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Hall S, Steinfort B, Dexter M. Giant aneurysms of the distal posterior inferior cerebellar artery - systematic review. Br J Neurosurg 2024; 38:687-693. [PMID: 34279172 DOI: 10.1080/02688697.2021.1950631] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/10/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Posterior inferior cerebellar artery (PICA) aneurysms are uncommon and are typically found at the origin or proximal segments of the vessel. Giant aneurysms are uncommon and present unique treatment challenges. Giant distal PICA aneurysms are exceedingly rare and have traditionally been managed via open surgical approaches. METHODS A total of 207 studies were assessed, identifying 26 cases of giant distal PICA aneurysms from 26 separate publications. One additional case is described followed by a review of presentation, anatomical characteristics, treatment and outcome. RESULTS Presentation was due to local mass effect in 19 (70%), hydrocephalus in 4 (15%) and acute haemorrhage in 5 (19%). All reported cases were partially (86%) or completely (14%) thrombosed. The telovelotonsillar segment was involved in 18/24 (75%) cases. Two cases (7%) were associated with an arteriovenous malformation. Twenty-two (81%) were managed surgically and 5 (19%) managed endovascularly. Outcome was good in 22 (85%) and poor in one (4%). CONCLUSIONS Giant distal PICA aneurysms can be managed effectively through a variety of open surgical and endovascular techniques.
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Affiliation(s)
- Samuel Hall
- Department of Neurosurgery, Westmead Hospital, Sydney, Australia
| | | | - Mark Dexter
- Department of Neurosurgery, Westmead Hospital, Sydney, Australia
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2
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Kościołek D, Kobierecki M, Tokarski M, Szalbot K, Kościołek A, Malicki M, Wanibuchi S, Wiśniewski K, Piotrowski M, Bobeff EJ, Szmyd BM, Jaskólski DJ. The Anterior Inferior Cerebral Artery Variability in the Context of Neurovascular Compression Syndromes: A Narrative Review. Biomedicines 2024; 12:452. [PMID: 38398054 PMCID: PMC10887044 DOI: 10.3390/biomedicines12020452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
The anterior inferior cerebellar artery (AICA) is situated within the posterior cranial fossa and typically arises from the basilar artery, usually at the pontomedullary junction. AICA is implicated in various clinical conditions, encompassing the development of aneurysms, thrombus formation, and the manifestation of lateral pontine syndrome. Furthermore, owing to its close proximity to cranial nerves within the middle cerebellopontine angle, AICA's pulsatile compression at the root entry/exit zone of cranial nerves may give rise to specific neurovascular compression syndromes (NVCs), including hemifacial spasm (HFS) and geniculate neuralgia concurrent with HFS. In this narrative review, we undertake an examination of the influence of anatomical variations in AICA on the occurrence of NVCs. Significant methodological disparities between cadaveric and radiological studies (CTA, MRA, and DSA) were found, particularly in diagnosing AICA's absence, which was more common in radiological studies (up to 36.1%) compared to cadaver studies (less than 5%). Other observed variations included atypical origins from the vertebral artery and basilar-vertebral junction, as well as the AICA-and-PICA common trunk. Single cases of arterial triplication or fenestration have also been documented. Specifically, in relation to HFS, AICA variants that compress the facial nerve at its root entry/exit zone include parabola-shaped loops, dominant segments proximal to the REZ, and anchor-shaped bifurcations impacting the nerve's cisternal portion.
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Affiliation(s)
- Dawid Kościołek
- Medical Faculty, Medical University of Lodz, Kosciuszki St., 90-419 Lodz, Poland; (D.K.); (M.K.); (M.T.); (K.S.); (A.K.); (M.M.)
| | - Mateusz Kobierecki
- Medical Faculty, Medical University of Lodz, Kosciuszki St., 90-419 Lodz, Poland; (D.K.); (M.K.); (M.T.); (K.S.); (A.K.); (M.M.)
| | - Mikołaj Tokarski
- Medical Faculty, Medical University of Lodz, Kosciuszki St., 90-419 Lodz, Poland; (D.K.); (M.K.); (M.T.); (K.S.); (A.K.); (M.M.)
| | - Konrad Szalbot
- Medical Faculty, Medical University of Lodz, Kosciuszki St., 90-419 Lodz, Poland; (D.K.); (M.K.); (M.T.); (K.S.); (A.K.); (M.M.)
| | - Aleksandra Kościołek
- Medical Faculty, Medical University of Lodz, Kosciuszki St., 90-419 Lodz, Poland; (D.K.); (M.K.); (M.T.); (K.S.); (A.K.); (M.M.)
| | - Mikołaj Malicki
- Medical Faculty, Medical University of Lodz, Kosciuszki St., 90-419 Lodz, Poland; (D.K.); (M.K.); (M.T.); (K.S.); (A.K.); (M.M.)
| | - Sora Wanibuchi
- The Faculty of Medicine, Aichi Medical University, Nagakute 480-1195, Japan;
| | - Karol Wiśniewski
- Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego St. 22, 90-153 Lodz, Poland; (M.P.); (E.J.B.); (D.J.J.)
| | - Michał Piotrowski
- Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego St. 22, 90-153 Lodz, Poland; (M.P.); (E.J.B.); (D.J.J.)
| | - Ernest J. Bobeff
- Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego St. 22, 90-153 Lodz, Poland; (M.P.); (E.J.B.); (D.J.J.)
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowieka St. 6/8, 92-251 Lodz, Poland
| | - Bartosz M. Szmyd
- Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego St. 22, 90-153 Lodz, Poland; (M.P.); (E.J.B.); (D.J.J.)
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Sporna St. 36/50, 91-738 Lodz, Poland
| | - Dariusz J. Jaskólski
- Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego St. 22, 90-153 Lodz, Poland; (M.P.); (E.J.B.); (D.J.J.)
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Sreenivasan S, Roychowdhury S, Kashibathla A, Kumarapuram S, Nourollah-Zadeh E, Sundararajan S, Sun H, Nanda A, Gupta G. Flow Diversion for Treatment of Anterior Inferior Cerebellar Artery Aneurysms: Mechanism and Pitfalls from a Novel Management Strategy. World Neurosurg 2024; 182:e163-e170. [PMID: 37992994 DOI: 10.1016/j.wneu.2023.11.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Anterior inferior cerebellar artery (AICA) aneurysms present a challenge for neurosurgeons and neurointerventionalists alike. METHODS Cases of AICA aneurysms managed with endovascular flow diversion at our institute are reviewed with their angiographic outcomes. RESULTS Both direct and indirect flow diversion provide complete aneurysm occlusion at follow-up. We propose a stratified method of approaching AICA aneurysms based on location, rupture status, and neck size. CONCLUSIONS Careful evaluation of preoperative parameters is paramount in deciding between a surgical or a neuroendovascular approach. Low-profile stents in the future may assist in direct flow diversion of AICA trunk aneurysms. In addition, neurosurgeons need to be well versed in endovascular approaches.
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Affiliation(s)
- Sanjeev Sreenivasan
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, New Jersey, USA
| | - Sudipta Roychowdhury
- Department of Interventional Radiology, University Radiology, Robert Wood Johnson Medical School, New Jersey, USA
| | - Ananth Kashibathla
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, New Jersey, USA
| | - Siddhant Kumarapuram
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, New Jersey, USA
| | - Emad Nourollah-Zadeh
- Department of Neurology, Robert Wood Johnson Medical School, Rutgers University, New Jersey, USA
| | - Srihari Sundararajan
- Department of Interventional Radiology, University Radiology, Robert Wood Johnson Medical School, New Jersey, USA
| | - Hai Sun
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, New Jersey, USA
| | - Anil Nanda
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, New Jersey, USA
| | - Gaurav Gupta
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, New Jersey, USA.
