Skip to main content
Log in

Developmental anomalies of the distal vertebral artery and posterior inferior cerebellar artery: diagnosis by CT angiography and literature review

  • Original Article
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to identify variations in the anatomy of the distal vertebral artery (VA) and posterior inferior cerebellar artery (PICA) with computed tomography (CT) angiography.

Methods

CT angiography was performed at two hospitals. And the results were analyzed for VA anomalies.

Results

Seven of the 3067 patients who received brain CT angiography in first hospital had seven intracranial VA fenestrations. Twelve of 546 patients who received CT angiography of intracranial and extracranial vessels in second hospital had 16 anatomical variations of the V3 segment. Two fenestrations of the V3 segment, three C1 origins of the PICA, seven aberrant VAs with an intradural course at the C2 level without a normal VA, and four aberrant VAs with an intradural course at the C2 level with a normal VA were observed. Seventeen of the 314 patients who received cervical CT angiography in second hospital had 21 anatomical variations of the VA. Two fenestrations of the V3 segment, six C1 origins of the PICA, three C2 origins of the PICA, one VA origin of the occipital artery, one fenestration of the V4 segment, five aberrant VAs with an intradural course at the C2 level without a normal VA, and three aberrant VAs with an intradural course at the C2 level with a normal VA were observed.

Conclusions

A certain number of anatomical variants of the distal VA and PICA may reflect variations in size and connections of the lateral or posterior spinal artery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11

Similar content being viewed by others

Abbreviations

3D:

Three-dimensional

ASA:

Anterior spinal artery

CIA:

Cervical intersegmental artery

CT:

Computed tomography

FIA:

First intersegmental artery

FOV:

Field of view

LSA:

Lateral spinal artery

NECT:

Nonenhanced CT

PACS:

Picture archiving and communication system

PIA:

Proatlantal intersegmental artery

PICA:

Posterior inferior cerebellar artery

PSA:

Posterior spinal artery

VA:

Vertebral artery

References

  1. Chen CJ, Wang LJ, Wong YC (1998) Abnormal origin of the vertebral artery from the common carotid artery. AJNR Am J Neuroradiol 19:1414–1416

    CAS  PubMed  Google Scholar 

  2. Hasegawa T, Ito H, Hwang WZ, Yamamoto S (1986) Single extracranial–intracranial duplication of the vertebral artery. Surg Neurol 25:369–372

    Article  CAS  PubMed  Google Scholar 

  3. Ionete C, Omojola MF (2006) MR angiographic demonstration of bilateral duplication of the extracranial vertebral artery: unusual course and review of the literature. AJNR Am J Neuroradiol 27:1304–1306

    CAS  PubMed  Google Scholar 

  4. Koyanagi S, Shiraishi T, Ueta K, Tabuchi K (1991) Bilateral fenestrations of the vertebrobasilar artery with trigeminal neuralgia. Case report. Neurol Med Chir (Tokyo) 31:995–998

    Article  CAS  Google Scholar 

  5. Lasjaunias P, Berenstein A, ter Brugge KG (2001) Surgical Neuroangiography. Clinical vascular anatomy and variations, 2nd edn. Springer, Berlin, pp 240–241

    Book  Google Scholar 

  6. Lasjaunias P, Braun JP, Hasso AN, Moret J, Manelfe C (1980) True and false fenestration of the vertebral artery. J Neuroradiol 7:157–166

    CAS  PubMed  Google Scholar 

  7. Lasjaunias P, Guibert-Tranier F, Braun JP (1981) The pharyngo-cerebellar artery or ascending pharyngeal artery origin of the posterior inferior cerebellar artery. J Neuroradiol 8:317–325

    CAS  PubMed  Google Scholar 

  8. Lasjaunias P, Vallee B, Person H, Ter Brugge K, Chiu M (1985) The lateral spinal artery of the upper cervical spinal cord. Anatomy, normal variations, and angiographic aspects. J Neurosurg 63:235–241

    Article  CAS  PubMed  Google Scholar 

  9. Mayer PL, Kier EL (1993) The ontogenetic and phylogenetic basis of cerebrovascular anomalies and variants. In: Apuzzo ML (ed) Brain surgery. complication avoidance and management. Churchill Livingstone, New York, pp 709–760

    Google Scholar 

  10. Mercier PH, Brassier G, Fournier HD, Picquet J, Papon X, Lasjaunias P (2008) Vascular microanatomy of the pontomedullary junction, posterior inferior cerebellar arteries, and the lateral spinal arteries. Interv Neuroradiol 14:49–58

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Padget DH (1948) The development of the cranial arteries in the numan embryo. Contrib Embryol 32:205–261

    Google Scholar 

  12. Salunke P, Futane S, Sahoo SK, Ghuman MS, Khandelwal N (2014) Operative nuances to safeguard anomalous vertebral artery without compromising the surgery for congenital atlantoaxial dislocation: untying a tough knot between vessel and bone. J Neurosurg Spine 20:5–10

