![]() ![]() However, among the cerebellar arteries, the course of the PICA shows the most variation. The PICA is generally thought to originate from the intradural (V 4) segment of the VA thus, surgeons pay careful attention to the artery after dural opening. Great care should be paid to this artery in operations that involve the craniovertebral junction (CVJ). It also results in serious sequelae, including difficulties in swallowing, saliva clearance, and articulation, as well as hemiparesis. Occlusion of this vessel may cause serious ischemic conditions, such as Wallenberg syndrome, cerebellar infarction, and, in the worst cases, acute tonsillar herniation due to neural edema. ![]() It perfuses important neural structures, including the lateral posterior area of the medulla oblongata, the inferior half of the anterior surface of the cerebellum, and the inferior half of the vermis. PICA = posterior inferior cerebellar artery VA = vertebral artery dissecting aneurysm far-lateral craniotomy posterior inferior cerebellar artery reimplantation vascular disorders vertebral artery.T he posterior inferior cerebellar artery (PICA) is considered to be the first branch from the vertebral artery (VA). The final decision to reimplant the PICA depends on careful inspection of perforator anatomy that is not visible preoperatively on angiography, as well as an assessment of technical difficulty intraoperatively. PICA reimplantation is a revascularization option for dissecting VA aneurysms incorporating the PICA origin that are < 13 mm in length, and for nonsaccular proximal PICA aneurysms that are < 6 mm in diameter. CONCLUSIONS The buffer lengths measured in this study describe the limitations of PICA reimplantation as a revascularization procedure for nonsaccular aneurysms in this location. The PICA was less maneuverable when it was reimplanted across the VA, due to perforator branches of the PICA (P 3 segment). The mean buffer length with reimplantation along the VA axis was 13.43 ± 4.61 mm, and it was 6.97 ± 4.04 mm with reimplantation across the VA. No direct perforator was found on the P 1 segment. The most common perforating artery on the P 1 and P 2 segments was the short circumflex type. ![]() RESULTS The PICA was reimplanted in all surgical simulations. The buffer lengths provided by mobilization of the artery in each paradigm were measured and the anatomy of perforator branching on the proximal PICAs was analyzed. The PICA was mobilized and reimplanted onto the VA according to 2 different paradigms: 1) transposition along the axis of the VA (along-VA) to simulate a dissecting VA, and 2) transposition perpendicular to the axis of the VA (across-VA) to simulate a nonclippable, proximal PICA aneurysm. Twenty far-lateral approaches were performed. METHODS Ten cadaver heads (20 sides) were prepared for surgical simulation. The goal of this study was to define the surgical anatomy and buffer lengths specific to the proximal segment of the PICA related to 2 variations of PICA reimplantation: 1) reimplantation "along-VA" (simulating a dissecting VA aneurysm), and 2) reimplantation "across-VA" (simulating a nonclippable, proximal PICA aneurysm). However, the anatomy and limitations of this technique have not been studied. OBJECTIVE Reimplantation of the posterior inferior cerebellar artery (PICA) to the vertebral artery (VA) is a safe and effective bypass option after deliberate PICA sacrifice during the treatment of nonsaccular and dissecting aneurysms at this location. ![]()
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