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4
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Hanel RA, Cortez GM, Benalia VHC, Sheffels E, Sutphin DJ, Pederson JM, Pereira VM. Patient outcomes after treatment of brain aneurysm in small diameter vessels with the silk vista baby flow diverter: A systematic review. Interv Neuroradiol 2024; 30:5-13. [PMID: 35392703 PMCID: PMC10956459 DOI: 10.1177/15910199221091645] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/16/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The Silk Vista Baby (SVB, BALT) is a first-in-class flow-diverter device delivered using a 0.017" microcatheter, designed for the treatment of intracranial aneurysms, including those in small diameter vessels. This study reports a systematic literature review (SLR) to evaluate the safety and efficacy of using SVB to treat intracranial aneurysms in vessels less than 3.5 mm in diameter. METHODS We performed a PRISMA-compliant SLR to evaluate the outcomes of SVB in the treatment of aneurysms in small intracranial vessels. Primary outcomes were occlusion status and major stroke, and secondary outcomes included all-cause mortality, procedure-related neurologic death, and post-operative aneurysm rupture. Data were expressed as descriptive statistics only. RESULTS A total of four studies, including 163 patients with 173 intracranial aneurysms, were included. The most common aneurysm locations were the anterior cerebral artery (24.9% [43/173]), the middle cerebral artery (24.3% [42/173]), and the anterior communicating artery (23.1% [40/173]). Parent artery diameter ranged from 0.9 mm to 3.6 mm, and 29% were acutely or previously ruptured aneurysms. Overall, complete or near-complete occlusion was 72.1% on early-term follow-up. Mortality rate among the studies was 2.5%, with 3 instances adjudicated as neurologic deaths (1.8%). Major stroke was noted in 1.2% of cases, and branch occlusion or stent thrombus formation in 5.5%. CONCLUSION Our review suggests that SVB is a safe and effective treatment for intracranial aneurysms in small vessels. Further prospective and comparative studies with patient outcome data specific to aneurysm location are needed to confirm the safety and efficacy of SVB.
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Affiliation(s)
- Ricardo A Hanel
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, FL, USA
| | - Gustavo M Cortez
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, FL, USA
- Research Department, Jacksonville University, Jacksonville, FL, USA
| | - Victor H C Benalia
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, FL, USA
- Research Department, Jacksonville University, Jacksonville, FL, USA
| | | | | | | | - Vitor M Pereira
- Departments of Surgery and Medical Imaging, Division of Neurosurgery, St Michaels Hospital, University of Toronto, Ontario, Canada
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5
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Catalano M, Crimi L, Belfiore G, Grippaldi D, David E, Spatola C, Cristaudo C, Foti PV, Palmucci S, Basile A. Congenital and acquired anomalies of the basilar artery: A pictorial essay. Neuroradiol J 2023:19714009231177412. [PMID: 37210636 DOI: 10.1177/19714009231177412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023] Open
Abstract
INTRODUCTION The basilar artery is one of the two cases in our body where an arterial vessel is formed by the union of two others - the vertebral arteries. It provides vascular supply to essential structures for the main vital functions; the posterior cerebral arteries originate from it as terminal branches, and form part of the anastomotic circle of Willis. IMAGING FINDINGS Congenital and acquired anomalies of the basilar trunk are described. We provide a schematic and detailed representation of normal anatomical variants - mainly represented by the fenestrated basilar artery or the persistence of carotid-basilar anastomosis; course anomalies are also illustrated, with reference to neuro-vascular conflicts and dolichoectasia. Among congenital anomalies, this pictorial review also shows the variants of the basilar origin, such as in the case of basilar trunk arising from only one of the two vertebral arteries, and the calibre changes - which are represented by aneurysm and hypoplasia. The latter appears to be a risk factor for posterior circulation stroke, when associated with a bilateral posterior foetal variant.Among the acquired forms, this pictorial essay describes some clinical cases of dissections, non-congenital aneurysms, thrombosis and tumour with vascular encasing or compression of basilar artery. CONCLUSION CT angiography and MRI allow us to study the posterior intracranial circulation in detail, providing useful pre-treatment information. Therefore, knowledge of congenital or acquired anomalies of the basilar artery is essential for radiologists, neuroradiologists and neurosurgeons.
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Affiliation(s)
- Marco Catalano
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", Italy
| | - Luca Crimi
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", Italy
| | - Giuseppe Belfiore
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", Italy
| | - Daniele Grippaldi
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", Italy
| | - Emanuele David
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", Italy
| | - Corrado Spatola
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", Italy
| | - Concetto Cristaudo
- UOC Neuroradiologia, Azienda Ospedaliera per L'Emergenza Cannizzaro, Italy
| | - Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", Italy
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", Italy
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", Italy
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Padmos RM, Arrarte Terreros N, Józsa TI, Závodszky G, Marquering HA, Majoie CBLM, Payne SJ, Hoekstra AG. Modelling collateral flow and thrombus permeability during acute ischaemic stroke. J R Soc Interface 2022; 19:20220649. [PMID: 36195117 PMCID: PMC9532024 DOI: 10.1098/rsif.2022.0649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The presence of collaterals and high thrombus permeability are associated with good functional outcomes after an acute ischaemic stroke. We aim to understand the combined effect of the collaterals and thrombus permeability on cerebral blood flow during an acute ischaemic stroke. A cerebral blood flow model including the leptomeningeal collateral circulation is used to simulate cerebral blood flow during an acute ischaemic stroke. The collateral circulation is varied to capture the collateral scores: absent, poor, moderate and good. Measurements of the transit time, void fraction and thrombus length in acute ischaemic stroke patients are used to estimate thrombus permeability. Estimated thrombus permeability ranges between 10-7 and 10-4 mm2. Measured flow rates through the thrombus are small and the effect of a permeable thrombus on brain perfusion during stroke is small compared with the effect of collaterals. Our simulations suggest that the collaterals are a dominant factor in the resulting infarct volume after a stroke.
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Affiliation(s)
- Raymond M. Padmos
- Computational Science Laboratory, Informatics Institute, Faculty of Science, University of Amsterdam, Science Park 904, Amsterdam 1098, The Netherlands,Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, Delft 2628, The Netherlands
| | - Nerea Arrarte Terreros
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands,Department of Biomedical Engineering and Physics, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Tamás I. Józsa
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Parks Road, Oxford OX1 3PJ, UK,Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
| | - Gábor Závodszky
- Computational Science Laboratory, Informatics Institute, Faculty of Science, University of Amsterdam, Science Park 904, Amsterdam 1098, The Netherlands
| | - Henk A. Marquering
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands,Department of Biomedical Engineering and Physics, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Charles B. L. M. Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Stephen J. Payne
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Parks Road, Oxford OX1 3PJ, UK,Institute of Applied Mechanics, National Taiwan University, Taiwan
| | - Alfons G. Hoekstra
- Computational Science Laboratory, Informatics Institute, Faculty of Science, University of Amsterdam, Science Park 904, Amsterdam 1098, The Netherlands
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7
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Hiremath SB, Erdenebold UE, Kontolemos M, Miller W, Zakhari N. Association between vascular calcification in intracranial vertebrobasilar circulation and luminal stenosis. Neuroradiology 2022; 64:2285-2293. [PMID: 35551423 DOI: 10.1007/s00234-022-02974-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/02/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The study aims to assess the correlation and association between calcium burden and luminal stenosis in the vertebrobasilar circulation. METHODS We evaluated 166 patients [mean age, 79.8 ± 8.8 (SD) with 93 males] with stroke symptoms. The calcification patterns were assessed on non-contrast CT (NCCT); quantitative calcium burden [Agatston-Janowitz (AJ) calcium score, volume, and mass] on the initial non-contrast phase of CT perfusion (CTP); and the qualitative and quantitative luminal stenosis on CT angiography (CTA) studies. We calculated the correlation coefficient and association between measures of calcium burden and luminal stenosis. RESULTS Two hundred twenty-eight of 498 arteries (45.8%) had detectable calcification on NCCT and measurable stenosis in 169 of 498 arteries (33.9%) on CTA. We found a moderate correlation between qualitative calcium burden and qualitative (0.51 for R1 and 0.62 for R2, p < 0.01) as well as quantitative luminal stenosis (0.67 for R1 and 0.69 for R2, p < 0.01). There was a moderate correlation of AJ score (0.66), volume (0.68), and mass of calcification (0.60, p < 0.01) with luminal stenosis measurements. The quantitative calcium burden and luminal stenosis showed statistically significant differences between different qualitative categories of calcium burden (p < 0.001 in both readers). However, severe stenosis was not seen even with the advanced circumferential wall calcification (mean stenosis of 35.3-40.7%). CONCLUSION Our study showed a moderate correlation between higher burden of vascular calcification and the degree of luminal stenosis. However, higher calcium burden and circumferential wall calcification were not associated with severe luminal stenosis.
