![]() Blood in the separated layers of the vessel wall can lead to blood clot formation. With carotid dissection, the dissection rarely goes completely through the artery due to its elastic outer layers. PICA-PICA anastomosis is a useful procedure for reconstruction of the PICA when parent vessel occlusion or trapping is necessary to exclude a VA aneurysm involving the origin of the PICA. An artery tear, also called a dissection, occurs when layers of the interior arterial walls separate. This bypass is highly challenging and its technical description is seldom cited in the literature. In the peer-reviewed literature, three double origin PICA cases have been documented by angiography and all arose from the left vertebral artery (VA) ( 1, 2 ). An anastomosis of the Occipital Artery (OA) to PICA is one bypass option in these cases. Although the posterior inferior cerebellar artery (PICA) commonly has a variable course, caliber, length, and target territory, fenestrations and bifid origins are exceedingly rare. The remaining four cases experienced no new neurologic deficits. Background Aneurysms located at the proximal posterior inferior cerebellar artery (PICA) may need to be addressed by trapping and concomitant bypass. One patient experienced myopathy of the lower extremities secondary to intraoperative fixed board compression and developed permanent lower extremity muscular weakness. The remaining patient experienced hemorrhage from contralateral VA dissection and subsequently died. An anas-tomosis of the Occipital Artery (OA) to PICA is one bypass option in these cases. Postoperative cerebral angiography demonstrated patency of the anastomosis and regression of the aneurysm in five of six patients. inferior cerebellar artery (PICA) may need to be ad-dressed by trapping and concomitant bypass. The VA was subsequently occluded by clipping proximal and distal to the aneurysm, and the PICA was occluded by clipping distal to the aneurysm. We present six patients with dissecting VA aneurysms who underwent PICA-PICA anastomosis combined with parent artery occlusion.Īfter a lower lateral suboccipital craniectomy and partial resection of the jugular tubercle, anastomoses were performed in a side-to-side fashion at the posterior medullary segment of the PICA. The vertebral artery was present in 49 and the PICA was present in 42 of the 50 hemispheres. The posterior inferior cerebellar artery (PICA), by definition, arose from the vertebral artery. In patients with aneurysms that involve the origin of the posterior inferior cerebellar artery (PICA) and require occlusion of the vertebral artery (VA), revascularization of the PICA is commonly performed. Abstract Fifty cerebellar hemispheres from 25 adult cadavers were examined.
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