Neurological Surgery No Shinkei Geka Volume 25, Issue 8 (August 1997)

True “PICA communicating artery” aneurysm:a case report Hiroki UDONO 1 , Tetsuya SHIRAISHI 1 , Takehisa TSUJI 1 , Masamitsu ABE 1 , Kazuo TABUCHI 1 1Department of Neurosurgery, Saga Medical School Keyword: posterior inferior cerebellar artery(PICA) , cerebral aneurysm , subarachnoid hemorrhage , communicating branch pp.763-766
Published Date 1997/8/10
  • Abstract
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We present an unusual case of an aneurysm of the distal posterior inferior cerebellar artery (PICA). A 51-year-old female presented a subarachnoid hemorrhage with mild consciousness disturbance on August 6, 1992. Computed tomography (CT) on admission showed sub-arachnoid hemorrhage with thick hematoma in the cis-terna magna and intraventricular hematoma in the 4th, 3rd and both lateral ventricles. The angiogram on admission revealed no definite vascular anomalies. Re-peated angiograms on the 11th day after onset showed an aneurysm on anastomotic branch between the bilate-ral distal PICAs. The aneurysm was clipped success-fully through a suboccipital craniectomy 14 days after the onset. In the literature reviewed, only one such aneurysm, located at an anastomotic vessel of the bi-lateral PICAs, has been reported by Hlavin et al in 1991. They reported that the aneurysm was associated with a unilateral PICA that supplied both cerebellar hemispheres and arose from an anastomotic vessel in the contralateral circulation. They called the aneurysm as “a PICA communicating artery” aneurysm. We assume that this “PICA communicating artery” is a remnant of a primitive lateral vertebrobasilar anasto-mosis, which appears in the embryo at the 9mm stage. It is suggested that the pathogenesis may be not only the hemodynamic factor but also a congenital anomaly.

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Neurological Surgery 脳神経外科
25巻8号 (1997年8月)
電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院