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Affiliation(s)
- Shivaprakash B Hiremath
- Department of Radiology, Division of Neuroradiology, University of Ottawa, The Ottawa Hospital Civic and General Campus, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada
| | - Undrakh-Erdene Erdenebold
- Department of Radiology, Division of Neuroradiology, University of Ottawa, The Ottawa Hospital Civic and General Campus, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada
| | - Mario Kontolemos
- Department of Radiology, Division of Neuroradiology, University of Ottawa, The Ottawa Hospital Civic and General Campus, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada
| | - William Miller
- Department of Radiology, Division of Neuroradiology, University of Ottawa, The Ottawa Hospital Civic and General Campus, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada
| | - Nader Zakhari
- Department of Radiology, Division of Neuroradiology, University of Ottawa, The Ottawa Hospital Civic and General Campus, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
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8
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Tsuji K, Nakamura S, Aoki T, Nozaki K. The cerebral artery in cynomolgus monkeys (Macaca fascicularis). Exp Anim 2022; 71:391-398. [PMID: 35444076 PMCID: PMC9388346 DOI: 10.1538/expanim.22-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cerebral artery structure has not been extensively studied in primates. The aim of this study was to examine the cerebrovascular anatomy of cynomolgus monkeys (Macaca fascicularis), which are one of the most commonly used primates in medical research on human diseases, such as cerebral infarction and subarachnoid hemorrhage. In this study, we investigated the anatomy and diameter of cerebral arteries from 48 cynomolgus monkey brain specimens. We found three anatomical differences in the vascular structure of this species compared to that in humans. First, the distal anterior cerebral artery is single. Second, the pattern in which both the anterior inferior cerebellar artery and posterior inferior cerebellar artery branch from the basilar artery is the most common. Third, the basilar artery has the largest diameter among the major arteries. We expect that this anatomical information will aid in furthering research on cerebrovascular disease using cynomolgus monkeys.
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Affiliation(s)
- Keiichi Tsuji
- Department of Neurosurgery, Shiga University of Medical Science
| | - Shinichiro Nakamura
- Laboratory of Laboratory Animal Science, Azabu University.,Research Center for Animal Life Science, Shiga University of Medical Science
| | - Tomohiro Aoki
- Department of Molecular Pharmacology, Research Institute, National Cerebral and Cardiovascular Center
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science
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9
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Dharshini P, Raghunath G, Gurusamy K, Begum Z, Dhamodaran S, Karunakaran B, Maria Francis Y, Kaveripakkam V. Morphometric Study of the Intracranial Segment of the Vertebral Artery. Cureus 2022; 14:e22137. [PMID: 35308728 PMCID: PMC8918444 DOI: 10.7759/cureus.22137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 11/30/2022] Open
Abstract
Background The vertebral artery (VA) forms the caudal part of the circle of Willis and is responsible for one-third of the blood supply of the cerebellum, pons, middle ear, and the upper part of the spinal cord and its meninges. The highest potential risk of injury to VA during cervical pedicle screw implantation is at C3 and then at C6. Knowledge about the morphometry of VA provides a better understanding of clinical conditions such as vertebra basilar insufficiency (VBI). Similarly, the knowledge of variation in the VA is needed during cervical pedicle screw implantation, which possesses the highest potential risk to VA at the C3 level. The origin of the vertebral artery from the aortic arch reached the upper cervical vertebra than the vertebral artery of subclavian origin. The length of the VA is greater on the left side than the right-side artery. Understanding and reporting of the same are essential to creating awareness that can aid in endarterectomy, angioplasty, and radiological procedures. Variations are noted in morphometry between sides. Aim To determine the morphometry of the vertebral artery (VA) with emphasis on the fourth segment (V4) and its variations using computed tomography angiogram (CTA). Materials and methods This present retrospective study was conducted in the Departments of Anatomy and Radiology and Imaging Sciences, Saveetha Medical College and Hospital. Participants were patients who took a head and neck CT for various clinical reasons. About 50 CT images, 33 male and 17 females, were selected from the archives. The length, diameter, and entry level of VA were studied. The data were tabulated and statistically analyzed. Result The mean length of VA was 24.49 ± 3.02 (cm) on the left side and 24.28 ± 3.91 (cm) on the right side in female subjects and was found to be 22.78 ± 1.7 (cm) on the left side and 21.5 ± 2.7 (cm) on the right side in male subjects. The mean diameter of VA at the level of the foramen magnum was 0.32 ± 0.05 (cm) on the right side and 0.322 ± 0.07 (cm) on the left side in females, 0.3 ± 0.064 (cm) on the left side and 0.26 ± 0.086 (cm) on the right side in males. Conclusion The length of VA was found to be statistically more on the left side than on the right side. The variations in morphometry seen can aid in various surgical and radiological procedures.
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10
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Morphologic characterization of the superior cerebellar artery. A direct anatomic study. TRANSLATIONAL RESEARCH IN ANATOMY 2021. [DOI: 10.1016/j.tria.2021.100150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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11
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Muskat JC, Rayz VL, Goergen CJ, Babbs CF. Hemodynamic modeling of the circle of Willis reveals unanticipated functions during cardiovascular stress. J Appl Physiol (1985) 2021; 131:1020-1034. [PMID: 34264126 DOI: 10.1152/japplphysiol.00198.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The circle of Willis (CW) allows blood to be redistributed throughout the brain during local ischemia; however, it is unlikely that the anatomic persistence of the CW across mammalian species is driven by natural selection of individuals with resistance to cerebrovascular disease typically occurring in elderly humans. To determine the effects of communicating arteries (CoAs) in the CW on cerebral pulse wave propagation and blood flow velocity, we simulated young, active adult humans undergoing different states of cardiovascular stress (i.e., fear and aerobic exercise) using discrete transmission line segments with stress-adjusted cardiac output, peripheral resistance, and arterial compliance. Phase delays between vertebrobasilar and carotid pulses allowed bidirectional shunting through CoAs: both posteroanterior shunting before the peak of the pulse waveform and anteroposterior shunting after internal carotid pressure exceeded posterior cerebral pressure. Relative to an absent CW without intact CoAs, the complete CW blunted anterior pulse waveforms, although limited to 3% and 6% reductions in peak pressure and pulse pressure, respectively. Systolic rate of change in pressure (i.e., ∂P/∂t) was reduced 15%-24% in the anterior vasculature and increased 23%-41% in the posterior vasculature. Bidirectional shunting through posterior CoAs was amplified during cardiovascular stress and increased peak velocity by 25%, diastolic-to-systolic velocity range by 44%, and blood velocity acceleration by 134% in the vertebrobasilar arteries. This effect may facilitate stress-related increases in blood flow to the cerebellum (improving motor coordination) and reticular-activating system (enhancing attention and focus) via a nitric oxide-dependent mechanism, thereby improving survival in fight-or-flight situations.NEW & NOTEWORTHY Hemodynamic modeling reveals potential evolutionary benefits of the intact circle of Willis (CW) during fear and aerobic exercise. The CW equalizes pulse waveforms due to bidirectional shunting of blood flow through communicating arteries, which boosts vertebrobasilar blood flow velocity and acceleration. These phenomena may enhance perfusion of the brainstem and cerebellum via nitric oxide-mediated vasodilation, improving performance of the reticular-activating system and motor coordination in survival situations.
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Affiliation(s)
- J C Muskat
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana
| | - V L Rayz
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana.,School of Mechanical Engineering, Purdue University, West Lafayette, Indiana
| | - C J Goergen
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana
| | - C F Babbs
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana
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12
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Abstract
Möbius syndrome is an extremely rare congenital disorder. We report a case of Möbius syndrome in a 2-year-old girl with bilateral convergent squint and left-sided facial weakness. The characteristic magnetic resonance imaging (MRI) findings of Möbius syndrome, which include absent bilateral abducens nerves and absent left facial nerve, were noted. In addition, there was absence of left anterior inferior cerebellar artery (AICA) and absence of bilateral facial colliculi. Clinical features, etiology, and imaging findings are discussed.
