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Aneurysms of the posterior inferior cerebellar artery

A clinical and anatomical analysis

Rroger J. Hudgins, Arthur L. Day, Ronald G. Quisling, Albert L. Rhoton Jr, George W. Sypert and Francisco Garcia-Bengochea

V ertebrobasilar aneurysms constitute approximately 15% of all intracranial aneurysms, most of which arise from the basilar apex. 21 One-fifth of these posterior fossa lesions originate from the posterior inferior cerebellar artery (PICA), thus accounting for 3% of all intracranial aneurysms. The anatomy of PICA is quite variable, 16 and aneurysms from this artery are often tightly confined between the medulla oblongata, the anterolateral base of the skull, and the lower cranial nerves. A clinical and anatomical correlation of our experience with 21

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G. Michael Lemole Jr., Jeffrey Henn, Sam Javedan, Vivek Deshmukh and Robert F. Spetzler

occlusion. Intraoperatively, bypass patency can be assessed using Doppler ultrasonography or angiography. Postoperatively, conventional cerebral angiography should be used to confirm the patency of the bypass and obliteration of the aneurysm. References 1. Ausman JI , Diaz FG , Mullan S , et al : Posterior inferior to posterior inferior cerebellar artery anastomosis combined with trapping for vertebral artery aneurysm. Case report. J Neurosurg 73 : 462 – 465 , 1990 Ausman JI, Diaz FG, Mullan S, et al: Posterior

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Heinz Fankhauser, Shuji Kamano, Tetsu Hanamura, Kazuyoshi Amano and Hiroshi Hatanaka

T he origin and course of the posterior inferior cerebellar artery (PICA) have been found confusingly variable. 7, 8, 15 Ordinarily the PICA emerges from the fourth segment of the vertebral artery at an average distance of about 1.5 cm below the vertebrobasilar junction. 8 In rare instances it arises from the junction itself or even from the basilar artery. 2, 7, 8 The artery originated within the skull in 57% of cases, outside the skull in 18%, and at the opening of the foramen magnum itself in 4%. 8 In a patient recently under our care the PICA

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Alan Hirschfeld and Eugene S. Flamm

extracranially. We are reporting a patient with a saccular aneurysm on a loop of the right posterior inferior cerebellar artery (PICA) located below the level of the foramen magnum. Case Report This 41-year-old Oriental woman was in good health until June 9, 1979, 8 months prior to the present admission, when she noted the sudden onset of severe right frontal headache associated with a stiff neck. Examination at another hospital revealed no neurological abnormalities, but bloody xanthochromic cerebrospinal fluid (CSF) was obtained by lumbar puncture. Angiography of both

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Stephen B. Lewis, Dongwoo John Chang, David A. Peace, Pamela J. Lafrentz and Arthur L. Day

inferior cerebellar artery originated at the level of C2. Radiat Med 16 : 141 – 143 , 1998 Abe T, Kojima K, Singer RJ, et al: Endovascular management of an aneurysm arising from posterior inferior cerebellar artery originated at the level of C2. Radiat Med 16: 141–143, 1998 2. Abrahams JM , Arle JE , Hurst RW , et al : Extracranial aneurysms of the posterior inferior cerebellar artery. Cerebrovasc Dis 10 : 466 – 470 , 2000 Abrahams JM, Arle JE, Hurst RW, et al: Extracranial aneurysms of the posterior

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R. Webster Crowley, Ricky Medel and Aaron S. Dumont

authors thank B. Shepherd and H. Fowler for their preparation of the figures. References 1 Ali MJ , Bendok BR , Tawk RG , Getch CC , Batjer HH : Trapping and revascularization for a dissecting aneurysm of the proximal posteroinferior cerebellar artery: technical case report and review of the literature . Neurosurgery 51 : 258 – 262 , 2002 2 Ausman JI , Diaz FG , Vacca DF , Sadasivan B : Superficial temporal and occipital artery bypass pedicles to superior, anterior inferior, and posterior inferior cerebellar arteries for

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Quentin J. Durward

technique is described for complete isolation of the aneurysm by trapping, with reimplantation of the posterior inferior cerebellar artery (PICA) into the vertebral artery proximal to the dissecting aneurysm. This technique may prevent both recurrent hemorrhage and potential vertebral artery—PICA syndrome. Case Report This 48-year-old woman developed acute headache at the base of her skull 24 hours following routine lithotripsy for a kidney stone. She was admitted to the hospital and noted to be moderately hypertensive at that time. On transfer to the floor for

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James I. Ausman, Fernando G. Diaz, Sean Mullan, Randy Gehring, Balaji Sadasivan and Manuel Dujovny

transvascularly with balloons 2 ), and thrombosis of the aneurysm (both directly 8 and stereotactically 9, 11 ). Reimplantment of branches involved with a fusiform aneurysm at the base of a giant saccular aneurysm has been described for anterior circulation aneurysms. 3, 14 In 1982, Dolenc 4 reported the successful removal of a posterior inferior cerebellar artery (PICA) aneurysm with end-to-end suture of the PICA vessel. Our report describes an unusual case in which the PICA originated from the waist of a giant vertebral aneurysm. After the aneurysm was trapped, the PICA

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Jun-ichiro Hamada, Tatemi Todaka, Shigetoshi Yano, Yutaka Kai, Motohiro Morioka and Yukitaka Ushio

anterograde flow to the PICA territory. In addition, it results in minimal mobilization of brainstem perforating vessels and the proximal PICA, even in situations in which it is difficult to obtain a sufficient length of the proximal portion of this vessel. The acquisition of additional hands-on experience and prolonged follow-up reviews are required to establish the effectiveness of our procedure. References 1. Ausman JI , Diaz FG , Mullan S , et al : Posterior inferior to posterior inferior cerebellar artery anastomosis combined with

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Sid Chandela, Juan Alzate, Chandranath Sen, Joon Song, Yasunari Nimi, Alejandro Berenstein and David Langer

aneurysm of the proximal posteroinferior cerebellar artery: technical case report and review of the literature . Neurosurgery 51 : 258 – 263 , 2002 2 Ausman J , Diaz F , Mullan S , Gehring R , Sadasivan B , Dujovny M : Posterior inferior to posterior inferior cerebellar artery anastomosis combined with trapping for vertebral artery aneurysm. Case report . J Neurosurg 73 : 462 – 465 , 1990 3 Ausman JI , Diaz FG , Vacca DF , Sadasivan B : Superficial temporal and occipital artery bypass pedicles to superior, anterior inferior, and