Abstract

Posterior circulation aneurysms account for approximately 10% of all aneurysms, which affect 1–6% of the population [1, 2]. Aneurysms of the posterior inferior cerebellar artery (PICA) are very rare, only 0.5–3% of all aneurysms [3]. Patients with PICA aneurysms usually present with subarachnoid hemorrhage, or they might have symptoms due to compression of the brainstem or lower cranial nerves. Microsurgical clipping of PICA aneurysms is difficult and very challenging due to the limited working space and its surrounding neurovascular structure, the brainstem and lower cranial nerves IX, X, XI, and XII, and very often the aneurysm is located very deep and far from the surgeon’s view. Surgical maneuvers require moving around and sometimes in between cranial nerves. PICA aneurysms may vary widely within a range in terms of their complex anatomy, as a result either of their origin, branching out of the vertebral artery (VA), or their course along the lower cranial nerve. The PICA itself is usually of a small caliber, and aneurysms on it with a wide neck create a difficult situation with respect to clipping the aneurysm and preserving the PICA.

Highlights

  • Posterior circulation aneurysms account for approximately 10% of all aneurysms, which affect 1–6% of the population [1, 2]

  • The vertebral artery (VA) ascends in front of the hypoglossal nerve to reach the medulla at its anterior surface, where it meets and unites with the contralateral VA to become the basilar artery at the junction of the medulla and pons

  • The posterior inferior cerebellar artery (PICA) is very complex, sometimes long and tortuous, having a variable course and a wide area of supply compared to other branches of the cerebellar arteries

Read more

Summary

19.1 Sign and Symptoms

Posterior circulation aneurysms account for approximately 10% of all aneurysms, which affect 1–6% of the population [1, 2]. Aneurysms of the posterior inferior cerebellar artery (PICA) are very rare, only 0.5–3% of all aneurysms [3]. Patients with PICA aneurysms usually present with subarachnoid hemorrhage, or they might have symptoms due to compression of the brainstem or lower cranial nerves. Microsurgical clipping of PICA aneurysms is difficult and very challenging due to the limited working space and its surrounding neurovascular structure, the brainstem and lower cranial nerves IX, X, XI, and XII, and very often the aneurysm is located very deep and far from the surgeon’s view. PICA aneurysms may vary widely within a range in terms of their complex anatomy, as a result either of their origin, branching out of the vertebral artery (VA), or their course along the lower cranial nerve. The PICA itself is usually of a small caliber, and aneurysms on it with a wide neck create a difficult situation with respect to clipping the aneurysm and preserving the PICA

19.2 Investigation and Vascular Anatomy
19.3 Steps in Surgery
Findings
19.4 Expert Opinion
Full Text

Published Version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call

Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.