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Affiliation(s)
- Maskal Revanna Srinivas
- Department of Radiodiagnosis and Imaging, Victoria Hospital, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - Dhulappa Mudabasappagol Vaishali
- Department of Radiodiagnosis and Imaging, Victoria Hospital, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - Kadaba Shamachar Vedaraju
- Department of Radiodiagnosis and Imaging, Victoria Hospital, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - Bangalore Rangaswamy Nagaraj
- Department of Radiodiagnosis and Imaging, Victoria Hospital, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
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13
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Zhang ZY, Zhou Z, Zhang HB, Jiao JS. Case report: the etiology of anterior inferior cerebellar artery infarction: what does basi-parallel anatomic scanning magnetic resonance imaging tell us? BMC Neurol 2021; 21:299. [PMID: 34330224 PMCID: PMC8323314 DOI: 10.1186/s12883-021-02309-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 07/06/2021] [Indexed: 11/23/2022] Open
Abstract
Background The precise etiology of anterior inferior cerebellar artery (AICA) infarction is difficult to identify because of the high anatomic variability of vertebrobasilar arteries and the limitations of conventional vascular examinations. Basi-parallel anatomic scanning magnetic resonance imaging (BPAS-MRI) can reveal the outer contour of the intracranial vertebrobasilar arteries, which may be helpful to distinguish the arteriosclerosis from congenital dysplasia and dissection. Case presentation In this study, we reported 3 cases of AICA infarction and discussed the diagnostic value of BPAS-MRI in the evaluation of vascular etiology. Conclusions The BPAS-MRI could be considered as an important supplementary in the diagnosis of vascular etiology of infarction in AICA territory.
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Affiliation(s)
- Zhi-Yong Zhang
- Department of Neurology, Beijing Geriatric Hospital, 118 Wenquan Road, Haidian District, Beijing, 100095, China.
| | - Zhi Zhou
- Department of Neurology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Hai-Bo Zhang
- Department of Radiology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Jin-Song Jiao
- Department of Neurology, China-Japan Friendship Hospital, Beijing, 100029, China
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14
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Keser N, Elshamy W, Chen X, Velioglu M, Is M, Xu Y, Eroksuz M, Ermutlu I, Huryol C, Jian R, Ates O. Challenges in Using the Posterior Inferior Cerebellar Artery for Revascularization of the Anterior Inferior Cerebellar Artery: A Microsurgical Anatomic Study. World Neurosurg 2021; 150:e591-e599. [PMID: 33753318 DOI: 10.1016/j.wneu.2021.03.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/12/2021] [Accepted: 03/13/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND A bypass is usually required to prevent ischemia during the treatment of anterior inferior cerebellar artery (AICA) aneurysms. The intracranial (IC)-to-IC bypass provides several advantages over the extracranial-to-IC bypass in the posterior fossa. However, there are only 2 case reports about AICA revascularization with the posterior inferior cerebellar artery (PICA). We aimed to investigate the microsurgical anatomical challenges for PICA to AICA anastomosis. METHODS Ten cadaveric heads injected with colored silicone were inspected on both sides using a lateral transcondylar approach. After the donor and recipient arteries were examined from the posterior side, neurovascular contents of the posterior fossa were excised and the origin, course, and variations of both arteries were investigated from the anterior view. The diameters of the AICA and PICA segments and the intersegment distance were measured. RESULTS PICA variations and posteromedial origins from the vertebral artery were identified in 8 of the 20 right and 6 of the 20 left sides, and the first segment of the PICA was not present in 7 sides. Furthermore, in 18 sides, the PICA was trapped between the lower cranial nerves and dentate ligaments. Therefore the donor artery could not be brought closer than 1 cm to the recipient artery in 19 sides. Moreover, AICA variations were identified in 6 sides, and in 12 sides, the diameter of the recipient artery was <1 mm. CONCLUSIONS The mostly PICA-related issues made PICA-to-AICA anastomosis unfeasible in all cadaveric heads included in the study.
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Affiliation(s)
- Nese Keser
- Department of Neurosurgery, University of Health Sciences, Istanbul Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey.
| | - Walid Elshamy
- Ain Shams University Faculty of Medicine, Department of Neurosurgery, Cairo, Egypt
| | - Xinpu Chen
- Zhengzhou University School of Medicine, Department of Neurosurgery, Zhengzhou, China
| | - Murat Velioglu
- Department of Radiology, University of Health Sciences, Istanbul Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Merih Is
- Retired Neurosurgeon, Department of Neurosurgery, University of Health Sciences, Istanbul, Turkey
| | - Yinfu Xu
- The Second People's Hospital of Liaocheng Shandong University, Department of Neurosurgery, Liaocheng Shandong, China
| | - Melih Eroksuz
- Marmara University School of Medicine, Institute of Neurological Sciences, Department of Neurosurgery, Istanbul, Turkey
| | - Ilcim Ermutlu
- Department of Neurosurgery, University of Health Sciences, Istanbul Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Cagin Huryol
- Bakirkoy Dr Sadi Konuk Training and Research Hospital, Department of Radiology, Istanbul, Turkey
| | - Ruan Jian
- Chongqing University Cancer Hospital, Department of Neurosurgery, Chongqing, China
| | - Ozkan Ates
- Koc University School of Medicine Hospital, Department of Neurosurgery, Istanbul, Turkey
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15
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Padmos RM, Józsa TI, El-Bouri WK, Konduri PR, Payne SJ, Hoekstra AG. Coupling one-dimensional arterial blood flow to three-dimensional tissue perfusion models for in silico trials of acute ischaemic stroke. Interface Focus 2021; 11:20190125. [PMID: 33335706 PMCID: PMC7739918 DOI: 10.1098/rsfs.2019.0125] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 01/08/2023] Open
Abstract
An acute ischaemic stroke is due to the sudden blockage of an intracranial blood vessel by an embolized thrombus. In the context of setting up in silico trials for the treatment of acute ischaemic stroke, the effect of a stroke on perfusion and metabolism of brain tissue should be modelled to predict final infarcted brain tissue. This requires coupling of blood flow and tissue perfusion models. A one-dimensional intracranial blood flow model and a method to couple this to a brain tissue perfusion model for patient-specific simulations is presented. Image-based patient-specific data on the anatomy of the circle of Willis are combined with literature data and models for vessel anatomy not visible in the images, to create an extended model for each patient from the larger vessels down to the pial surface. The coupling between arterial blood flow and tissue perfusion occurs at the pial surface through the estimation of perfusion territories. The coupling method is able to accurately estimate perfusion territories. Finally, we argue that blood flow can be approximated as steady-state flow at the interface between arterial blood flow and tissue perfusion to reduce the cost of organ-scale simulations.
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Affiliation(s)
- Raymond M. Padmos
- Computational Science Laboratory, Institute for Informatics, Faculty of Science, University of Amsterdam, Science Park 904, 1098 XH Amsterdam, The Netherlands
| | - Tamás I. Józsa
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Parks Road, Oxford OX1 3PJ, UK
| | - Wahbi K. El-Bouri
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Parks Road, Oxford OX1 3PJ, UK
| | - Praneeta R. Konduri
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands
- Biomedical Engineering and Physics, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands
| | - Stephen J. Payne
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Parks Road, Oxford OX1 3PJ, UK
| | - Alfons G. Hoekstra
- Computational Science Laboratory, Institute for Informatics, Faculty of Science, University of Amsterdam, Science Park 904, 1098 XH Amsterdam, The Netherlands
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16
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Junctional dilatation of the basilar tip: A Normal anatomical variant with a benign natural history. J Neurol Sci 2020; 419:117161. [PMID: 33035868 DOI: 10.1016/j.jns.2020.117161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/04/2020] [Accepted: 09/26/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE The intracranial arterial vasculature has numerous anatomical variants, which vary from largely benign to having remarkable clinical implications. The significance of a lesser known variant described as a junctional dilatation of the basilar artery tip has not yet been described in the literature. METHODS Retrospective query of radiology imaging reports was performed for vascular specific imaging of the head, which included descriptions related to the basilar junctional dilatation variant from 2005 to 2019 at a single institution. Imaging studies were individually scrutinized for true presence of the variant, and were assessed for any change in appearance over time. Primary data-points collected included length of time between imaging studies with stable appearance, intracranial aneurysm incidence, and frequency of hemorrhage associated with aneurysm rupture. RESULTS Fifty patients with multiple vascular exams were found to have the typical appearance of the basilar junctional dilatation variant. The variant was found to be stable over time in all patients, without interval expansion or basilar tip aneurysm development. Interval follow-up ranged from 1 to 156 months, with a mean follow-up length of 3.83 years, and total patient-years of follow-up of 192. No adverse neurological events were found which could be attributed to the basilar junctional dilatation variant. CONCLUSION Junctional dilatation of the basilar artery tip is a benign, normal variant of the posterior intracranial arterial circulation. It is important for both radiologists and clinicians to recognize its characteristic appearance and benign nature, as misdiagnosis may lead to unnecessary work-up, imaging, and/or treatment.
