Aneurysm of the Distal Posterior Inferior Cerebellar Artery Originating from the Extracranial and Extradural Vertebral Artery-Case Report-

Tamano, Yoshinori; Kobayashi, Tomonori; Hagiwara, Shinji; Tanaka, Noriko; Ide, Mitsunobu; Kawamura, Hirotsune

doi:10.2176/nmc.43.301

Cited by 7 publications

(7 citation statements)

References 12 publications

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“…15 -30 % of all PICA aneurysms are seen in the distal part and especially in the peripheral PICA segments [2] . Although in some series, the distal segment PICA aneurysm incidence is higher in the telovelotonsillar and tonsillomedullar segments [1] , it is reported that, in a 16-case-series which comprises 18 aneurysms, the incidence is higher in the anterior medullar segment [11] . It is thought that hemodynamic stress and congenital factors play role in the occurrence of distal PICA aneurysms [12] .…”

Section: Discussionmentioning

confidence: 90%

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Multiple Aneurysms of the Distal Posterior Inferior Cerebellar Artery: Two Case Reports

Demirgil

Günaldı²,

Tuğcu³

et al. 2008

Minim Invasive Neurosurg

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Section: Discussionmentioning

confidence: 90%

“…Distal PICA aneurysms are particularly rare. It is reported that their observation rate is about 0.28 -1.4 % among all cerebral aneurysms [1] . The VA-originated aneurysms appear in the PICA in 80 % and usually in the VA-PICA division point.…”

Section: Discussionmentioning

confidence: 93%

Multiple Aneurysms of the Distal Posterior Inferior Cerebellar Artery: Two Case Reports

Demirgil

Günaldı²,

Tuğcu³

et al. 2008

Minim Invasive Neurosurg

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“…Some authors described the existence of PICAs originating from V 3 in case reports, and the incidence of these PICAs was estimated based on cadaveric inspection in Western countries. 2,6,10,13,15,20,24,[29][30][31] However, the clinical utility of using enhanced CT scans as a diagnostic tool has not been evaluated. In the present study, we analyzed Japanese patients who underwent contrast CT examination.…”

Section: Discussionmentioning

confidence: 99%

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

Isaji

Yasuda

Kawaguchi

et al. 2018

Journal of Neurosurgery: Spine

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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.

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“…The variability and complexity of PICA anatomy makes aneurysms appear in unusual locations, and there is great variation in shape and size of the lesions. [40] Extracranial PICA aneurysms are frequently associated with aberrant PICA anatomy; lack of caudal or/and cranial loops is frequently observed, and PICA may cross to the contralateral site[2844] [Table 1]. It seems that hemodynamic stress plays an important role in the formation of distal PICA aneurysms,[15] including those formed outside of the cranium.…”

Section: Discussionmentioning

confidence: 99%

“…[202539] Distal PICA aneurysms are even less common,[1226] and can occur extracranially. Overall, only 22 lesions reported in the literature have been located extracranially,[12359101116171819232837394042434445] and of these, only 11 were distal aneurysms. [29]…”

Section: Introductionmentioning

confidence: 99%

Extracranial aneurysms of the distal posterior inferior cerebellar artery: Resection and primary reanastomosis as the preferred management approach

Chwajol¹,

Hage²,

Amin‐Hanjani³

et al. 2013

Surg Neurol Int

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Background:Extracranial aneurysms of the posterior inferior cerebellar artery (PICA) are rare, with only 22 reported cases in the English literature. For saccular extracranial distal PICA aneurysms not amenable to coiling, a surgically placed clip is not protected by the cranium postoperatively, and can be subject to movement in the mobile cervical region. Furthermore, fusiform or complex aneurysms cannot be clipped primarily. Resection and primary reanastomosis is a useful surgical approach not previously described for these extracranial lesions.Case Description:We report three cases of extracranially located distal PICA aneurysms successfully treated with this surgical strategy at our center. One patient harboring a broad necked saccular aneurysm originally underwent successful primary clipping of the aneurysm but sustained a second subarachnoid hemorrhage (SAH) on postoperative day 25 due to clip dislodgement from vigorous neck movement. The other two patients were found to have fusiform and complex aneurysms, respectively. All three patients were ultimately treated with resection and end-to-end PICA anastomosis, which successfully obliterated their aneurysms.Conclusions:Resection and primary reanastomosis of extracranial distal PICA aneurysms averts the risk of clip dislodgement due to neck movement and/or compression by soft tissues in the upper cervical region. It is a safe and efficacious technique, which we propose as the preferred management strategy for these rare vascular lesions.

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Aneurysm of the Distal Posterior Inferior Cerebellar Artery Originating from the Extracranial and Extradural Vertebral Artery-Case Report-

Cited by 7 publications

References 12 publications

Multiple Aneurysms of the Distal Posterior Inferior Cerebellar Artery: Two Case Reports

Multiple Aneurysms of the Distal Posterior Inferior Cerebellar Artery: Two Case Reports

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

Extracranial aneurysms of the distal posterior inferior cerebellar artery: Resection and primary reanastomosis as the preferred management approach

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