open access

Vol 82, No 2 (2023)
Case report
Submitted: 2021-11-03
Accepted: 2021-12-08
Published online: 2022-04-05
Get Citation

Bihemispheric posterior inferior cerebellar artery in a cadaver with Chiari I malformation

N. Boggio1, M. Mathkour2, Ł. Olewnik3, J. Iwanaga45, C. J. Bui6, E. E Biro6, R. S. Tubbs15678910
·
Pubmed: 35411545
·
Folia Morphol 2023;82(2):375-381.
Affiliations
  1. Department of Neurosurgery, Tulane Centre for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, United States
  2. Tulane University and Ochsner Clinic Neurosurgery Programme, Tulane University School of Medicine, New Orleans LA, United States
  3. Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
  4. Department of Neurosurgery, Tulane Centre for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, United States
  5. Department of Neurology, Tulane University School of Medicine, New Orleans, LA, United States
  6. Department of Neurosurgery, Ochsner Health System, New Orleans, LA, United States
  7. Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, United States
  8. Department of Anatomical Sciences, St. George’s University, St. George’s, Grenada, West Indies
  9. Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States
  10. University of Queensland, Brisbane, Australia

open access

Vol 82, No 2 (2023)
CASE REPORTS
Submitted: 2021-11-03
Accepted: 2021-12-08
Published online: 2022-04-05

Abstract

Typically, patients with Chiari I malformations (CM I) do not have other intracranial anatomical variations, especially vascular derailments. Here, we report the findings of a cadaveric specimen found to have CM I and cerebellar tonsils supplied by
a single posterior inferior cerebellar artery (PICA) i.e., a bihemispheric PICA. An adult male cadaver was found to have CM I. It was also noted that the left PICA descended inferiorly to the level of C1 and that there was absence of the right PICA. The territory of the right PICA was supplied by the left PICA. The tonsillar component of the left PICA gave rise to a branch that crossed to the right inferior cerebellum and herniated cerebellar tonsil. A bihemispheric PICA is very rare. To our knowledge, this is the first report of this vascular variation in combination with CM I. Such a variation should be kept in mind, especially during posterior fossa decompression for symptomatic CM I as unilateral PICA injury could have catastrophic results.

Abstract

Typically, patients with Chiari I malformations (CM I) do not have other intracranial anatomical variations, especially vascular derailments. Here, we report the findings of a cadaveric specimen found to have CM I and cerebellar tonsils supplied by
a single posterior inferior cerebellar artery (PICA) i.e., a bihemispheric PICA. An adult male cadaver was found to have CM I. It was also noted that the left PICA descended inferiorly to the level of C1 and that there was absence of the right PICA. The territory of the right PICA was supplied by the left PICA. The tonsillar component of the left PICA gave rise to a branch that crossed to the right inferior cerebellum and herniated cerebellar tonsil. A bihemispheric PICA is very rare. To our knowledge, this is the first report of this vascular variation in combination with CM I. Such a variation should be kept in mind, especially during posterior fossa decompression for symptomatic CM I as unilateral PICA injury could have catastrophic results.

Get Citation

Keywords

hindbrain herniation, vertebrobasilar system, posterior cranial fossa, tonsillar ectopia, variation

About this article
Title

Bihemispheric posterior inferior cerebellar artery in a cadaver with Chiari I malformation

Journal

Folia Morphologica

Issue

Vol 82, No 2 (2023)

Article type

Case report

Pages

375-381

Published online

2022-04-05

Page views

2208

Article views/downloads

813

DOI

10.5603/FM.a2022.0038

Pubmed

35411545

Bibliographic record

Folia Morphol 2023;82(2):375-381.

Keywords

hindbrain herniation
vertebrobasilar system
posterior cranial fossa
tonsillar ectopia
variation