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17
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Aberrant AICA Injury During Translabyrinthine Approach. Otol Neurotol 2020; 41:1423-1426. [PMID: 33003181 DOI: 10.1097/mao.0000000000002826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To define a complication of the translabyrinthine surgical approach to the posterior fossa related to a rare variant of the anterior inferior cerebellar artery (AICA) that penetrated into the petrous temporal bone. PATIENT A healthy 59-year-old male with a unilateral sporadic vestibular schwannoma. INTERVENTION The patient elected to undergo a translabyrinthine approach for resection of a vestibular schwannoma. An aberrant loop of AICA was encountered during the temporal bone dissection within the petrous portion of the temporal bone. OUTCOMES The patient suffered a presumed ischemic insult resulting in a fluctuating ipsilateral facial paresis and atypical postoperative nystagmus. RESULTS MRI demonstrated an ischemic lesion in the vascular distribution of the right anterior-inferior cerebellar artery, including the lateral portion of the right cerebellar hemisphere, middle cerebellar peduncle, and bordering the right cranial nerve VII nucleus. His functional recovery was excellent, essentially identical to the anticipated course in an otherwise uncomplicated surgery. CONCLUSIONS This case highlights the irregular anatomy of the AICA as well as the importance of thorough neurological exams in the postsurgical lateral skull base patient.
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18
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Ballesteros LE, Forero PL, Estupiñan HY. Morphologic characterization of the anterior inferior cerebellar artery: a direct anatomic study. Neurol Res 2020; 42:828-834. [PMID: 32584208 DOI: 10.1080/01616412.2020.1785743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE An adequate knowledge of the anterior inferior cerebellar artery (AICA) is oriented to the morphological sciences, clinical management and surgical planning of the posterior fossa. We aimed to determine the morphology of AICA in a sample from Colombian population. METHOD We studied 92 AICA from fresh cadavers. For each specimen, the vertebral arteries were injected with 100 cc of semi-synthetic resin (a mixture of Palatal E210® BASF 80 cc and Styrene 20 cc) dyed with mineral red. The biometrics and morphological variables of AICA were registered. RESULTS AICA originated at 9.9 ± 3.2 mm from the vertebrobasilar junction. In 12 samples (8.1%), we observed a common trunk between AICA and posterior inferior cerebellar artery, which presented a caliber of 1.56 ± 0.23 mm and a length of 11.3 Â ± 3. 53 mm. In 80 (51.3%) specimens, AICA was originated from the proximal segment of basilar artery, while in 76 (48.7%) of them emerged from the medium segment. The AICA bifurcation distance from its origin was less than 20 mm in 20.5% of cases; between 20 and 40 mm in 62.3%. In its trajectory, AICA passed ventral to the facial nerve in 85 samples (53.2%), dorsal to the facial nerve in 68 samples (43.6%) and between the roots in 5 samples (3.2%). CONCLUSIONS The origin of the AICA from the proximal segment of the basilar artery is confirmed in this study, which disagrees with reports that point out its origin in the middle segment.
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Affiliation(s)
- L E Ballesteros
- Department of Basic Sciences, Medicine School, Universidad Industrial De Santander , Bucaramanga, Colombia
| | - P L Forero
- Department of Pathology, Medicine School, Universidad Industrial De Santander , Bucaramanga, Colombia.,Forensic pathology, National Institute of Legal Medicine and Forensic Sciences , Bucaramanga, Colombia
| | - H Y Estupiñan
- Department of Basic Sciences, Medicine School, Universidad Industrial De Santander , Bucaramanga, Colombia
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19
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Rasmussen J, Plou P, Campero Á, Ajler P. A Classification for the Anterior Inferior Cerebellar Artery-Subarcuate Artery Complex Based on the Embryological Development. J Neurol Surg B Skull Base 2019; 81:536-545. [PMID: 33134020 DOI: 10.1055/s-0039-1692474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/11/2019] [Indexed: 10/26/2022] Open
Abstract
Objective To hierarchize the anterior inferior cerebellar artery (AICA)-subarcuate artery (SAA) complex's variations in the surgical field. Background The AICA's "subarcuate loop" (SL) presents multiple variations, closely related to the SAA. AICA-SAA complex's variations may represent major issues in cerebellopontine angle (CPA) surgery. As the spectrum of configurations is originated during the development, a systematized classification was proposed based on the interaction between the petrosal bone and the AICA in the embryonic period. Methods The variations were defined as follow: Grade 0: free, purely cisternal AICA, unidentifiable or absent SAA; Grade 1: purely cisternal AICA, loose SL, SAA > 3 mm; Grade 2: AICA near the subarcuate fossa, pronounced SL, SAA <3 mm; Grade 3: "duralized" AICA, unidentifiable SAA, or included in the petromastoid canal (PMC); and Grade 4: intraosseous AICA, unidentifiable SAA, or included in the PMC. The classification was applied to a series of patients assessed by magnetic resonance constructive interference in steady state sequence. Surgical examples were also provided. Results Eighty-four patients were evaluated, including 161 CPA. The proportions found in the gradation remained within the range of previous publications (Grade 0: 42.2%; Grade 1: 11.2%; Grade 2: 35.4%; Grade 3: 10.6%; and Grade 4: 0.6%). Moreover, the degrees of the classification were related to the complexity of the anatomical relationships and, therefore, to the difficulty of the maneuvers required to overcome them. Conclusion The proposed AICA-SAA complex classification allowed to distinguish and objectify pre- and intraoperatively the spectrum of variations, to thoroughly plan the required actions and instrumentation.
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Affiliation(s)
- Jorge Rasmussen
- Department of Neurosurgery, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Pedro Plou
- Department of Neurosurgery, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Álvaro Campero
- Department of Neurosurgery, Padilla Hospital, Tucumán, Argentina
| | - Pablo Ajler
- Department of Neurosurgery, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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20
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Meybodi AT, Moreira LB, Zhao X, Lawton MT, Preul MC. Double Origin of the Posterior Inferior Cerebellar Artery: Anatomic Case Report. World Neurosurg 2019; 124:110-115. [PMID: 30611945 DOI: 10.1016/j.wneu.2018.12.127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Double origin of the posterior inferior cerebellar artery (DOPICA) is rare. It has important clinical implications especially in cases of aneurysms of the vertebral artery (VA) or the posterior inferior cerebellar artery (PICA). Several radiologic reports of this variant exist. However, no anatomical illustration of this rarity exists in the literature. This brief report provides the first anatomic illustration of this important variation of the vertebrobasilar system. CASE DESCRIPTION A cadaveric specimen was prepared for dissection. A far lateral craniotomy was performed on the right side. While exploring the right cerebellomedullary cistern, two separate origins of PICA were found from the vertebral artery (VA) as the caudal and rostral trunks that joined to form the distal PICA trunk at the tonsillomedullary segment. Microscopic and endoscopic illustrations are provided. CONCLUSIONS To the best of the authors' knowledge, this is the first anatomic report on the DOPICA. Cadaveric illustration of this variant helps with understanding its anatomical relationship with adjacent neurovascular structures of the cerebellomedullary cistern including the perforating arteries and the lower cranial nerves.
