Download PDF
Minim Invasive Neurosurg 2004; 47(2): 93-101
DOI: 10.1055/s-2004-818437
Original Article
© Georg Thieme Verlag Stuttgart · New York

Why are Aneurysms of the Posterior Inferior Cerebellar Artery so Unique? Clinical Experience and Review of the Literature

G.  Kleinpeter1
  • 1Neurochirurgie, Donauspital, Vienna, Austria
Further Information

Publication History

Publication Date:
16 July 2004 (online)

    Permissions and Reprints

Abstract

Background: Aneurysms of the posterior inferior cerebellar artery (PICA) are rare lesions. The anatomical behaviour of the artery itself is complex and characterised by a multitude of variations. The same holds true for the aneurysms discovered there. Dissecting aneurysms can be found from the PICA origin to the distal artery berry. They have a wider range of clinical and radiographical presentations and their surgical treatment requires more than one standard approach.

Methods: We encountered 14 patients with PICA aneurysms within two surgical series of a total of 1345 cerebral aneurysm patients (1 %). In this patient group of the last 27 years only 3 of the 14 were distal aneurysms (“true” PICA aneurysms)

Results: The 14 patients harboured 15 aneurysms (9 right-sided and 6 left-sided). The female/male ratio of the patients was 9/5, the mean age 52.7 years. 13 of them had sustained an SAH. 7/14 patients were hypertensive, in 10 patients at least one of putative cerebrovascular risk factors was found. From the 15 aneurysms treated, 11 were typical berry aneurysms, 4 dissecting aneurysms. The aneurysms ranged in size from 5 to 20 mm (mean 9.1). 11 aneurysms were located within the anterior medullary segment, 1 in the tonsillomedullary and 2 in the telovelomedullary segments. All patients were surgically treated, 10 in a semi-sitting position via a suboccipital craniotomy, 4 in the prone position. 13 aneurysms were clipped, two were treated differently. Two patients died due to their bad preoperative clinical status.

Conclusions: The clinical, radiographical and surgical approaches to PICA aneurysms still represent a challenge.

Key words

Aneurysm - incidence - posterior inferior cerebellar artery - subarachnoidal - haemorrhage - surgical approach

