![]() When the aneurysm is immediately adjacent to the ASA, revascularization and open trapping should be considered.ĪSA = anterior spinal artery BTO = balloon test occlusion FD = flow diversion PICA = posterior inferior cerebellar artery VA = vertebral artery anterior spinal artery cerebral aneurysm medullary infarct posterior inferior cerebellar artery surgical technique vascular disorders vertebral artery. In cases in which the ASA is removed from the aneurysm, the authors recommend revascularization followed by endovascular sacrifice. When the ASA originates from the aneurysm, proximal occlusion with or without a PICA bypass is suggested. The anatomy of the ASA is the most critical determinant of treatment recommendations for fusiform VA aneurysms involving PICA. Filling of the sole angiographic ASA remote from the aneurysm was preserved in both cases. Locclusione dellarteria cerebellare inferiore posteriore o uno dei suoi rami, o dellarteria vertebrale porta alla sindrome midollare laterale nota anche con il. The subsequent cases were treated with PICA-PICA bypass and subsequent endovascular embolization of the VA. L arteria cerebellare inferiore posteriore (PICA), il più grande ramo dell arteria vertebrale, è uno dei tre principali vasi che riforniscono di sangue arterioso il cervelletto. A complete occlusion of the aneurysm and VA was complicated by ASA thrombosis. ![]() In the first case, they performed a V3-PICA bypass using an interposition graft and then performed endovascular coil embolization of the parent VA. Occlusion of an unpaired ASA can result in bilateral medial medullary syndrome. The anterior spinal artery (ASA) commonly originates from a unilateral ramus just distal to the PICA. Patients present with nausea, vomiting, and vertigo from involvement of the vestibular system. The authors propose a treatment paradigm for ASA preservation based on the artery's proximity to fusiform VA aneurysms, and they present 3 representative cases. Fusiform aneurysms of the vertebral artery (VA) involving the posterior inferior cerebellar artery (PICA) origin are uncommon and challenging. This syndrome is most often due to vertebral artery occlusion or, less commonly, to posterior inferior cerebellar artery (PICA) occlusion. Fusiform aneurysms of the vertebral artery (VA) involving the posterior inferior cerebellar artery (PICA) origin are uncommon and challenging.
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