Authors

N. Boggio
M. Mathkour
Ł. Olewnik
J. Iwanaga
C. J. Bui
E. E Biro
R. S. Tubbs

References (44)
  1. Aboulezz AO, Sartor K, Geyer CA, et al. Position of cerebellar tonsils in the normal population and in patients with Chiari malformation: a quantitative approach with MR imaging. J Comput Assist Tomogr. 1985; 9(6): 1033–1036.
  2. Akar ZC, Dujovny M, Slavin KV, et al. Microsurgical anatomy of the intracranial part of the vertebral artery. Neurol Res. 1994; 16(3): 171–180.
  3. Alai A, Reddy CG, Amrami KK, et al. Charcot arthropathy of the shoulder associated with typical and atypical findings. Clin Anat. 2013; 26(8): 1017–1023.
  4. Azahraa Haddad F, Qaisi I, Joudeh N, et al. The newer classifications of the chiari malformations with clarifications: An anatomical review. Clin Anat. 2018; 31(3): 314–322.
  5. Barkovich AJ, Wippold FJ, Sherman JL, et al. Significance of cerebellar tonsillar position on MR. Am J Neuroradiol. 1986; 7(5): 795–799.
  6. Bebin J. The cerebellopontile angle, the blood supply of the brain stem and the reticular formation. Anatomical and functional correlations relevant to surgery of acoustic tumors. Henry Ford Hosp Med J. 1968; 16(1): 61–86.
  7. Bindal AK, Dunsker SB, Tew JM. Chiari I malformation: classification and management. Neurosurgery. 1995; 37(6): 1069–1074.
  8. Bordes S, Jenkins S, Tubbs RS. Defining, diagnosing, clarifying, and classifying the Chiari I malformations. Childs Nerv Syst. 2019; 35(10): 1785–1792.
  9. Cahan LD, Bentson JR. Considerations in the diagnosis and treatment of syringomyelia and the Chiari malformation. J Neurosurg. 1982; 57(1): 24–31.
  10. Carlson AP, Alaraj A, Dashti R, et al. The bihemispheric posterior interior cerebellar artery: anatomic variations and clinical relevance in 11 cases. J Neurointerv Surg. 2013; 5(6): 601–604.
  11. Carmel PW, Markesbery WR. Early descriptions of the Arnold-Chiari malformation. The contribution of John Cleland. J Neurosurg. 1972; 37(5): 543–547.
  12. Cesmebasi A, Loukas M, Hogan E, et al. The Chiari malformations: a review with emphasis on anatomical traits. Clin Anat. 2015; 28(2): 184–194.
  13. UeberVeranderungen des Kleinhirnsinfolge von Hydrocephalie des Grosshirns. Med Wochenschr. 1891; 17: 1172–1175.
  14. Chiari H. UeberVeranderungen des Kleinhirns, des Pons und der Medulla oblongata Infolge von congenitalerHydrocephalie des Grosshirns. DenkschriftenKaisAkadWiss. 1895; 63: 71–116.
  15. Cullen SP, Ozanne A, Alvarez H, et al. The bihemispheric posterior inferior cerebellar artery. Neuroradiology. 2005; 47(11): 809–812.
  16. Fujii K, Lenkey C, Rhoton AL. Microsurgical anatomy of the choroidal arteries. Fourth ventricle and cerebellopontine angles. J Neurosurg. 1980; 52(4): 504–524.
  17. Fusco MR, Ogilvy CS. Microsurgery of Vertebral Artery and Posterior Inferior Cerebellar Artery. In: Winn HR, Youmans JR (eds.), Youmans and Winn Neurological Surgery. 7th ed. Elsevier 2017: 3343–3350.
  18. Gabrielsen TO, Seeger JF, Amundsen P. Some new angiographic observations in patients with Chiari type I and II malformations. Radiology. 1975; 115(3): 627–634.
  19. Hagenah R, Kosak M, Freckmann N. Anatomic topographical relationship of the intraspinal accessory root to the upper cervical roots and to the vessels of the cranial cervical region. Acta Anat (Basel). 1983; 115(2): 158–167.
  20. Icardo JM, Ojeda JL, Garcia-Porrero JA, et al. The cerebellar arteries: cortical patterns and vascularization of the cerebellar nuclei. Acta Anat (Basel). 1982; 113(2): 108–116.
  21. Iwanaga J, Singh V, Ohtsuka A, et al. Acknowledging the use of human cadaveric tissues in research papers: Recommendations from anatomical journal editors. Clin Anat. 2021; 34(1): 2–4.
  22. Lesley WS, Rajab MH, Case RS. Double origin of the posterior inferior cerebellar artery: association with intracranial aneurysm on catheter angiography. AJR Am J Roentgenol. 2007; 189(4): 893–897.