References

  • 1 Alexander Jr E, Davis C H, Pikula L. Aneurysm of the posterior inferior cerebellar artery filling the fourth ventricle.  J Neurosurg. 1966;  24 99-101
    PubMedSearch in Google Scholar
  • 2 Chen C J, Chen S T. Extracranial distal aneurysm of posterior inferior cerebellar artery.  Neuroradiology. 1997;  39 344-347
    CrossrefPubMedSearch in Google Scholar
  • 3 Fujimura N, Abe T, Hirohata M, Morimitsu H, Tokutomi T, Shigemori M. Bilateral anomalous posterior inferior cerebellar artery-anterior inferior cerebellar artery anastomotic arteries associated with a ruptured cerebral aneurysm - case report.  Neurol Med Chir (Tokyo). 2003;  43 396-398
    PubMedSearch in Google Scholar
  • 4 Hirschfeld A, Flamm E S. Extracranial aneurysm arising from the posterior inferior cerebellar artery. Case report.  J Neurosurgery. 1981;  54 537-539
    PubMedSearch in Google Scholar
  • 5 Hlavin M L, Takaoka Y, Smith A S. A “pica communicating artery” aneurysm: Case report.  Neurosurgery. 1991;  29 926-929
    PubMedSearch in Google Scholar
  • 6 Hoffman E P, Kooiker J C. Extracranial PICA aneurysms.  J Neurosurg. 1981;  55 497
    PubMedSearch in Google Scholar
  • 7 Jane J A. A large aneurysm of the posterior inferior cerebellar artery in a one-year-old child.  J Neurosurg. 1961;  18 245-247
    PubMedSearch in Google Scholar
  • 8 Judice D, Connolly E S. Foramen magnum syndrome caused by a giant aneurysm of the posterior inferior cerebral artery. Case report.  J Neurosurg. 1978;  48 639-641
    PubMedSearch in Google Scholar
  • 9 Okuno S, Ohnishi H. Aneurysm of the posterior inferior cerebellar arteries/communicating artery.  Cerebrovasc Dis. 2001;  12 276-279
    PubMedSearch in Google Scholar
  • 10 Pasco A, Thouveny F, Papon X, Tanguy J Y, Mercier P, Caron-Poitreau C, Herbreteau D. Ruptured aneurysm on a double origin of the posterior inferior cerebellar artery: a pathological entity in an anatomical variation. Report of two cases and review of the literature.  J Neurosurg. 2002;  96 127-131
    PubMedSearch in Google Scholar
  • 11 Ruelle A, Cavazzani P, Andrioli G. Extracranial posterior inferior cerebellar artery aneurysm causing isolated intraventricular hemorrhage: A case report.  Neurosurgery. 1988;  23 774-777
    CrossrefPubMedSearch in Google Scholar
  • 12 Tanaka A, Simura M, Yoshinaga S, Tomonaga M. Extracranial aneurysm of the posterior inferior cerebellar artery: case report.  Neurosurgery. 1993;  33 742-744
    PubMedSearch in Google Scholar
  • 13 Yamaura A, Isobe K, Nakamura T, Ono J, Makino H. Posterior inferior cerebellar aneurysm in the fourth ventricle.  Surg Neuro. 1980;  13 297-299
    PubMedSearch in Google Scholar
  • 14 Abe T, Kojima K, Singer R J, Marks M P, Watanabe M, Ohtsuru K, Nishimura H, Hayabuchi N. Endovascular management of an aneurysm arising from posterior inferior cerebellar artery originated at the level of C2.  Radiat Med. 1998;  16 141-143
    PubMedSearch in Google Scholar
  • 15 Rabinov J D, Hellinger F R, Morris P P, Ogilvy C S, Putman C M. Endovascular management of vertebrobasilar dissecting aneurysms.  AJNR. 2003;  24 1421-1428
    PubMedSearch in Google Scholar
  • 16 Kleinpeter G, Schatzer R, Bock F. Is blood pressure really a trigger for the circadian rhythm of subarachnoid hemorrhage?.  Stroke. 1995;  26 1805-1810
    PubMedSearch in Google Scholar
  • 17 Drake C G. Report of World Federation of Neurological Surgeons Committee on a universal subarachnoid hemorrhage grading scale.  J Neurosurg. 1988;  68 985-986
    PubMedSearch in Google Scholar
  • 18 Lang J. Clinical anatomy of the posterior fossa and its foramina. New York: Georg Thieme Verlag 1991: 15-46
    Search in Google Scholar
  • 19 Lister J R, Rhoton Jr A L, Matsushima T, Peace D A. Microsurgical anatomy of the posterior inferior cerebellar artery.  Neurosurgery. 1982;  10 170-199
    CrossrefPubMedSearch in Google Scholar