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Affiliation(s)
- Ali Tayebi Meybodi
- Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Leandro Borba Moreira
- Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Xiaochun Zhao
- Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Michael T Lawton
- Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Mark C Preul
- Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
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21
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Abstract
Posterior fossa houses very vital and sensitive structures namely midbrain, pons, medulla, and cerebellum. These structures are irrigated by vertebral, posterior inferior cerebellar, anterior inferior cerebellar, and superior cerebellar arteries. Parts of brain located in posterior fossa control important parts of body so any variation pertaining to stenosis, atresia, hypoplasia, fenestration, agenesis, and duplication in the arteries supplying these parts alter the irrigation pattern culminating into various morbid and mortal neurologic disorders. Therefore, a sound understanding and thorough knowledge of posterior circulation vascular variant anatomy builds the foundation for the accurate diagnosis and appropriate management of neurovascular ischemic and hemorrhagic diseases of posterior fossa. To aid in addressing these complex neurologic disorders and neurosurgical treatment to be carried out successfully, updating and consolidating the knowledge of all the variations/insults of these arteries becomes essential. Therefore, review study has been carried out.Literature search was carried out using databases, including Scielo, Scopmed, Medline, PubMed, and Wiley online library. Papers containing original data were selected and secondary references retrieved from bibliographies. Search terms used were posterior fossa, anomalies of vertebral, posterior inferior cerebellar, anterior inferior cerebellar, and superior cerebellar arteries.The study will be of paramount importance to angiographers in interpreting angiographs, neurologists in diagnosis and treatment of neurologic disorders, and neurosurgeons in performing surgery in posterior fossa and craniovertebral region particularly dealing with tumors and vascular malformations.
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22
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Refaee EE, Rosenstengel C, Baldauf J, Pillich DT, Matthes M, Schroeder HWS. Microvascular Decompression for Patients With Hemifacial Spasm Associated With Common Trunk Anomaly of the Cerebellar Arteries-Case Study and Review of Literature. Oper Neurosurg (Hagerstown) 2018; 14:121-127. [PMID: 29351689 DOI: 10.1093/ons/opx105] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 05/08/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Few previous studies have described the origin of both anterior and posterior inferior cerebellar arteries from one vessel as a common trunk anomaly. No previous studies have clearly described the aforementioned anomaly depending on intraoperative endoscopic visualization. OBJECTIVE To evaluate the association of a common trunk anomaly with hemifacial spasm, which makes microvascular decompression more challenging. METHODS All patients with common trunk anomaly associated with hemifacial spasm who received surgical treatment between 2006 and 2015 in our institution were identified in our prospectively collected database. Detection of the common trunk anomaly was performed using the intraoperative high-definition endoscopic inspection and confirmed by a retrospective review of the obtained operative videos. RESULTS Out of 248 cases of hemifacial spasm, 21 cases with a common trunk anomaly were detected, with an incidence rate of 8.5%. In 6 cases, the spasm was caused by more than 1 offending vessel "complex compression." In 19 cases, total recovery occurred on follow-up, while in 1 case, 90% recovery occurred. One patient was spasm-free immediately after surgery, but died 3 wk after operation from herpes encephalitis. CONCLUSION Common trunk anomaly in hemifacial spasm is rare. The surgical technique is mostly identical to decompression with normally arising vessels. However, in case of a bifurcation situated close to the compression site where the offending vessel cannot be transposed freely, an extensive cushioning along the trunk and the offending vessels with teflon pledgets should be performed. The presence of a common trunk anomaly does not affect the surgical results.
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Affiliation(s)
- Ehab El Refaee
- Department of Neurosurgery, Ernst Moritz Arndt University, Greifswald, Germany.,Department of Neurosurgery, Cairo University, Cairo, Egypt
| | | | - Joerg Baldauf
- Department of Neurosurgery, Ernst Moritz Arndt University, Greifswald, Germany
| | - Dirk T Pillich
- Department of Neurosurgery, Ernst Moritz Arndt University, Greifswald, Germany
| | - Marc Matthes
- Department of Neurosurgery, Ernst Moritz Arndt University, Greifswald, Germany
| | - Henry W S Schroeder
- Department of Neurosurgery, Ernst Moritz Arndt University, Greifswald, Germany
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23
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Chen MM, Chen SR, Diaz-Marchan P, Schomer D, Kumar VA. Anterior Inferior Cerebellar Artery Strokes Based on Variant Vascular Anatomy of the Posterior Circulation: Clinical Deficits and Imaging Territories. J Stroke Cerebrovasc Dis 2017; 27:e59-e64. [PMID: 29150242 DOI: 10.1016/j.jstrokecerebrovasdis.2017.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/30/2017] [Accepted: 10/11/2017] [Indexed: 12/21/2022] Open
Abstract
We report imaging findings of 3 patients with anterior inferior cerebellar artery (AICA) infarcts who presented with atypical clinical findings of cerebellar strokes. AICA strokes are rare, and diagnosis can be difficult because of the high variability of the posterior circulation vascular anatomy. We describe the embryology and variant anatomy of AICA so that clinicians can understand and recognize the patterns of these infarcts.
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Affiliation(s)
- Melissa M Chen
- Diagnostic Radiology, MD Anderson Cancer Center, Houston, Texas.
| | - Stephen R Chen
- Radiology and Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | - Donald Schomer
- Diagnostic Radiology, MD Anderson Cancer Center, Houston, Texas
| | - Vinodh A Kumar
- Diagnostic Radiology, MD Anderson Cancer Center, Houston, Texas
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24
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Chung MS, Jung SC, Kim SO, Kim HS, Choi CG, Kim SJ, Kwon SU, Kang DW, Kim JS. Intracranial Artery Steno-Occlusion: Diagnosis by Using Two-dimensional Spatially Selective Radiofrequency Excitation Pulse MR Imaging. Radiology 2017; 284:834-843. [DOI: 10.1148/radiol.2017161490] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mi Sun Chung
- From the Department of Radiology and Research Institute of Radiology (M.S.C., S.C.J., H.S.K., C.G.C., S.J.K.), Department of Clinical Epidemiology and Biostatistics (S.O.K.), and Department of Neurology (S.U.K., D.W.K., J.S.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Song pa-gu, Seoul 138-736, Korea
| | - Seung Chai Jung
- From the Department of Radiology and Research Institute of Radiology (M.S.C., S.C.J., H.S.K., C.G.C., S.J.K.), Department of Clinical Epidemiology and Biostatistics (S.O.K.), and Department of Neurology (S.U.K., D.W.K., J.S.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Song pa-gu, Seoul 138-736, Korea
| | - Seon-Ok Kim
- From the Department of Radiology and Research Institute of Radiology (M.S.C., S.C.J., H.S.K., C.G.C., S.J.K.), Department of Clinical Epidemiology and Biostatistics (S.O.K.), and Department of Neurology (S.U.K., D.W.K., J.S.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Song pa-gu, Seoul 138-736, Korea
| | - Ho Sung Kim
- From the Department of Radiology and Research Institute of Radiology (M.S.C., S.C.J., H.S.K., C.G.C., S.J.K.), Department of Clinical Epidemiology and Biostatistics (S.O.K.), and Department of Neurology (S.U.K., D.W.K., J.S.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Song pa-gu, Seoul 138-736, Korea
| | - Choong Gon Choi
- From the Department of Radiology and Research Institute of Radiology (M.S.C., S.C.J., H.S.K., C.G.C., S.J.K.), Department of Clinical Epidemiology and Biostatistics (S.O.K.), and Department of Neurology (S.U.K., D.W.K., J.S.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Song pa-gu, Seoul 138-736, Korea
| | - Sang Joon Kim
- From the Department of Radiology and Research Institute of Radiology (M.S.C., S.C.J., H.S.K., C.G.C., S.J.K.), Department of Clinical Epidemiology and Biostatistics (S.O.K.), and Department of Neurology (S.U.K., D.W.K., J.S.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Song pa-gu, Seoul 138-736, Korea
| | - Sun U. Kwon
- From the Department of Radiology and Research Institute of Radiology (M.S.C., S.C.J., H.S.K., C.G.C., S.J.K.), Department of Clinical Epidemiology and Biostatistics (S.O.K.), and Department of Neurology (S.U.K., D.W.K., J.S.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Song pa-gu, Seoul 138-736, Korea
| | - Dong-Wha Kang
- From the Department of Radiology and Research Institute of Radiology (M.S.C., S.C.J., H.S.K., C.G.C., S.J.K.), Department of Clinical Epidemiology and Biostatistics (S.O.K.), and Department of Neurology (S.U.K., D.W.K., J.S.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Song pa-gu, Seoul 138-736, Korea
| | - Jong S. Kim
- From the Department of Radiology and Research Institute of Radiology (M.S.C., S.C.J., H.S.K., C.G.C., S.J.K.), Department of Clinical Epidemiology and Biostatistics (S.O.K.), and Department of Neurology (S.U.K., D.W.K., J.S.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Song pa-gu, Seoul 138-736, Korea
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25
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Evaluation of a Traumatic Vertebral Artery Occlusion. World Neurosurg 2017; 101:815.e13-815.e17. [PMID: 28254602 DOI: 10.1016/j.wneu.2017.02.089] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/17/2017] [Accepted: 02/18/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Penetrating neck injury occurs in 5%-10% of all trauma cases and carries a significant burden of morbidity and mortality (15%). We describe the evaluation and management of a 25-year-old man shot in the neck with occlusion of the left vertebral artery from its origin to C6. This is a case report in which medical data were analyzed retrospectively with institutional review board approval. CASE DESCRIPTION Neurologic examination revealed paresthesias and dysesthesias in a left C8 dermatomal distribution. Computed tomography angiography of the neck demonstrated no opacification of the left vertebral artery from its origin to C6. Magnetic resonance imaging of the cervical spine revealed an acute infarct in the left cerebellum. A cerebral angiogram highlighted hemodynamic compromise, and the patient was felt to be at significant risk of further cerebral infarction. Augmenting flow to the posterior circulation would mitigate that risk. The patient was taken to the operating room for a transposition of the vertebral artery to the common carotid artery. CONCLUSIONS The patient presented with silent cerebellar infarction due to a vertebral artery injury and impending vertebrobasilar insufficiency. This case demonstrates clinical evaluation of the posterior circulation and treatment with a bypass technique through mobilization of the vertebral artery from the boney vertebral foramen with anastomosis to the common carotid.
