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Posterior inferior cerebellar artery originating from the posterior meningeal artery mimicking dural arteriovenous fistula

  • Anatomic Variations
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Abstract

Purpose

Many variations in the origin of the posterior inferior cerebellar artery (PICA) have been reported. To our knowledge, only one case of a PICA originating from the posterior meningeal artery (PMA) has been reported.

Methods

We describe a case with a PICA that was supplied retrograde from the distal segment of the PMA, mimicking a dural arteriovenous fistula on magnetic resonance angiography (MRA).

Results

A 31-year-old man was admitted to our hospital with a sudden occipital headache and nausea. MRA showed a hyperplastic left PMA, continuing to an abnormal vessel that was suspicious for venous drainage. Digital subtraction angiography revealed the left PMA originated from the extradural segment of the vertebral artery and then connected to the left PICA near the torcula. The cortical segment of the PICA flowed retrograde, which appeared as venous reflux on MRA. A second PICA originated from the extradural segment of the left vertebral artery and perfused the tonsillomedullary and televelotonsillar segment of the left PICA territory.

Conclusion

We present an anatomical variant of the PICA mimicking a dural arteriovenous fistula. Digital subtraction angiography is useful for diagnosis of the cortical segment of the PICA flowing retrograde from the distal segment of the PMA because signal intensity in MRA of retrograde flow tends to decrease and diagnosis may be difficult. During endovascular treatment and open surgery, we should note that ischemic complications may occur due to the potential anastomosing channels between cerebral and dural arteries.

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Abbreviations

DAVF:

Dural arteriovenous fistula

DSA:

Digital subtraction angiography

MRA:

Magnetic resonance angiography

PICA:

Posterior inferior cerebellar artery

PMA:

Posterior meningeal artery

VA:

Vertebral artery

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Acknowledgements

We thank Jane Charbonneau, DVM, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

Funding

No funds, grants, or other support was received for this study.

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Authors and Affiliations

  1. Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-Ku, Sapporo, Hokkaido, 060-8570, Japan

    Yasuyuki Tatsuta, Hideki Endo, Mamoru Fukuda & Hirohiko Nakamura

Authors
  1. Yasuyuki Tatsuta
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  2. Hideki Endo
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  3. Mamoru Fukuda
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  4. Hirohiko Nakamura
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Contributions

YT: Protocol/project development, Data collection and management, Data analysis, Manuscript writing/editing. HE: Protocol/project development, Data analysis, Manuscript editing. MF: Data collection, Data analysis, Manuscript editing. HN: Data management, Manuscript editing.

Corresponding author

Correspondence to Yasuyuki Tatsuta.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of Nakamura Memorial Hospital (No.2023021601).

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Tatsuta, Y., Endo, H., Fukuda, M. et al. Posterior inferior cerebellar artery originating from the posterior meningeal artery mimicking dural arteriovenous fistula. Surg Radiol Anat 45, 765–768 (2023). https://doi.org/10.1007/s00276-023-03150-7

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  • DOI: https://doi.org/10.1007/s00276-023-03150-7

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