  • 20 Baldwin H Z, Miller C G, Loveren H R van, Keller I T, Daspit C P, Spetzler R F. The far lateral/combined supra- and infratentorial approach. A human cadaveric prosection model for routes of access to the petroclival region and ventral brain stem.  J Neurosurg. 1994;  81 60-68
    Search in Google Scholar
  • 21 Bertalanffi H, Seeger W. The dorsolateral, suboccipital, transcondylar approach to the lower clivus and anterior portion of the craniocervical junction.  Neurosurgery. 1991;  29 815-821
    CrossrefPubMedSearch in Google Scholar
  • 22 Hosoda K, Fujita S, Kawaguchi T, Yamada H. A transcondylar approach to the arteriovenous malformation at the ventral cervicomedullary junction: report of three cases.  Neurosurgery. 1994;  34 748-753
    PubMedSearch in Google Scholar
  • 23 Lee K S, Gower D J, Branch C L, Lelly D L, McWhorter J M, Bell W O. Surgical repair of aneurysms of the posterior inferior cerebellar artery - A clinical series.  Surg Neurol. 1989;  31 85-91
    CrossrefPubMedSearch in Google Scholar
  • 24 Jennett B, Bond M. Assessment of outcome after severe brain damage.  Lancet. 1975;  1 480-489
    Search in Google Scholar
  • 25 Cruveilhier J. Anatomie pathologique de corps humain. Paris: JB Bailliere, 1829 - 1835, Vol 2. Cited in Schwartz HG. Arterial aneurysm of the posterior fossa.  J Neurosurg. 1948;  5 312-316
    CrossrefPubMedSearch in Google Scholar
  • 26 Schwartz H G. Arterial aneurysm of the posterior fossa.  J Neurosurg. 1948;  5 312-316
    CrossrefPubMedSearch in Google Scholar
  • 27 Rizzoli H V, Hayes G J. Congenital berry aneurysm of the posterior fossa. Case report with successful operative excision.  J Neurosurg. 1953;  10 550-551
    CrossrefPubMedSearch in Google Scholar
  • 28 Höök O, Norlen G, Guzman J. Saccular aneurysms of the vertebral-basilar arterial system. A report of 28 cases.  Act Neurol Scand. 1963;  39 271-304
    PubMedSearch in Google Scholar
  • 29 McDonald C A, Korb M. Intracranial aneurysms.  Arch Neurol Psychiatry. 1939;  42 298-328
    PubMedSearch in Google Scholar
  • 30 Locksley H B. Report on the cooperative study of intracranial aneurysms and subarachnoid hemorrhage. Section V, Part 1. Natural history of subarachnoid hemorrhage, intracranial aneurysms, and arteriovenous malformations. Based on 6368 cases in the Cooperative Study.  J Neurosurg. 1966;  25 219-239
    CrossrefPubMedSearch in Google Scholar
  • 31 Wolf B S, Newman C M, Khilnani M T. The posterior inferior cerebellar artery on vertebral angiography.  Am J Roentgenology. 1960;  87 322-337
    PubMedSearch in Google Scholar
  • 32 Yeh H, Tomsick T, Tew J M. Intraventricular hemorrhage due to aneurysms of the distal posterior inferior cerebellar artery.  J Neurosurg. 1985;  62 772-775
    PubMedSearch in Google Scholar
  • 33 Caplan L R, Baquis G D, Pessin M S, D'Alton G, Adelman L S, DeWitt L D, Ho K, Izukawa D, Kwan D S. Dissection of the intracranial vertebral artery.  Neurology. 1988;  38 868-877
    CrossrefPubMedSearch in Google Scholar
  • 34 Friedman A H, Drake C G. Subarachnoid hemorrhage from intracranial dissecting aneurysm of the vertebral artery.  J Neurosurg. 1984;  60 325-334
    CrossrefPubMedSearch in Google Scholar
  • 35 Ojemann R G, Fisher C M, Rich J C. Spontaneous dissecting aneurysm of the internal carotid artery.  Stroke. 1972;  3 434-440
    CrossrefPubMedSearch in Google Scholar
  • 36 Iwama T, Sakai N, Iwata T, Hirata T, Yamada H. Dissecting and fusiform aneurysms of vertebro-basilar systems. MR imaging.  Neuroradiology. 1990;  32 272-279
    CrossrefPubMedSearch in Google Scholar
  • 37 Nagahiro S, Hamada J, Sakamoto Y, Ushio Y. Follow-up evaluation of dissecting aneurysms of the vertebrobasilar circulation by using gadolinium-enhanced magnetic resonance imaging.  J Neurosurg. 1997;  87 385-390
    PubMedSearch in Google Scholar
  • 38 Quint D J, Spickler E M. Magnetic resonance demonstration of vertebral artery dissection.  J Neurosurg. 1990;  72 964-967
