No abstract available.
Pica*

OBJECTIVE: Aneurysms arising from the posterior inferior cerebellar artery(PICA) are uncommon. We review literature on that and surgical results on aneurysmal treatment by choice of surgical approach. METHODS: On the basis of radiologic findings & charts, we review retrospectively the surgical results of 12 cases from Mar 1999 to Dec 2003. RESULTS: The mean age of the 12 patients was 55.8(ranged from 36 to 71) and female was predominant (female: male=8: 4). Locations of PICA aneurysms revealed variously(vertebral artery-PICA junction: 8, lateral medullary segment: 2, PICA-anterior inferior cerebellar artery common trunk: 1, telovelomedullary: 1). Surgical approaches & treatments were attempted in 11 cases and embolization was done in 1 case(Far lateral transcondylar or supracondylar approach & clipping: 9, Far lateral transcondylar or supracondylar approach and trapping: 2, suboccipital approach & clipping: 1). The surgical result were 8 of 12 patients were good outcome, 1 of 12 was severely disabled and 3 of 12 were died. CONCLUSION: First, we choose surgical approach by the laterality of aneurysms and surgical or interventional treatment is attempted as soon as possible. The PICA aneurysm is regarded as having a relatively good surgical outcome without drilling of the posterior arch of the atlas.
Aneurysm* ; Arteries* ; Female ; Humans ; Pica ; Retrospective Studies

Although dissecting aneurysm of vertebral artery were once thought to be extremely rare, they are now recognized with increasing frequency by dint of aggressive work-up using sophisticated imaging techniques. Vertebral dissection most commonly result from cervical hyperextension and lateral cervical rotation. Our two cases followed suit respectively and presented with ischemic symptoms. The vertebral angiogram demonstrated a pseudoaneurysm at the site of dissection in both cases. Presence or absence of SAH, size of dissection and incorporation of the PICA into dissection greatly have influence upon the outcome after treatment. The authors report two cases of dissecting aneurysm of vertebral artery, in which complete resolution of the pseudoaneurysm was spontaneously achieved following conservative management.
Aneurysm, Dissecting* ; Aneurysm, False ; Pica ; Vertebral Artery*

Aneurysms arising from the posterior inferior cerebellar artery (PICA) are uncommon. Surgical treatment of PICA aneurysm was difficult and had relatively poor outcome. This study was undertaken to analyze the surgical and endovascular results of PICA aneurysm with review of the literature. Medical records and neuroimaging studies of nine patients who underwent treatment of PICA aneurysm from March 1995 to December 2003 were reviewed. The mean age of the nine patients was 57.9 (ranged from 41 to 68) and female was predominant (female : male = 7:2). Locations of PICA aneurysms was various and surgical treatments were attempted in 7 cases and endovascular treatment was done in 2 cases. The results of treatment were as follows : 4 patients showed good outcome, 5 patients showed poor outcome. Although clipping of the aneurysm neck is preferable in the aneurysm of PICA, trapping is useful when neck clipping is impossible in distal segment of telovelotonsillar segment. Endovascular treatment is becoming a promising treatment option.
Aneurysm* ; Arteries* ; Female ; Humans ; Male ; Medical Records ; Neck ; Neuroimaging ; Pica

Aneurysms of the posterior inferior cerebellar artery (PICA) are rarely encountered. In particular, due to frequent anatomic complexity and the presence of nearby critical structures, PICA origin aneurysms are difficult to treat. However, recent reports of anecdotal cases using advanced endovascular instruments and skills have made the results of endovascular treatment rather outstanding. PICA preservation is the key to a successful endovascular treatment, based on the premise that a PICA origin aneurysm is well occluded. To secure PICA flow, stenting into the PICA would be the best method, however, it is nearly impossible technically via the ipsilateral vertebral artery (VA) if the PICA arose at an acute angle from the sac. In such a case, a bilateral approach for stent-assisted coiling can be a creative method for achievement of two goals of both aneurysm occlusion and PICA preservation: ipsilateral approach for coil delivery and contralateral cross-over approach for stent delivery via a retrograde smooth path into the PICA.
Achievement ; Aneurysm ; Arteries ; Intracranial Aneurysm ; Pica ; Stents ; Vertebral Artery

A case of ruptured aneurysm of the distal PICA presenting with isolated intraventricular hemorrhage is presented. The diagnosis of distal PICA aneurysm should be considered if isolated intraventricular hematoma is found without obvious parenchymal hemorrhage or subarachnoid blood in the basal cisterns. Complete vertebral arteriography is a requiste for the recognition of this condition. The outcome in patients with these aneurysms should be good if surgical repair is performed before rebleeding occurs.
Aneurysm* ; Aneurysm, Ruptured ; Angiography ; Arteries* ; Diagnosis ; Hematoma ; Hemorrhage* ; Humans ; Pica

