![]() Aneurysms of the posterior inferior cerebellar artery Posterior circulation aneurysms account for approximately 10% of all aneurysms, which affect 1–6% of the population. This process is experimental and the keywords may be updated as the learning algorithm improves. These keywords were added by machine and not by the authors. Posterior Inferior Cerebellar Artery (PICA). ![]() 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. 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. Surgical maneuvers require moving around and sometimes in between 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. Patients with PICA aneurysms usually present with subarachnoid hemorrhage, or they might have symptoms due to compression of the brainstem or lower cranial nerves. Aneurysms of the posterior inferior cerebellar artery (PICA) are very rare, only 0.5–3% of all aneurysms. All rights reserved.Posterior circulation aneurysms account for approximately 10% of all aneurysms, which affect 1–6% of the population. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. Left vertebral artery that originated from the arch should be managed with care, because PICA termination is highly prevalent.īrain infarction Left subclavian artery occlusion Magnetic resonance angiography Posterior inferior cerebellar artery Vertebral artery. PICA termination and right side hypoplasia/occlusive lesion, where left subclavian perfusion is important for brain protection, is present in ∼ 30%. No brain infarction occurred with this strategy. In 1 patient with hypoplasia between the basilar artery and the left PICA, bypass was added immediately after deployment because radial pressure dropped critically. During thoracic endovascular aortic repair with Zone-2 proximal landing, debranching bypass was employed to preserve left subclavian perfusion when there was PICA termination, hypoplasia or occlusive lesion. In aortic arch replacement, these were reconstructed together with the left subclavian artery while hypothermia was maintained. Two of the seven arch-originated arteries terminated in the PICA. There were 19 hypoplasia (12%), 10 PICA termination (6%) and 12 occlusive lesion (8%) on the right vertebral artery and 10 hypoplasia (6%), 5 PICA termination (3%), 7 direct arch origin (4%) and 3 occlusive lesion (2%) on the left. Prevalence rates of vertebral artery variations and occlusive lesions were reported, together with operative strategies and outcomes. ![]() Patients' age ranged from 35 to 88 (median 72), 122 were male and 115 had degenerative aneurysms. ![]() We report the results of preoperative vertebral artery evaluation by magnetic resonance angiography (MRA) and its impact upon operative strategy.Īmong the 214 patients who underwent thoracic aortic surgery from 2009 through 2012, 159 patients with preoperative MRA were retrospectively analysed. Arterial variation is common in the vertebral artery, and simple occlusion of the left subclavian artery may result in brain infarction, especially when it terminates in the posterior inferior cerebellar artery (PICA). ![]()
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