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Familial hemifacial spasm of young-onset: Report of two cases. J Neurol Sci 2017; 373:83-85. [PMID: 28131234 DOI: 10.1016/j.jns.2016.12.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 11/25/2016] [Accepted: 12/19/2016] [Indexed: 11/24/2022]
Abstract
Hemifacial spasm (HFS) is defined as an involuntary twitching of the hemifacial muscles supplied by the facial nerve. It is mostly attributed to a vascular compression with the facial nerve. Familial HFS has been described in less than 10% of cases of sporadic HFS and usually develops after the age of 40. Young-onset HFS is a rare condition, generally presenting prior to the age of 30 with an estimated prevalence of 6.5% of sporadic HFS. No familial component has been described in small series of young-onset HFS. Here we report the cases of a patient and his mother who both developed right HFS in their early twenties. Both patients had a neurovascular contact between their right facial nerve and a branch of their right posterior inferior cerebellar artery. Our report explores how young-onset familial HFS may be the consequence of hereditary vascular variations.
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De Cocker LJL, Lövblad KO, Hendrikse J. MRI of Cerebellar Infarction. Eur Neurol 2017; 77:137-146. [PMID: 28095387 DOI: 10.1159/000455229] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 12/17/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND MRI is the imaging modality of choice for diagnosing brain infarction. Because of few or atypical clinical symptoms and a relatively low sensitivity of CT scans, many cerebellar infarctions may be detected only with MRI. With adequate recognition of cerebellar infarction on MRI and prompt initiation or optimisation of preventive therapeutic measures, more dramatic strokes may be avoided in selected cases. SUMMARY We first briefly review the clinical presentation of cerebellar infarctions, followed by a short refresher on cerebellar anatomy and pathophysiological mechanisms of cerebellar infarcts. Then, we review the arterial cerebellar perfusion territories recently made visible with territorial arterial spin labeling (ASL), followed by a discussion and illustration of the MRI appearance of cerebellar infarcts in different stages. Similar to large cerebellar infarcts, recent studies investigating volumetric MRI datasets have now shown that small cerebellar infarcts occur in typical spatial patterns, knowledge of which may help in the diagnosis of even the smallest of cerebellar infarcts on MRI. Key Messages: MRI is the modality of choice for diagnosing cerebellar infarction. The posterior inferior cerebellar artery (PICA)-territories can be visualised with super-selective territorial ASL MRI. The PICA supplies at least the medial part of the posterior cerebellar surface. Anterior inferior cerebellar artery-infarcts can be mistaken for lateral PICA-infarcts. Small infarcts typically affect the cortex and often present as incidental cavities. Subacute cerebellar infarcts may be missed on imaging due to a phenomenon called "fogging."
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Affiliation(s)
- Laurens J L De Cocker
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
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Magnetic resonance angiography in evaluation of acute intracranial steno-occlusive arterial disease. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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De Leacy RA, Berenstein A, Naidich TP. Vascular Disorders of the Cerebellum in Children. Neuroimaging Clin N Am 2016; 26:435-58. [PMID: 27423802 DOI: 10.1016/j.nic.2016.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Key differences exist in the epidemiology, pathophysiology, and clinical presentation of vascular lesions of the cerebellum in children versus adults. An understanding of these differences and an appreciation of the distinct imaging features of these lesions aid in distinguishing normal vascular variations from pathology, in predicting lesion etiology, and in directing effective treatment strategies. This paper reviews the embryogenesis of the normal vascular system of the cerebellum and brainstem and then discusses the clinical and imaging features of the common vascular lesions affecting these structures in the pediatric population.
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Affiliation(s)
- Reade A De Leacy
- Department of Neurosurgery, Cerebrovascular Center, Mount Sinai Hospital, Mount Sinai Medical Center, KCC 1-North, 1450 Madison Avenue, New York, NY 10029, USA; Department of Radiology, Cerebrovascular Center, Mount Sinai Hospital, Mount Sinai Medical Center, KCC 1-North, 1450 Madison Avenue, New York, NY 10029, USA.
| | - Alejandro Berenstein
- Department of Radiology, Cerebrovascular Center, Mount Sinai Hospital, Mount Sinai Medical Center, KCC 1-North, 1450 Madison Avenue, New York, NY 10029, USA; Pediatric Cerebrovascular Program, Department of Neurosurgery, Cerebrovascular Center, Mount Sinai Hospital, Mount Sinai Medical Center, KCC 1-North, 1450 Madison Avenue, New York, NY 10029, USA; Department of Pediatrics, Cerebrovascular Center, Mount Sinai Hospital, Mount Sinai Medical Center, KCC 1-North, 1450 Madison Avenue, New York, NY 10029, USA
| | - Thomas P Naidich
- Department of Radiology, Mount Sinai Medical Center, Box 1234, One Gustave Levy Place, New York, NY 10029, USA; Department of Neurosurgery, Mount Sinai Medical Center, One Gustave Levy Place, New York, NY 10029, USA; Department of Pediatrics, Mount Sinai Medical Center, One Gustave Levy Place, New York, NY 10029, USA
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Jung SC, Kim HS, Choi CG, Kim SJ, Lee DH, Suh DC, Kwon SU, Kang DW, Kim JS. Quantitative Analysis Using High-Resolution 3T MRI in Acute Intracranial Artery Dissection. J Neuroimaging 2016; 26:612-617. [PMID: 27173143 DOI: 10.1111/jon.12357] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 03/31/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND PURPOSE Quantitative measurements, as well as qualitative characterizations, of the vessel walls of the small intracranial arteries became clinically available and reliable beyond the resolution limit of 1.5 T high-resolution magnetic resonance imaging (HR-MRI) with the development of 3 T HR-MRI. We present the quantitative dissection findings of spontaneous and unruptured acute intracranial artery dissection (SID) using 3 T HR-MRI and investigate the differences between each cerebral artery. METHODS Twenty-eight lesions (anterior cerebral artery = 6; middle cerebral artery = 4; vertebral artery = 18) from 26 patients (17 male and 9 female patients; mean age = 47 years; age range = 32-74 years) with presumptive diagnoses of SID were included. The diagnosis was determined based on the clinical features, findings on luminal angiography (such as digital subtraction angiography, computed tomography, or magnetic resonance angiography), and HR-MRI. HR-MRI was performed within one month from onset. The neuroimaging indices (maximal outer diameter and area, remodeling index and modified remodeling index, and wall thickness and wall area index) of aneurysmal dilatation and the signal intensities of the intramural hematomas were rated using HR-MRI. The results were compared between each cerebral artery. RESULTS The maximal outer diameter and area, remodeling index and modified remodeling index, and wall thickness index and length were significantly different between anterior and posterior circulation (P < .05). The mean relative signal intensities of the intramural hematoma showed consistent values, regardless of the cerebral arteries, without significant difference. CONCLUSIONS Neuroimaging indices of aneurysmal dilatation may be adjunctive indicators in the evaluation of SID.