    PubMedSearch in Google Scholar
  • 39 Schweighofer B W, Klein M Y, Leyden P D, Hesseling J R. MR imaging of vertebrobasilar vascular disease.  J Comput Assist Tomogr. 1990;  14 895-904
    PubMedSearch in Google Scholar
  • 40 Fazzari I. Die Arterien des Kleinhirns.  Anat Anz. 1929;  67 497-501
    PubMedSearch in Google Scholar
  • 41 Lang J. Über extradurale Ursprünge der PICA und deren klinische Bedeutung.  Neurochirurgia. 1985;  28 183-187
    PubMedSearch in Google Scholar
  • 42 Stopford J SB. The arteries of the pons and medulla oblongata. Part 1 and 2.  J Anat Physiol. 1916;  50 130-164
    PubMedSearch in Google Scholar
  • 43 Lanz T v, Wachsmut W, Lang J. Praktische Anatomie, Vol. 1, Teil B (Kopf). Wien, New York: Springer 1985: 283-290
    Search in Google Scholar
  • 44 Lang J, Kollmansberger A. Beitrag zur Anatomie der Kleinhirnarterien.  Gegenbauers Morph Jb. 1962;  102 170-179
    PubMedSearch in Google Scholar
  • 45 Stopford J SB. The arteries of the pons and medulla oblongata. Part 3.  J Anat Physiol. 1917;  51 250-277
    PubMedSearch in Google Scholar
  • 46 Müller J. Über Lage und Ursprungszone der Kleinhirnarterien und deren Quellgefäße. Würzburg: Inaugural Diss 1975
    Search in Google Scholar
  • 47 Fankhauser H, Kamano S, Hanamurat T, Amano K, Hatanaka H. Abnormal origin of the PICA.  J Neurosurg. 1979;  51 569-571
    PubMedSearch in Google Scholar
  • 48 Fine A D, Cardoso A, Rhoton Jr A L. Microsurgical anatomy of the extracranial-extradural origin of the posterior inferior cerebellar artery.  J Neurosurg. 1999;  91 645-652
    PubMedSearch in Google Scholar
  • 49 Salas E, Ziyal I M, Bank W O, Santi M R, Sekhar L N. Extradural origin of the posteroinferior cerebellar artery: An anatomical study with histological and radiographic correlation.  Neurosurgery. 1998;  42 1326-1331
    PubMedSearch in Google Scholar
  • 50 Huang Y P, Wolf B S. Angiographic features of fourth ventricle tumors with special reference to the posterior inferior cerebellar artery.  AJR. 1969;  107 543-564
    PubMedSearch in Google Scholar
  • 51 Bertalanffy H, Sure U, Petermeyer M, Becker R, Gilsbach J M. Management of aneurysms of the vertebral artery-posterior inferior cerebellar artery complex.  Neurol Med Chir (Tokyo). 1998;  38 (Suppl) 93-103
    CrossrefPubMedSearch in Google Scholar
  • 52 Horowitz M, Kopitnik T, Landreneau F, Krummerman J, Batjer H H, Thomas G, Samson D. Posteroinferior cerebellar artery aneurysms: surgical results for 38 patients.  Neurosurgery. 1998;  43 1026-1032
    CrossrefPubMedSearch in Google Scholar
  • 53 Hudgins R J, Day A L, Quisling R G, Rhoton Jr A L, Sypert G W, Garcia-Bengochea F. Aneurysm of the posterior inferior cerebellar artery. A clinical and anatomical analysis.  J Neurosurg. 1983;  58 381-387
    CrossrefPubMedSearch in Google Scholar
  • 54 Pia H W. Classification of the vertebro-basilar aneurysms.  Acta Neurochir. 1979;  47 3-30
    CrossrefPubMedSearch in Google Scholar
  • 55 Salcman M, Rigamonti D, Numaguchi Y, Sadato N. Aneurysms of the posterior inferior cerebellar artery complex: Variations on a theme.  Neurosurgery. 1990;  27 12-21
    CrossrefPubMedSearch in Google Scholar
  • 56 Todaka T, Hamada J, Yano S, Kai Y, Morioka M, Ushio Y. Successful clipping of a distal posterior inferior cerebellar aneurysm located on the anterior surface of the medulla oblongata - case report.  Neurol Med Chir (Tokyo). 2002;  42 158-161
    PubMedSearch in Google Scholar
  • 57 Gacs G, Vinuela F, Fox A I, Drake C G. Peripheral aneurysms of the cerebellar arteries.  J Neurosurg. 1983;  58 63-68
    PubMedSearch in Google Scholar
  • 58 Nishizaki T, Tamaki N, Nishida Y, Fujita K, Matsumoto S. Aneurysms of the distal posterior inferior cerebellar artery: Experience with three cases and review of the literature.  Neurosurgery. 1985;  16 829-832
    PubMedSearch in Google Scholar
