A Rare Case of the Posterior Inferior Cerebellar Artery

The course of the posterior inferior cerebellar artery (PICA) was analyzed with reference to its origin and relationships with the medullary and cerebellar surfaces and the adjacent cranial nerves in 40 brains after the injection with acrylic resins of the vertebrobasilar system. In 42.5% of instances, the PICA originated from the lateral medullary segment of the vertebral artery (VA), in 32.5% from its premedullary segment, in 22.5% from the basilar artery (BA), and in 2.5% it was absent. With reference to the level of origin, three patterns of course for the lateral medullary segment of the PICA can be outlined. (1) When it arises from the lateral medullary segment of the VA, it passes below the hypoglossal nerve, and the lateral medullary segment may form a loop with an anterosuperior convexity towards the pontomedullary sulcus (41%), or it may follow a rectilinear course (41%). It passes at the level of the accessory nerve. The tonsillomedullary (TM) segment shows a caudal loop and the telovelotonsillary (TVT) has a cranial loop. (2) When the PICA arises from the BA, it passes above the hypoglossal nerve. The lateral medullary segment forms a loop with lateral convexity (78%) and passes above or through the glossopharyngeal nerve, frequently showing a recurrent course among the roots of the IX, X, or XI cranial nerve. The TM and the TVT segments do not have loops. (3) When the PICA arises from the premedullary segment of the VA, it passes above, below, or through the rootlets of the hypoglossal nerve. In the lateral medullary segment, it follows a rectilinear course (54%) and passes the plane formed by the IX, X, and XI cranial nerves at an intermediate level with respect to the other two patterns. The TM and the TVT segments show caudal and cranial loops. The different origins and courses of the PICA derive from the selection of different branches of the primitive vertebrobasilar plexus during the development of the cerebellum. The existence of an embryologic correlation between the course of the PICA and its level of origin may be useful in the evaluation of its angiographic anatomy.

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The course of the posterior inferior cerebellar artery may be related to its level of origin

Macchi

Porzionato

Parenti

et al. 2004

Surgical and Radiologic Anatomy

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Double posterior inferior cerebellar artery

2009

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Posterior inferior cerebellar artery (PICA) is one of the cerebellar arteries which originates from the vertebral artery and has the most complex and variable course. It usually originates from the vertebral artery intracranially and as a single trunk; however, absent, double trunk, extracranial, and extradural PICA may exists although very rare. In a collection of 50 cerebellar specimens (100 hemispheres) injected with colored gelatin, we have encountered unilateral double PICA in 2 specimens. In both the cases (both male, aged 45 and 65 years) double trunks of PICA were observed on the right side. Double-trunk PICA may signal an improved blood supply to the corresponding cerebellar hemisphere; however, the second trunk, which may also be called an accessory trunk, is usually smaller than the first (main) trunk of PICA.

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Bilaterally absent posterior inferior cerebellar artery: case report

Sharifi

Ciszek

2013

Surg Radiol Anat

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Posterior inferior cerebellar artery (PICA) is one of the cerebellar arteries which originates from the vertebral artery and has the most complex and variable course. The PICA usually originates from the vertebral artery intracranially as a single trunk, however, absent, double trunk, extracranial, and extradural PICA may also exist. In a collection of 50 cerebellar specimens (100 hemispheres) injected with colored gelatin, one case of bilaterally absent PICA was encountered, male aged 59 (causes of the death was not taken into consideration).

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A Rare Case of the Posterior Inferior Cerebellar Artery

Cited by 5 publications

References 5 publications

The course of the posterior inferior cerebellar artery may be related to its level of origin

The course of the posterior inferior cerebellar artery may be related to its level of origin

Double posterior inferior cerebellar artery

Bilaterally absent posterior inferior cerebellar artery: case report

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