  23. Lister JR, Rhoton AL, Matsushima T, et al. Microsurgical anatomy of the posterior inferior cerebellar artery. Neurosurgery. 1982; 10(2): 170–199.
  24. Magklara EP, Pantelia ET, Solia E, et al. Vertebral artery variations revised: origin, course, branches and embryonic development. Folia Morphol. 2021; 80(1): 1–12.
  25. Margolis MT, Newton TH. An angiographic sign of cerebellar tonsillar herniation. Neuroradiology. 1971; 2(1): 3–8.
  26. Menezes AH. Chiari I malformations and hydromyelia-complications. Pediatr Neurosurg. 1991; 17(3): 146–154.
  27. Miao HL, Zhang DY, Wang T, et al. Clinical importance of the posterior inferior cerebellar artery: a review of the literature. Int J Med Sci. 2020; 17(18): 3005–3019.
  28. Oakes WJ, Tubbs ST. Chiari Malformations. In: Winn HR, Youmans JR (eds.), Youmans and Winn Neurological Surgery. 2nd ed. Elsevier 2004: 1531–1540.
  29. Oakes WJ. Treatment of the Pediatric Chiari I Malformation. In: Tubbs RS, Turgut M, Oakes W (eds.), The Chiari Malformations. 2nd ed. Springer, Cham 2020: 437–441.
  30. OʼDonnell CM, Child ZA, Nguyen Q, et al. Vertebral artery anomalies at the craniovertebral junction in the US population. Spine (Phila Pa 1976). 2014; 39(18): E1053–E1057.
  31. Pekcevik Y, Pekcevik R. Variations of the cerebellar arteries at CT angiography. Surg Radiol Anat. 2014; 36(5): 455–461.
  32. Ravindra VM, Brockmeyer DL. Chiari and Scoliosis. In: Tubbs RS, Turgut M, Oakes W (eds.), The Chiari Malformations. 2nd ed. Springer, Cham 2020: 219–224.
  33. Rodríguez-Hernández A, Rhoton AL, Lawton MT. Segmental anatomy of cerebellar arteries: a proposed nomenclature. Laboratory investigation. J Neurosurg. 2011; 115(2): 387–397.
  34. Scialfa G, Bank W, Megret M, et al. The arteries of the roof of the fourth ventricle. Neuroradiology. 1976; 11(2): 69–71.
  35. Sgouros S, Kountouri M, Natarajan K. Skull base growth in children with Chiari malformation Type I. J Neurosurg. 2007; 107(3 Suppl): 188–192.
  36. Sharifi M, Ungier E, Ciszek B. Double posterior inferior cerebellar artery. Surg Radiol Anat. 2010; 32(1): 87–89.
  37. Shoja MM, Johal J, Oakes WJ, et al. Embryology and pathophysiology of the Chiari I and II malformations: A comprehensive review. Clin Anat. 2018; 31(2): 202–215.
  38. Shoja MM, Ramdhan R, Jensen CJ, et al. Embryology of the craniocervical junction and posterior cranial fossa, part I: Development of the upper vertebrae and skull. Clin Anat. 2018; 31(4): 466–487.
  39. Shoja MM, Ramdhan R, Jensen CJ, et al. Embryology of the craniocervical junction and posterior cranial fossa, part II: Embryogenesis of the hindbrain. Clin Anat. 2018; 31(4): 488–500.
  40. Tubbs RS, Iskandar BJ, Bartolucci AA, et al. A critical analysis of the Chiari 1.5 malformation. J Neurosurg. 2004; 101(2 Suppl): 179–183.
  41. Tubbs ST. Surgical Anatomy of the Craniocervical Junction Relevant to Chiari Malformations. In: Tubbs RS, Turgut M, Oakes W (eds.), The Chiari Malformations. 2nd ed. Springer, Cham : 21–39.
  42. Tubbs RS, Turgut M. Defining the Chiari Malformations: Past and Newer Classifications. In: Tubbs RS, Turgut M, Oakes W (eds.), The Chiari Malformations. 2nd ed. Springer, Cham 2020: 21–39.
  43. Wellons JC, Tubbs RS, Oakes WJ. Chiari Malformations and Syringohydromyelia. In: Rengachary SS, Ellenbogen RG (eds.), Principles of Neurosurgery. Elsevier, Edinburgh 2005: 181–195.
  44. Wollschlaeger G, Wollschlaeger PB, Lucas FV, et al. Experience and result with postmortem cerebral angiography performed as routine procedure of the autopsy. Am J Roentgenol Radium Ther Nucl Med. 1967; 101(1): 68–87.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Group sp. z o.o., Grupa Via Medica, Świętokrzyska 73, 80–180 Gdańsk, Poland

tel.: +48 58 320 94 94, faks: +48 58 320 94 60, e-mail: viamedica@viamedica.pl