  • 59 Zingale A, Chiaramonte I, Consoli V, Albanese V. Distal posterior inferior cerebellar artery saccular and giant aneurysm: Report of two new cases and a comprehensive review of the surgically-treated cases.  J Neurosurg Sci. 1994;  38 93-104
    PubMedSearch in Google Scholar
  • 60 Iihara K, Sakai N, Murao K, Sakai H, Higashi T, Kogure S, Takahashi J C, Nagata I. Dissecting aneurysms of the vertebral artery: a management strategy.  J Neurosurg. 2002;  97 259-267
    CrossrefPubMedSearch in Google Scholar
  • 61 Urbach H, Meyer B, Cedzich C, Solmosi L. Posterior inferior cerebellar artery aneurysm in the fourth ventricle.  Neuroradiology. 1995;  37 267-269
    PubMedSearch in Google Scholar
  • 62 Hiscott P, Crockard A. Multiple aneurysms of the distal posterior inferior cerebellar artery.  Neurosurgery. 1982;  10 101-102
    PubMedSearch in Google Scholar
  • 63 Sugita K, Kobayashi S, Takemae T, Tanaka Y, Okudera H, Ohsawa M. Giant aneurysms of the vertebral artery.  J Neurosurg. 1988;  68 960-966
    PubMedSearch in Google Scholar
  • 64 Lewis S B, Chang D J, Peace D A, Laftentz P I, Day A L. Distal posterior inferior cerebellar artery aneurysms: clinical features and management.  J Neurosurg. 2002;  97 756-766
    CrossrefPubMedSearch in Google Scholar
  • 65 Kanemoto Y, Hisanaga M, Bessho H. De novo vertebral artery-posterior inferior cerebellar artery aneurysm: a case report.  Surg Neurol. 1997;  47 473-475
    PubMedSearch in Google Scholar
  • 66 Kaim A, Proske M, Kirsch E, Weymarn A von, Radu E W, Steinbrich W. Value of repeat-angiography in cases of unexplained subarachnoid hemorrhage (SAH).  Acta Neurol Scand. 1996;  93 366-373
    PubMedSearch in Google Scholar
  • 67 Sadato N, Numaguchi Y, Rigamonti D, Salcman M, Gellad F E, Kishikawa T. Bleeding patterns in ruptured posterior fossa aneurysms: A CT study.  J Comput Assist Tomogr. 1991;  15 612-617
    CrossrefPubMedSearch in Google Scholar
  • 68 Nussbaum E S, Mendez P I, Camarata P, Sebring L. Surgical management of fusiform aneurysms of the peripheral posteroinferior cerebellar artery.  Neurosurgery. 2003;  53 831-834
    CrossrefPubMedSearch in Google Scholar
  • 69 Sasaki O, Ogawa H, Koike T, Koizumi T, Tanaka R. A clinicopathological study of dissecting aneurysm of the intracranial vertebral artery.  J Neurosurg. 1991;  75 874-882
    CrossrefPubMedSearch in Google Scholar
  • 70 Turnbull H M. Alterations in arterial structure, and their relation to syphilis.  Quart J Med. 1915;  8 201-253
    PubMedSearch in Google Scholar
  • 71 Berger M S, Wilson C B. Intracranial dissecting aneurysms of the posterior circulation.  J Neurosurg. 1984;  61 882-894
    CrossrefPubMedSearch in Google Scholar
  • 72 Sano H, Kato Y, Okuma I, Yamaguchi S, Ninomiya T, Arunkumar R, Kanno T. Classification and treatment of vertebral dissecting aneurysm.  Surg Neurol. 1997;  48 596-605
    PubMedSearch in Google Scholar
  • 73 Tawk R G, Bendok B R, Qureshi A I, Getch C C, Srinivasan J, Alberts M, Russell E J, Batjer H H. Isolated dissections and dissecting aneurysms of the posterior inferior cerebellar artery: topic and literature review.  Neurosurg Rev. 2003;  26 180-187
    CrossrefPubMedSearch in Google Scholar
  • 74 Dinichert A, Rufenacht D A, Tribolet N. Dissecting aneurysms of the posterior inferior cerebellar artery: report of four cases and review of the literature.  J Clin Neurosci. 2000;  7 515-520
    CrossrefPubMedSearch in Google Scholar
  • 75 Jafar J J, Kamiryo T, Chiles B W, Nelson P K. A dissecting aneurysm of the posteroinferior cerebellar artery: Case report.  Neurosurgery. 1998;  43 353-356
    PubMedSearch in Google Scholar
  • 76 Kanou Y, Arita K, Kurisu K, Ikawa F, Eguchi K, Monden S, Watanabe K. Dissecting aneurysm of the peripheral posterior inferior cerebellar artery.  Acta Neurochir (Wien). 2000;  142 1151-1156
    CrossrefPubMedSearch in Google Scholar
  • 77 Tikkakoski T, Leinonen S, Siniluoto T, Koivukangas J. Isolated dissecting aneurysm of the left posterior inferior cerebellar artery: endovascular treatment with a Guglielmi detachable coil.  AJNR. 1997;  18 936-938
