![]() ![]() Unruptured A1As also need microneurosurgical clipping even when they are small. The most common variations reported in the literature are agenesis of AICA or PICA, AICA originating from PICA, PICA originating from internal carotid artery, persistence of a primitive communicating vessel (presegmental artery) between anterior and posterior circulation, and PICA originating from posterior meningeal artery. Because of their small size and involvement of perforating arteries at their base, microneurosurgical clipping is the method of choice in treatment of ruptured A1As. Our data suggest that A1As rupture at smaller size than IAs in general. Aneurysms arising from A1 are usually small, with a fragile wall. Seventy percent of patients had at least 1 associated aneurysm. Non-visualization of left PCOM ( posterior communicating artery ), but normal appearing posterior cerebral artery and anterior circulation. Twelve (52%) patients presented with ruptured A1As with ICH in 3 (25%) and IVH in 2 (17%). A markedly hypolastic right vertebral artery which is terminating in to the PICA ( posterior inferior cerebellar artery ). ![]() Variations are common and the PICA syndrome for example, often presents with. There are multiple eponymous posterior stroke syndromes, often presenting incompletely 4. In the Kuopio Cerebral Aneurysm Database of 3005 patients with 4253 aneurysms, there were 23 patients carrying 23 A1As, forming 0.8% of all patients with aneurysm, 0.5% of all aneurysms, and 2% of all ACA aneurysms. However, the PICA originating from the ascending pharyngeal artery (APA) has been very rarely reported. Headache and neck pain is normally the result of full posterior inferior cerebellar artery territory infarcts and is likely secondary to the associated swelling and mass effect 3. These 2 centers have treated more than 10,000 patients with aneurysm since 1951. Objective: In the present study, we characterized the vestibulo-ocular reflex (VOR) gain and properties of corrective saccades (CS) in patients with posterior inferior cerebellar artery (PICA) stroke and determined the best parameter to differentiate PICA stroke from benign peripheral vestibular neuritis (VN). This review, and the whole series on IAs, is mainly based on the personal microneurosurgical experience of the senior author (JH) in 2 Finnish centers (Helsinki and Kuopio), which serve without patient selection the catchment area in Southern and Eastern Finland. In this article, the authors review the practical anatomy, preoperative planning, and avoidance of complications in the microsurgical dissection and clipping of A1As. There are only few reports on microneurosurgical management of A1As. Aneurysms originating from the proximal segment of anterior cerebral artery (A1As) are rare, forming less than 1% of all IAs. At the mid to lower basilar segment, a homologous enlarging channel is the AICA. ![]()
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