BACKGROUND: Many studies about unilateral cerebellar infarctions (UCI) have been reported to delineate the clinical findings and stroke mechanisms but have not been studied extensively in acute bilateral cerebellar infarctions (BCI). In order to evaluate the neurological features and mechanisms of BCI, we compared those between BCI and UCI. METHODS: Using diffusion-weighted imaging, we divided 103 patients with acute cerebellar infarctions into two groups: BCI and UCI. Clinical features, outcome and their mechanisms were compared between the groups. RESULTS: Among the 103 patients, 45 patients (44%) had BCI and the remaining 58 patients had UCI. The PICA territory was the most frequently involved site in both groups, and 15 patients were non-territorial infarctions. Clinical symptoms and signs were not different between the groups, however, most patients with decreased mentality had BCI (86%) and also had concomitant lesions outside the cerebellum (72%). Patients with BCI showed poorer prognosis than UCI (modified Rankin score, 1.41 and 2.87 respectively). Other factors included the presence of concomitant lesiona outside the cerebellum, however, mass effect did not affect their prognosis. The main cause of BCI was large artery disease (57%), whereas about half of the patients with UCI (51%) had no demonstrable cause of stroke. CONCLUSIONS: Owing to its poorer outcome and its higher frequency of demonstrable causes of stroke, more intensive work-up, such as vascular study, may be warranted in the patients with acute BCI.
Arteries ; Cerebellum ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Pica ; Prognosis ; Stroke

Humans ; Metals, Heavy ; toxicity ; Paint ; toxicity ; Pica ; complications

Angiographic diagnosis of lesions of the posterior fossa requires detailed knowledge of the normal anatomy of both arteries and veins of the brainstem and cerebellum. For this perfuse we measured normal distribution of the vertebrobasilar vessels from three base lines namely clival line, Twining line and foramen magnum line. In the measurement are also included some of the methods which were published in the past. This paper is based on the results of the measurements on 18 cases of normal vertebral angiogram among 77 cases of serial vertebral angiography performed at Catholic Medical center from October 1972 to August 1975. The result obtained were as follows: 1) Distance from the most posterior portion of the pericallosal artery to the clival line is 6.55+/-0.68 cm. 2) Distance from the most posterior portion of the arcuate portion of the lateral posterior choroidal artery to the clival line is 5.16+/-0.61 cm. 3) Distance from the posterior portion of the quadrigeminal portion of the medial posterior choroidal artery to the clival line is 4.87+/-0.67 cm. 4) Distance from the most posterior portion of the distal segment of the medial posterior choroidal artery to the clival line is 4.47+/-0.49 cm. 5) Distance from the bifurcation portion of the basilar artery to the clival line is 1.22+/-0.26 cm. 6) Distance from the forward convexity of the basilar artery to the clival line is 0.15+/-0.11 cm. 7) Distance from the choroidal point to the clival line is 2.99+/-0.51 cm. 8) Distance from the posterior medullary portion of the PICA to the clival line is 2.58+/-0.45 cm. 9) Distance from the tuberculum sellae to the Torcular Herophilli(Twining line) is 10.96+/-0.52 cm. 10) Distance between the tuberculum sellae to the point on the Twining line crossed by a perpendicular line drawn from the choroidal point is 6.61+/-0.40 cm. 11) Distance from the superior portion of the anterior culminate segment of the superior cerebellar artery to the Twining line is 3.28+/-0.48 cm. 12) Distance from the supratonsilar portion of the PICA to the Twining line is 0.97+/-0.42 cm. 13) Distance from the colliculocentral point to the clival line is 3.74+/-0.37 cm. 14) Distance from the crural portion of the anterior pontomesencephalic vein to the clival line is 1.65+/-0.33 cm. 15) Distance from the crural portion of the anterior pontomesencephalic vein to the colliculocentral point is 2.51+/-0.35 cm. 16) Distance from the copular point to the clival line is 3.99+/-0.51 cm. 17) Distance from the copular point to the line drawn from the anterior margin of the foramen magnum is 1.63+/-0.38 cm. 18) Distance from the highest point of the lateral posterior choroidal artery to the Twining line is 4.74+/-0.37 cm. 19) Distance from the highest point of the medial posterior choroidal artery to the Twining line is 4.35+/-0.34 cm. 20) Distance between two bisected points of the anterior culminate segment of the superior cerebellar artery by a line drawn parallel to the Twining line at 1cm from the top of the anterior culminate segment is 2.86+/-0.29 cm.
Angiography ; Arteries ; Basilar Artery ; Brain Stem ; Cerebellum ; Choroid ; Diagnosis ; Foramen Magnum ; Normal Distribution* ; Pica ; Veins

The dissecting aneurysms of the posterior cerebral circulation arise most commonly from the vertebral artery and occasionally extend to the posterior inferior cerebellar artery(PICA). The dissecting aneurysm localized in the PICA without involving the vertebral artery is rare. We present a PICA dissecting aneurysm that had kaleidoscopic clinical course of bleeding, occlusion, and recanalization before the surgery. The patient had serial follow-up angiograms based on significant changes of clinical status. The patient successfully underwent microsurgical trapping with clips for the dissecting aneurysm and showed neurological improvement.
Aneurysm, Dissecting* ; Arteries* ; Follow-Up Studies ; Hemorrhage ; Humans ; Pica ; Subarachnoid Hemorrhage ; Vertebral Artery