    PubMedSearch in Google Scholar
  • 78 Stehbens W E. Medial defects of the cerebral arteries of man.  J Path Bact. 1959;  8 179-185
    PubMedSearch in Google Scholar
  • 79 Stehbens W E. Etiology of intracranial berry aneurysms.  J Neurosurg. 1989;  70 823-831
    PubMedSearch in Google Scholar
  • 80 Alexander B C, Burger P C, Goree J A. Dissecting aneurysms of the basilar artery in 2 patients.  Stroke. 1979;  10 294-299
    PubMedSearch in Google Scholar
  • 81 De Luca G P, Volpin L, Colombo F, Fomezza U, Pinna V. Spontaneous healing of cerebral aneurysm at the beginning of left posterior inferior cerebellar artery (PICA). Case report.  J Neurosurg Sci. 1998;  42 115-118
    PubMedSearch in Google Scholar
  • 82 Nishioka T, Maeda Y, Tomogane Y, Nakano A, Arita N. Unexpected delayed rupture of the vertebral-posterior inferior cerebellar artery aneurysms following closed head injury.  Acta Neurochir (Wien). 2002;  144 839-845
    CrossrefPubMedSearch in Google Scholar
  • 83 Sure U, Becker R, Petermeyer M, Bertalanffy H. Aneurysm of the posterior inferior cerebellar artery caused by a traumatic perforating artery tear-out mechanism in a child.  Childs Nerv Syst. 1999;  15 354-356
    CrossrefPubMedSearch in Google Scholar
  • 84 Day J D, Fukushima T, Gianotta S L. Cranial base approaches to posterior circulation aneurysms.  J Neurosurg. 1997;  87 544-554
    CrossrefPubMedSearch in Google Scholar
  • 85 Heros R C. Lateral suboccipital approach for vertebral and vertebrobasilar artery lesions.  J Neurosurgery. 1986;  64 559-562
    CrossrefPubMedSearch in Google Scholar
  • 86 Lang D A, Neil-Dwyer G, Ianotti F. The suboccipital transcondylar approach to the clivus and cranio-cervical junction for ventrally placed pathology at and above the foramen magnum.  Acta Neurochir. 1993;  125 132-137
    CrossrefPubMedSearch in Google Scholar
  • 87 Kitanaka C, Tanaki J-I, Kuwahara M, Teraoka A, Sasaki T, Takakura K. Nonsurgical treatment of unruptured intracranial vertebral artery dissection with serial follow-up angiography.  J Neurosurg. 1994;  80 667-674
    PubMedSearch in Google Scholar
  • 88 Aoki N, Sakai T. Rebleeding from intracranial dissecting aneurysm of the vertebral artery.  Stroke. 1990;  21 1628-1631
    PubMedSearch in Google Scholar
  • 89 Ogilvy C S, Quinones-Hinojosa A. Surgical treatment of vertebral and posterior inferior cerebellar artery aneurysms.  Neurosurg Clin N Am. 1998;  9 851-860
    PubMedSearch in Google Scholar
  • 90 Guglielmi G, Vinuela F, Duckwiler G, Dion J, Lylyk P, Berenstein A, Strother C, Graves V, Halbach V, Nichols D, Hopkins N, Ferguson R, Sepetka I. Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils.  J Neurosurg. 1992;  77 515-524
    CrossrefPubMedSearch in Google Scholar
  • 91 Adams Jr H P, Aschenbrenner C A, Kassel N F, Ansbacher L, Cornell S H. Intracranial hemorrhage produced by spontaneous dissecting intracranial aneurysms.  Arch Neurol. 1982;  39 773-775
    PubMedSearch in Google Scholar
  • 92 Kulla L, Deymeer F, Smith T W, Weiner M, Mullins T F. Intracranial dissecting and saccular aneurysms in polycystic kidney disease.  Arch Neurol. 1982;  39 776-778
    PubMedSearch in Google Scholar
  • 93 Ito K, Tanaka Y, Kakizawa Y, Hongo K, Kobayashi S. Aneurysms at the posterior inferior cerebellar artery of extradural origin for preoperative evaluation of safe clipping: case report and review of literature.  Surg Neurol. 2003;  60 329-333
    PubMedSearch in Google Scholar
  • 94 Theodosopoulos P V, Lawton M T. Fenestration of the posteroinferior cerebellar artery: case report.  Neurosurgery. 2000;  47 463-465
    CrossrefPubMedSearch in Google Scholar

Dr. Gunther Kleinpeter

Neurochirurgie · Donauspital

Langobardenstrasse 122

1220 Wien

Austria

Phone: +43-1-28802-3602

Fax: +43-1-28802-3680

Email: g.kleinpeter@billrothhaus.at