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.

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 Lessons from the Diagnosis and Treatment of Spontaneous Vertebral Arterial Dissection

2009 ◽  
Vol 15 (2) ◽  
pp. 203-208 ◽  
Author(s):  
S. Shi ◽  
K. Chen ◽  
X. Ge ◽  
B. Ni
Keyword(s):  
Vertebral Artery ◽  
Digital Subtraction Angiography ◽  
Posterior Inferior Cerebellar Artery ◽  
Left Vertebral Artery ◽  
Digital Subtraction ◽  
Limb Weakness ◽  
Cerebellar Artery ◽  
Autopsy Data ◽  
Basilar Arteries ◽  
Occipital Headache

A 36-year-old man presented a sudden left occipital headache and right limb weakness after tooth-brushing. Conventional catheter digital subtraction angiography (DSA) showed a left VA occlusion at the crotch of the posterior inferior cerebellar artery. Four days later, the patient got worse. The angiogram showed the left vertebral artery had reopened and the basilar trunk occluded above the AICA. He died two days later and autopsy demonstrated a dissection of the basilar arteries. Based on the autopsy data from the patient in this study, we suggest that the BA dissection might be due to left VA dissection, and placing a stent on the juncture between the uninjured VA and the basilar trunk might be an effective method to prevent fatal BA occlusion.

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.

Intracranial Vertebral Endarterectomy

Neurosurgery ◽  
1990 ◽  
Vol 26 (3) ◽  
pp. 465-471 ◽  
Author(s):  
James I. Ausman ◽  
Fernando G. Diaz ◽  
Balaji Sadasivan ◽  
Manuel Dujovny
Keyword(s):  
Vertebral Artery ◽  
Medical Therapy ◽  
Superficial Temporal Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Temporal Artery ◽  
Superior Cerebellar Artery ◽  
Focal Lesion ◽  
Cerebellar Infarction ◽  
Vertebrobasilar Insufficiency ◽  
Cerebellar Artery

Abstract Intracranial vertebral endarterectomy was performed on six patients with vertebrobasilar insufficiency in whom medical therapy failed. The patients underwent operations for stenotic plaque in the intracranial vertebral artery with the opposite vertebral artery being occluded, hypoplastic, or severely stenosed. In four of the patients, the stenosis was mainly proximal to the posterior inferior cerebellar artery (PICA). In this group, after endarterectomy, the vertebral artery was patent in two patients, and their symptoms resolved: in one patient the endarterectomy occluded, but the patient's symptoms improved; and in one patient the endarterectomy was unsuccessful, and he continued to have symptoms. In one patient, the plaque was at the origin of the PICA. The operation appeared technically to be successful, but the patient developed a cerebellar infarction and died. In one patient the stenosis was distal to the PICA. During endarterectomy, the plaque was found to invade the posterior wall of the vertebral artery. The vertebral artery was ligated, and the patient developed a Wallenburg syndrome. The results of superficial temporal artery to superior cerebellar artery anastomosis are better than those for intracranial vertebral endarterectomy for patients with symptomatic intracranial vertebral artery stenosis. The use of intracranial vertebral endarterectomy should be limited to patients who have disabling symptoms despite medical therapy, a focal lesion proximal to the PICA, and a patent posterior circulation collateral or bypass.

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