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Affiliation(s)
- Seung Chai Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Choong-Gon Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sang Joon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Deok Hee Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dae Chul Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sun U Kwon
- Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong-Wha Kang
- Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong S Kim
- Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Shi SK. An unusual variation of carotid-vertebrobasilar arteries: An anatomical case report. Neuroradiol J 2016; 29:277-9. [PMID: 27033095 DOI: 10.1177/1971400916642629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE Having no obvious clinical symptoms and signs, it is difficult to find head and neck vascular variations without the aid of vascular imaging techniques. SUMMARY OF CASE A 66-year-old female patient underwent head and neck computed tomographic angiography examination. Her computed tomographic angiography examination revealed that the internal carotid artery directly migrated to the ophthalmic artery. Brain blood supply is provided by the vertebrobasilar artery independently. CONCLUSION To the best of the author's knowledge, this is a very rare anatomical vascular variation of the head and neck found by computed tomographic angiography.
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Affiliation(s)
- Shi-Kui Shi
- Department of Radiology, First Affiliated Hospital of Bengbu Medical College, People's Republic of China
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Akhtar S, Azeem A, Jiwani A, Javed G. Aneurysm in the anterior inferior cerebellar artery-posterior inferior cerebellar artery variant: Case report and review of literature. Int J Surg Case Rep 2016; 22:23-7. [PMID: 27017276 PMCID: PMC4844662 DOI: 10.1016/j.ijscr.2016.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 03/06/2016] [Accepted: 03/07/2016] [Indexed: 11/26/2022] Open
Abstract
We reported a case of an aneurysm in the AICA-PICA variant which was subsequently excised. Considerable variation exists in the anatomy of the vertebrobasilar system. Understanding the variations and the aneurysms that may arise from them is an important aspect of neurosurgical practice.
Introduction There are variations in the anatomy of the vertebrobasilar system amongst which the Anterior Inferior Cerebellar Artery-Posterior Inferior Cerebellar Artery (AICA-PICA) variant is thought to have a prevalence of 20–24% (based on retrospective studies). Despite this, aneurysms of the AICA-PICA variant are rare. We present a case of an AICA-PICA aneurysm and discuss its presentation and management, along with a review of literature. Presentation of case We describe the case of a 35 year old female who presented with signs of meningismus. On the basis of radiological imaging it was initially misdiagnosed as a thrombosed arteriovenous malformation (AVM). The patient was eventually discharged with a plan of interval imaging and interventional radiology (if required). The patient presented again with similar signs and symptoms. Re-evaluation of imaging revealed an aneurysm of the AICA-PICA variant which was managed surgically. Discussion Aneurysms of the AICA-PICA variant are rare. The radiological features and surgical management represent a unique clinical entity and are discussed below. Conclusion The prevalence of the AICA-PICA variant might be high but aneurysms in this vessel are rare. The scant knowledge available on this subject makes it a diagnostic difficulty.
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Affiliation(s)
- Saad Akhtar
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
| | - Abdul Azeem
- Medical College, The Aga Khan University, Karachi, Pakistan.
| | - Amyna Jiwani
- Section of General Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
| | - Gohar Javed
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
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Common and uncommon intracranial arterial anatomic variations in multi-detector computed tomography angiography (MDCTA). What radiologists should be aware of. Insights Imaging 2015; 6:33-42. [PMID: 25680324 PMCID: PMC4330235 DOI: 10.1007/s13244-014-0381-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 12/18/2014] [Accepted: 12/19/2014] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES The aim of this retrospective study was twofold: (1) to show the role of multi-detector computed tomography angiography (MDCTA) in the evaluation of intracranial arterial anatomic variations; (2) to highlight their clinical importance with illustrated example cases. MATERIALS AND METHODS One thousand seven hundred thirty-nine patients who underwent carotid and/or cerebral CTA using a 16-row multi-detector CT over the last 9 years were retrospectively analysed with attention to the presence of persistent carotid-basilar anastomosis and other intracranial arterial variations. RESULTS All kinds of persistent carotid-basilar anastomosis were present in our series. The most common was the presence of fetal pCom (23 %). From the other studied anatomic variants, the most common was the presence of a hypoplastic A1 segment. In all cases CTA was an excellent diagnostic tool, providing not only high-resolution angiographic images, but also details of the surrounding structures. CONCLUSIONS The knowledge of intracranial anatomic variations could be very important for the treatment planning of patients who need neurointervention or to explain uncommon and unexpected clinical findings. CTA can reliably provide this kind of information by depicting intracranial anatomic variations. TEACHING POINTS • Knowledge of intracranial anatomic variations is important. • Radiologist should be aware of the intracranial anatomic variations. • Computed tomography angiography can reliably depict intracranial anatomic variations.
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Vertebral Artery Hypoplasia in a Black Kenyan Population. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:934510. [PMID: 27382606 PMCID: PMC4897114 DOI: 10.1155/2014/934510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 06/30/2014] [Accepted: 06/30/2014] [Indexed: 11/26/2022]
Abstract
This study examined the characteristics of vertebral artery hypoplasia in 346 arteries of adult black Kenyans. The circumference was measured on haematoxylin/eosin stained microscopic sections of the distal one-third of the intracranial vertebral arteries using scion image analyser. Internal diameter was calculated in millimetre. Data were analysed using SPSS version 16.0. Vertebral artery hypoplasia (diameter < 2.0 mm) occurred in 100 (28.9%) arteries. Sixty of these (17.3%) were on the left and 40 (11.6%) on the right. Sixty (17.3%) were in females while 40 (11.6%) were in males. The side and gender differences were statistically significant at confidence interval of 95%. Frequency of vertebral artery hypoplasia was higher than in most other populations studied. The condition differs from that in other populations because it is more common on the left side and in females. We recommend ultrasound, angio-CT, or angio-MRI evaluation of vertebral arterial system before diagnostic or interventional procedures on posterior circulation.
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Variations of the vertebrobasilar circulation and its impact on the clinical and radiologic evaluation. Surg Radiol Anat 2014; 36:203-4. [DOI: 10.1007/s00276-013-1164-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 07/01/2013] [Indexed: 10/26/2022]
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Hamcan S, Bozkurt Y, Akgun V, Battal B. Variations of the vertebrobasilar circulation and its impact on the neurosurgical interventions. Clin Neurol Neurosurg 2014; 119:133. [PMID: 24560442 DOI: 10.1016/j.clineuro.2013.10.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 10/14/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Salih Hamcan
- Agri Military Hospital, Department of Radiology, Agri, Turkey
| | - Yalcin Bozkurt
- Gulhane Military Medical School, Department of Radiology, Ankara, Turkey
| | - Veysel Akgun
- Gulhane Military Medical School, Department of Radiology, Ankara, Turkey
| | - Bilal Battal
- Gulhane Military Medical School, Department of Radiology, Ankara, Turkey.
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Re: Variants of hepatic arterial supply in a Caribbean population: A computed tomography based study. Clin Radiol 2014; 69:e56-7. [DOI: 10.1016/j.crad.2013.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 07/15/2013] [Indexed: 11/22/2022]
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Battal B, Hamcan S, Akgun V, Bozkurt Y. Congenital superior-inferior mesenteric arterial variation or arc of Riolan due to occlusion of proximal superior mesenteric artery. Surg Radiol Anat 2013; 36:309-10. [PMID: 24135762 DOI: 10.1007/s00276-013-1212-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 10/09/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Bilal Battal
- Department of Radiology, Gulhane Military Medical School, Etlik, 06018, Ankara, Turkey,
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