    Article  PubMed  Google Scholar 

  13. Sanders WP, Sorek PA, Mehta BA (1993) Fenestration of intracranial arteries with special attention to associated aneurysms and other anomalies. AJNR Am J Neuroradiol 14:675–680

    CAS  PubMed  Google Scholar 

  14. Siclari F, Burger IM, Fasel JH, Gailloud P (2007) Developmental anatomy of the distal vertebral artery in relationship to variants of the posterior and lateral spinal arterial systems. AJNR Am J Neuroradiol 28:1185–1190

    Article  CAS  PubMed  Google Scholar 

  15. Sim E, Vaccaro AR, Berzlanovich A, Thaler H, Ullrich CG (2001) Fenestration of the extracranial vertebral artery: review of the literature. Spine (Phila Pa 1976) 26:E139–E142

    Article  CAS  Google Scholar 

  16. Tabatabai SA, Zadeh MZ, Meybodi AT, Hashemi M (2007) Extracranial aneurysm of the posterior inferior cerebellar artery with an aberrant origination: case report. Neurosurgery 61:E1097–E1098

    Article  PubMed  Google Scholar 

  17. Takahashi T, Tominaga T, Hassan T, Yoshimoto T (2003) Cervical cord compression with myelopathy caused by bilateral persistence of the first intersegmental arteries: case report. Neurosurgery 53:234–237

    Article  PubMed  Google Scholar 

  18. Tetiker H, Cimen M, Kosar MI (2014) Fenestration of the vertebral artery: case presentation. Folia Morphol (Warsz) 73:84–86

    Article  CAS  Google Scholar 

  19. Tokuda K, Miyasaka K, Abe H, Abe S, Takei H, Sugimoto S, Tsuru M (1985) Anomalous atlantoaxial portions of vertebral and posterior inferior cerebellar arteries. Neuroradiology 27:410–413

    Article  CAS  PubMed  Google Scholar 

  20. Tran-Dinh HD, Soo YS, Jayasinghe LS (1991) Duplication of the vertebro-basilar system. Australas Radiol 35:220–224

    Article  CAS  PubMed  Google Scholar 

  21. Uchino A, Saito N, Ishihara S (2015) Double origin of the posterior inferior cerebellar artery diagnosed by MR angiography: a report of two cases. Neuroradiol J 28:187–189

    Article  PubMed  PubMed Central  Google Scholar 

  22. Uchino A, Saito N, Okada Y, Kozawa E, Nishi N, Mizukoshi W, Inoue K, Nakajima R, Takahashi M (2012) Fenestrations of the intracranial vertebrobasilar system diagnosed by MR angiography. Neuroradiology 54:445–450

    Article  PubMed  Google Scholar 

  23. Uchino A, Saito N, Watadani T, Okada Y, Kozawa E, Nishi N, Mizukoshi W, Inoue K, Nakajima R, Takahashi M (2012) Vertebral artery variations at the C1–2 level diagnosed by magnetic resonance angiography. Neuroradiology 54:19–23

    Article  PubMed  Google Scholar 

  24. Uchino A, Sawada A, Takase Y, Kudo S (2002) Extreme fenestration of the right vertebral artery: magnetic resonance angiographic demonstration. Eur Radiol 12(Suppl 3):S32–S34

    PubMed  Google Scholar 

  25. Wakao N, Takeuchi M, Nishimura M, Riew KD, Kamiya M, Hirasawa A, Kawanami K, Imagama S, Sato K, Takayasu M (2014) Vertebral artery variations and osseous anomaly at the C1–2 level diagnosed by 3D CT angiography in normal subjects. Neuroradiology 56:843–849

    Article  PubMed  Google Scholar 

  26. Yamazaki M, Okawa A, Furuya T, Sakuma T, Takahashi H, Kato K, Fujiyoshi T, Mannoji C, Takahashi K, Koda M (2012) Anomalous vertebral arteries in the extra- and intraosseous regions of the craniovertebral junction visualized by three-dimensional computed tomographic angiography: analysis of 100 consecutive surgical cases and review of the literature. Spine (Phila Pa 1976) 37:E1389–E1397

    Article  Google Scholar 

Download references

Acknowledgments

This work was supported by research Grant from a Pohang SM Christianity Hospital.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Myoung Soo Kim.

Ethics declarations

Conflict of interest

The author declare that he have no conflict of interest with any organization or institute.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, M.S. Developmental anomalies of the distal vertebral artery and posterior inferior cerebellar artery: diagnosis by CT angiography and literature review. Surg Radiol Anat 38, 997–1006 (2016). https://doi.org/10.1007/s00276-016-1654-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00276-016-1654-5

Keywords

Navigation