽

Institutional Review ◽

Cerebellar Artery ◽

Patient Consent ◽

Supracerebellar Infratentorial Approach ◽

Lumbar Cerebrospinal Fluid ◽

The University ◽

Lateral Positioning

Abstract Tentorial margin arteriovenous malformations (AVMs) at the cerebello-mesencephalic fissure are deep lesions, which can be safely resected via a lateral supracerebellar infratentorial approach. This video illustrates the case of a patient who presented with hemorrhage from a tentorial AVM. He was managed in the hybrid neurovascular operating room with Onyx (Medtronic) embolization of a superior cerebellar artery feeder followed by resection of the AVM, which included cerebellar relaxation from lumbar cerebrospinal fluid (CSF) drainage and lateral positioning. Wide cisternal arachnoid dissection at the quadrigeminal cistern allowed for a straight trajectory to the AVM without fixed retraction. Intraoperative transradial angiography confirmed complete AVM exclusion. This video was deemed Institutional Review Board (IRB) exempt by the University of Pennsylvania IRB as it is considered a case report, which does not require IRB approval or patient consent. The patient consented to the procedure.

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