IJAR.2018.176

Type of Article:  Original Research

Volume 6; Issue 2.2 (May 2018)

Page No.: 5261-5267

DOI: https://dx.doi.org/10.16965/ijar.2018.176

VARIATIONS IN POSTERIOR INFERIOR CEREBELLAR ARTERY AND ITS CLINICAL SIGNIFICANCE IN UTTAR PRADESH REGION: A 64-SLICE CT ANGIOGRAPHIC STUDY

Sangma Sarah 1, Sehgal Garima *2, Chopra Jyoti 3, Pankaj AK 4, Lakra Vandana 5.

1Junior Resident IIIrd year, Department of Anatomy, King George’s Medical University, U.P., Lucknow, India (KGMU, U.P., Lucknow, India).

*2 Assistant Professor, Department of Anatomy, KGMU, U.P., Lucknow, India.

3 Professor, Department of Anatomy, KGMU, U.P., Lucknow, India.

4 Assistant Professor, Department of Anatomy, KGMU, U.P., Lucknow, India.

5 Junior Resident IInd year, Department of Anatomy, KGMU, U.P., Lucknow, India.

Corresponding Author: Dr. Garima Sehgal, Assistant Professor, King George’s Medical University, UP, Lucknow-226003, India. Mob: 91-9044513758 E-Mail: drgarimabhasin@gmail.com

ABSTRACT:

Background: Posterior Inferior cerebellar artery (PICA) is the largest and most distal branch of Vertebral artery (VA) arising near the lower end of olive. Variations of PICA are numerous but have been infrequently reported in this region. Occlusion or blockage of PICA may cause an infarction of the medulla oblongata which plays an important role in circulatory and respiratory functioning. This may lead to lateral medullary syndrome, also called Wallenberg syndrome. The study focuses on normal and variant anatomy of PICA in Uttar Pradesh region of North India.

Materials and Methods: The study population included 100 subjects, of either sex, who underwent Head and Neck CT Angiography in the Department of Radiodiagnosis, King George’s Medical College, Lucknow, Uttar Pradesh. The diameters of PICAs of both sides were measured and variations encountered were noted.

Results: Mean diameter of PICA was 1.76±0.64 mm on right side and 1.73±0.60 mm on left side. Mean diameter in males was 1.75±0.62 mm and in females was 1.73±0.62 mm. Variations observed included: Unilateral aplasia of PICA in 16% with equal prevalence on both sides; bilateral aplasia in 3% cases; hypoplasia of RPICA in10% and hypoplasia of LPICA in 6%. VA-PICA variation where the VA continued as posterior inferior cerebellar artery was observed in 8 subjects (4 right, 4 left).

Conclusion: The knowledge of normal diameters and variations in PICA supplying the brain can be a useful guide to the surgeons and interventional radiologists for careful pre-operative planning thus helping them in avoiding potentially life threatening complications.

Key words:  Posterior Inferior cerebellar artery, Wallenburg syndrome, Vertebral artery CT Angiography, VA- PICA, Hypoplasia, Aplasia.

REFERENCES

  1. Akgun V, Battal B, Bozkurt Y, et al. Normal anatomical features and variations of the vertebrobasilar circulation and its branches: an analysis with 64-detector row CT and 3T MR angiographies. Scientific World Journal 2013; 2013, 620162.
  2. Williams Pl, Bannister LH, Berry MM, Collins P, Dyson M, Dussek JE, Ferguson MWJ, eds. Gray’s Anatomy New York: Churchill Livingstone; 28th Edition:1995.
  3. O’Rahilly R, Mu¨ller F. Enumeration and interrelationships in staged human embryos, and implications for neural tube defects. Cells Tissues Organs 2003; 173:75–92.
  4. Macchi V, Porzionato A, Guidolin D, Parenti A, De Caro R. Morphogenesis of the posterior inferior cerebellar artery with three-dimensional reconstruction of the late embryonic vertebrobasilar system. Surgical and Radiologic Anatomy 2005; 27(1): 56–60.
  5. Lake AR, Van Niekerk IJ, Le Roux CG, Trevor-Jones TR, De Wet PD. Angiology of the brain of the baboon Papioursinus, the velvet monkey Cercopithecus Pygerithrus, and the bushbaby Galago Senegalensis. Am J Anat. 1990; 187: 277–286.
  6. Kramer M, Ellman S, Allmendinger T, Eller A, Kammerer F, May MS et al. Computed tomography angiography of carotid arteries and vertebrobasilar system. Medicine 2015; 94(26):doi10.1097/MD.0000000000001058.
  7. Lesley WS, Dalsania HJ. Double origin of the posterior inferior cerebellar artery. Am J Neuroradiol. 2004; 25: 425-427.
  8. Cooke DL, Stout CE, Kim WT, Kansagra AP, Yu JP, Gu A et al. Cerebral arterial fenestrations. Interv Neuroradiol. 2014; 20(3):261-274.
  9. Liu IW, Ho BL, Chen CF, Han K,  Lin CJ, Sheng WY et al., Vertebral artery terminating in posterior inferior cerebellar artery: A normal variation with clinical significance. PLoSOne. 2017 Apr 10; 12(4): e0175264. doi: 10. 1371/ journal. pone. 0175264.  eCollection 2017.
  10. Shrontz C, Dujovny M, Ausman JI, Diaz FG, Pearce JE, Berman SK et al. Surgical anatomy of the arteries of the posterior fossa. Journal of Neurosursurgery 1986; 65(4): 540–544.
  11. Pai B, Varma R, Kulkarni R, Nirmala S, Manjunath L, Rakshith S. Microsurgical anatomy of the posterior circulation. Neurology India 2007; 55(1): 31–41.
  12. Von Bortel LM, Spek JJ. Influence of aging on arterial compliance. J. Hum. Hypertens. 1998; 12: 583-586.
  13. Tumer N, Toklu HZ, Scarpace PJ et al. The Effects of Aging on the Functional and Structural Properties of the Rat Basilar Artery. Physiological Reports 2014; 2(6):1-18.
  14. Pekcevik Y and Pekcevik R. Variations of the cerebellar arteries at CT angiography. Surgical and Radiologic Anatomy.2013; 36(5):455–461.
  15. Cullen SP, Ozanne A, Alvarez H, Lasjaunias P. The bihemispheric posterior inferior cerebellar artery. Neuroradiology 2005; 47(11): 809–812.

Cite this article: Sangma Sarah, Sehgal Garima, Chopra Jyoti, Pankaj AK, Lakra Vandana. VARIATIONS IN POSTERIOR INFERIOR CEREBELLAR ARTERY AND ITS CLINICAL SIGNIFICANCE IN UTTAR PRADESH REGION: A 64-SLICE CT ANGIOGRAPHIC STUDY. Int J Anat Res 2018;6(2.2):5261-5267. DOI: 10.16965/ijar.2018.176