12/8/2023 0 Comments Pica artery syndrome![]() ![]() We then performed a statistical analysis to elucidate the relationship between VA variations, including PICAs originating from V 3, and atlas variations. Enhanced CT images were reviewed to clarify their incidence, along with other VA variations and skeletal variations of the atlas. In the present study, we focused on PICAs originating from V 3 as observed on CT. It is essential to know if radiological examinations are applicable to the evaluation of PICAs originating from V 3. Although some cadaveric investigations have reported extradural PICAs originating from V 3, the precise incidence and anatomical nature of this variation have not been studied on clinical images. It is important to understand the course of the PICA on imaging studies before surgery. Because of the abundant venous plexus covering the epidural space in this region, it is hard to visualize the extradural part of the PICA. In such cases, the PICA may be damaged during extradural surgical dissection. ![]() 25 In this variation, the PICA branches off the extradural space between the occiput and the atlas. ![]() 14 Rhoton reported on extradurally originating PICAs from the V 3 segment, which is the extradural portion from the transverse foramen of the atlas to its dural penetration close to the foramen magnum. However, among the cerebellar arteries, the course of the PICA shows the most variation. The PICA is generally thought to originate from the intradural (V 4) segment of the VA thus, surgeons pay careful attention to the artery after dural opening. Great care should be paid to this artery in operations that involve the craniovertebral junction (CVJ). It also results in serious sequelae, including difficulties in swallowing, saliva clearance, and articulation, as well as hemiparesis. Occlusion of this vessel may cause serious ischemic conditions, such as Wallenberg syndrome, cerebellar infarction, and, in the worst cases, acute tonsillar herniation due to neural edema. It perfuses important neural structures, including the lateral posterior area of the medulla oblongata, the inferior half of the anterior surface of the cerebellum, and the inferior half of the vermis. T he posterior inferior cerebellar artery (PICA) is considered to be the first branch from the vertebral artery (VA). ![]()
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