Abstract
Aim
The aim of our study was to demonstrate some possible variations in the vertebrobasilar system (VBS) in the Turkish population and to compare our results with the literature.
Materials and methods
The VBS samples were taken from 109 fresh forensic autopsies and one anatomic cadaver. The widths of the vertebral artery (VA), the basilar artery (BA) and their branches were measured; dominancy and hypoplastic arteries, as well as the types of variations and their locations, were determined.
Results
Hypoplastic VA was observed at rates of 20.2% on the right, 14.4% on the left and 4.8% bilaterally. The vertebrobasilar junction was found to be either at the level of bulbopontine sulcus (20%), below the sulcus (67%) or above the sulcus (12%). BA variations were observed as duplications of the proximal (0.9%) and distal segments (1.8%). Anterior spinal artery (ASA) originated as a single trunk in 12.5% of the cases. ASA arose from a transverse anastomosis connecting VAs in 6.3% of the cases. Furthermore, 15.6% of ASAs were double. The observed variations in the superior cerebellar artery were early bifurcation (7.2% on the right, 12.7% on the left), fenestration (4.5% on the right, 7.2% on the left), duplication (14.5% on the right, 12.7% on the left) and origin as a common trunk (6.3% on the right, 10% on the left).
Conclusion
Our results show that a high percentage of variations can be seen even in a small number of cases. We believe that our data are clinically important because, for example, variations are a factor which increases the incidence of aneurism and thrombus. We also think our results will contribute to the demography of our country and to clinical medicine.
Similar content being viewed by others
References
Akar ZC, Dujovny M, Slavin KV et al (1994) Microsurgical anatomy of the intracranial part of the vertebral artery. Neurol Res 16:171–180
Berry M, Bannister LH, Standring SM (1995) Nervous system. In: Willams PL (ed) Gray’s anatomy, 38th edn. Churchill Livingstone, London, pp 1530–1535
Caruso G, Vincentelli F, Rabehanta P et al (1991) Anomalies of the P1 segment of the posterior cerebral artery: early bifurcation or duplication, fenestration, common trunk with the superior cerebellar artery. Acta Neurochir (Wien) 109(1–2):66–71
Cosar M, Iplikcioglu AC, Arslan M et al (2004) Vertebral artery fenestration with middle cerebral artery aneurysm: case report. J Turk Neurosurg 3:196–199 (in Turkish)
Duus P (2001) Topical diagnosis in neurorology, 3rd Turkish edition. Palme, Ankara, p 148
Finlay HM, Canham PB (1994) The layered fabric of cerebral artery fenestrations. Stroke 25:1799–1806
Fujimura M, Sugawara T, Higuchi H et al (1997) A rupture aneurysm at the distal end of the basilar artery fenestration associated with multiple fenestrations of the vertebrobasilar system case report. Surg Neurol 47:469–472
Fujimura N, Abe T, Hirohata M et al (2003) Bilateral anomalous posterior inferior cerebellar artery- anterior inferior cerebellar artery anastomotic arteries associated with a ruptured cerebral aneurysm. Neurol Med Chir (Tokyo) 43:396–398
Goldstein JH, Woodcock R, Do MH et al (1999) Complete duplication or extreme fenestration of the basilar artery. Am J Neuroradiol 20:149–150
Govsa F, Aktan ZA, Arısoy Y et al (1996) Origin of the anterior spinal artery. Surg Radiol Anat 18:189–193
Grand W, Budny JL, Gibbons KJ et al (1997) Microvascular surgical anatomy of the vertebrobasilar junction. Neurosurgery 40:1219–1223
Grasso G, Alafaci C, Passalacqua M et al (2005) Landmarks for vertebral artery repositioning in bulbar compression syndrome: anatomic and microsurgical nuances. Neurosurgery 56:160–164
Graves BV, M Strother C, Weir B et al (1996) Vertebrobasilar junction aneurysms associated with fenestration: treatment with guglielmi detachable coils. AJNR Am J Neuroradiol 17:35–40
Hardy DG, Peace DA, Rhoton AL Jr. (1980) Microsurgical anatomy of the superior cerebellar artery. Neurosurgery 6:10–28
Islak C, Kocer N, Kantarci F et al (2002) Endovascular management of basilar artery aneurysms associated with fenestrations. AJNR Am J Neuroradiol 23:958–964
Kamath S (1981) Observations on the length and diameter of vessels forming the circle of willis. J Anat 133:419–423
Love S, Coakham HB (2001) Trigeminal neuralgia: pathology and pathogenesis. Brain 124:2347–2360
Lovrencic-Huzjan A, Demarin V, Bosnai M et al (1999) Color Doppler flow imaging (CDFI) of the vertebral arteries the normal appearance, normal values and the proposal for the standards. Coll Antropol 23:175–181
Mani RL, Newton TH, Glickman MG (1968) The superior cerebellar artery: an anatomic-roentgenographic correlation. Radiology 91:1102–1108
Mordasini P, Remonda L, Lukes A et al (2006) Growth, rupture and endovascular treatment of a vertebrobasilar junction aneurysm associated with a basilar fenestration. Eur J Radiol 59:93–95
Ozdemir S, Yildiz C, Cankur NS (2002) Evaluation of vertebral artery system in a healthy population by using colour duplex Doppler ultrasonography. Med School J Uludag 28:95–99 (in Turkish)
Ravensbergen J, Ravensbergen JW, Krijger JKB et al (1998) Localizing role of hemodynamics in atherosclerosis in several human vertebrobasilar junction geometries. Arterioscler Thromb Vasc Biol 18:708–716
Rodriguez-Baeza A, Muset-Lara A, Rodriguez-Pazos M et al (1989) Anterior spinal arteries. Acta Anat 136:217–221
Stehbens WE (1989) Etiology of intracranial berry aneurysms. J Neuro surg 70:823–831
Tran-Dinh HD, Soo YS, Jayasinghe LS (1991) Duplication of the vertebro-basilar system. Australas Radiol 35(3):220–4
Tsutsumi M, Kazekawa K, Tanaka A et al (2002) Duplication of distal part of the basilar artery. Radiat Med 20:265–267
Tuccar E, Yazar F, Kırıcı Y et al (2002) A complex variation of the vertebrobasilar system. Neuroanatomy 1:12–13
Uchino A, Sawada A, Takase Y et al (2003) Variations of the superior cerebellar artery: MR angiographic demonstration. Radiat Med 21:235–238
Yagi K, Satoh K, Satomi J et al (2004) Primitive vertebrobasilar system associated with a ruptured aneurysm. AJNR Am J Neuroradiol 25:781–783
Yoon MS, I Chun Y, Kwon Y et al (2004) Vertebrobasilar junction aneurysms associated with fenestration: experience of five cases treated with guglielmi detachable coils. Surg Neurol 61:248–254
Zwiebel WJ (2000) Ultrasound vertebral examination. In: Zwiebel WJ (ed) Introduction to vascular ultrasonography, 4th edn. WB Saunders, Philadelphia, pp 167–176
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Songur, A., Gonul, Y., Ozen, O.A. et al. Variations in the intracranial vertebrobasilar system. Surg Radiol Anat 30, 257–264 (2008). https://doi.org/10.1007/s00276-008-0309-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00276-008-0309-6