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Double Origin of the Posterior Inferior Cerebellar Artery: Association with Intracranial Aneurysm on Catheter Angiography

Walter S. Lesley1,2, M. Hasan Rajab3 and Robert S. Case1

1 Department of Radiology, Section of Surgical Neuroradiology, Texas A & M Health Science Center, College of Medicine, Scott and White Clinic, 2401 S 31st St., Temple, TX 76502.
2 Department of Surgery, Texas A & M Health Science Center, College of Medicine, Scott and White Clinic, Temple, TX.
3 Department of Biostatistics, Texas A & M Health Science Center, College of Medicine, Scott and White Clinic, Temple, TX.


Figure 1
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  		Fig. 1A —67-year-old woman with double origin of left posterior inferior cerebellar artery (PICA), trigeminal aneurysm, and vertebrobasilar junction fenestration. Anteroposterior angiogram of right (A) and lateral angiogram of left (B) vertebral arteries show two origins of left PICA (solid black arrows) converging at proximal aspect of anterior medullary segment of PICA (white arrow). Fenestrated vertebrobasilar junction (dashed arrow, A) and bulbous basilar tip–aneurysmal infundibuli of bilateral origins of posterior cerebral and superior cerebellar artery are evident (A). Double origin of PICA arises from nondominant vertebral artery.

 

Figure 2
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  		Fig. 1B —67-year-old woman with double origin of left posterior inferior cerebellar artery (PICA), trigeminal aneurysm, and vertebrobasilar junction fenestration. Anteroposterior angiogram of right (A) and lateral angiogram of left (B) vertebral arteries show two origins of left PICA (solid black arrows) converging at proximal aspect of anterior medullary segment of PICA (white arrow). Fenestrated vertebrobasilar junction (dashed arrow, A) and bulbous basilar tip–aneurysmal infundibuli of bilateral origins of posterior cerebral and superior cerebellar artery are evident (A). Double origin of PICA arises from nondominant vertebral artery.

 

Figure 3
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  		Fig. 1C —67-year-old woman with double origin of left posterior inferior cerebellar artery (PICA), trigeminal aneurysm, and vertebrobasilar junction fenestration. Three-dimensional (C) and lateral conventional (D) angiograms of left internal carotid artery show trigeminal artery (black arrows, D) arising from small trigeminal aneurysm (white arrow, C).

 

Figure 4
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  		Fig. 1D —67-year-old woman with double origin of left posterior inferior cerebellar artery (PICA), trigeminal aneurysm, and vertebrobasilar junction fenestration. Three-dimensional (C) and lateral conventional (D) angiograms of left internal carotid artery show trigeminal artery (black arrows, D) arising from small trigeminal aneurysm (white arrow, C).

 

Figure 5
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  		Fig. 2A —42-year-old woman with double origin of left posterior inferior cerebellar artery (PICA) and basilar tip aneurysm. Lateral (A) and frontal (B) angiograms obtained during left vertebral artery injection show left PICA has two origins (black arrows, A), which converge at mid aspect of anterior medullary segment of PICA (white arrow). Coils are evident in basilar tip aneurysm (A). Double origin of PICA arises from slightly dominant vertebral artery.

 

Figure 6
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  		Fig. 2B —42-year-old woman with double origin of left posterior inferior cerebellar artery (PICA) and basilar tip aneurysm. Lateral (A) and frontal (B) angiograms obtained during left vertebral artery injection show left PICA has two origins (black arrows, A), which converge at mid aspect of anterior medullary segment of PICA (white arrow). Coils are evident in basilar tip aneurysm (A). Double origin of PICA arises from slightly dominant vertebral artery.

 

Figure 7
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  		Fig. 3A —82-year-old man with double origin of right posterior inferior cerebellar artery (PICA) and superior hypophyseal aneurysm. Frontal (A) and lateral (B) angiograms obtained during right vertebral artery injection show right PICA has two origins (arrowheads), which converge at mid aspect of anterior medullary segment (arrow) of PICA.

 

Figure 8
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  		Fig. 3B —82-year-old man with double origin of right posterior inferior cerebellar artery (PICA) and superior hypophyseal aneurysm. Frontal (A) and lateral (B) angiograms obtained during right vertebral artery injection show right PICA has two origins (arrowheads), which converge at mid aspect of anterior medullary segment (arrow) of PICA.

 

Figure 9
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  		Fig. 3C —82-year-old man with double origin of right posterior inferior cerebellar artery (PICA) and superior hypophyseal aneurysm. Lateral right internal carotid angiogram shows small unruptured superior hypophyseal aneurysm (arrow).

 

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