Infarction of this artery due to thrombosis or stroke leads to PICA syndrome, a neurological disease with characteristic, stereotyped symptoms. The medial branch is continued backward to the notch between the two hemispheres of the cerebellum while the lateral supplies the under surface of the cerebellum, as far as its lateral border, where it anastomoses with the anterior inferior cerebellar and the superior cerebellar branches of the basilar artery.īranches from this artery supply the choroid plexus of the fourth ventricle. It winds backward around the upper part of the medulla oblongata, passing between the origins of the vagus and accessory nerves, over the inferior peduncle to the under surface of the cerebellum, where it divides into two branches. Clipping of the neck is the preferred treatment, but trapping is usually safe, if necessary.The posterior inferior cerebellar artery (PICA), the largest branch of the vertebral, is one of the three main arterial blood supplies for the cerebellum. More distal (retromedullary) PICA aneurysms are sometimes associated with another vascular anomaly (two cases in this series), and are best handled through a bilateral suboccipital craniectomy. Isolated clipping of the aneurysm neck is essential in this instance, as trapping may compromise vital perforating arteries of the brain stem. Aneurysms at the PICA-vertebral junction usually occur at least 1 cm above the foramen magnum level, arise distal to the PICA origin in the angle between the two vessels, and are best approached by a paramedian incision with the patient in the lateral recumbent position. Periprocedural downstream emboli occurred in 3 cases (2.1). Aneurysms at the PICA-vertebral junction usualthese lesions are determined by the course of the vertebral artery and PICA that is, they occur at branching sites and at curves in the parent vessel, and point in the direction in which flow would have continued if the curve at the aneurysm's origin had not been present. In 5 of 143 patients (3.5), a distal embolization to a new vessel territory occurred, of which 2 occlusions of the superior cerebellar artery and 1 occlusion of the posterior inferior cerebellar artery were successfully recanalized with mechanical thrombectomy. Aneurysms at the PICA-vertebral junction usualthese lesions are determined by the course of the vertebral artery and PICA that is, they occur at branching sites and at curves in the parent vessel, and point in the direction in which flow would have continued if the curve at the aneurysm's origin had not been present. The angiographic and surgical features of these lesions are determined by the course of the vertebral artery and PICA that is, they occur at branching sites and at curves in the parent vessel, and point in the direction in which flow would have continued if the curve at the aneurysm's origin had not been present. Clinically significant vasospasm and aneurysm multiplicity occurred with approximately equal frequency as at other locations. The lack of specific focal deficits prevented an accurate pre-angiographic determination of aneurysm location in most instances. Most of these aneurysms occurred in females (16 of 21) and presented as classic subarachnoid hemorrhage. Twelve lesions arose from the left PICA, nine were right-sided, and all were small (less than 12.5 mm). Seventeen of these lesions originated from the PICA-vertebral junction, and four arose from distal PICA branching sites. The clinical and anatomical features of 21 surgically treated saccular aneurysms of the posterior inferior cerebellar artery (PICA) are analyzed.
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