Posterior inferior cerebellar artery (PICA)

The posterior inferior cerebellar artery (PICA), the largest branch of the vertebral artery, is one of the three main arterial blood supplies for the cerebellum.

Fm: Foramen of Magendie; imv: inferior medullary velum; icp: inferior cerebellar peduncle; pica: posterior inferior cerebellar artery (third and forth segments) tc: tela chorioidea; tvj: telovelar junction ( yellow discontinous line).

Occlusion of the posterior inferior cerebellar artery or one of its branches, or of the vertebral artery leads to Wallenberg syndrome, also called lateral medullary syndrome.

It winds backward around the upper part of the medulla oblongata, passing between the origins of the vagus and accessory nerves, over the inferior cerebellar peduncle to the undersurface of the cerebellum, where it divides into two branches.

The medial branch continues backward to the notch between the two hemispheres of the cerebellum; while the lateral supplies the under surface of the cerebellum, as far as its lateral border, where it anastomoses with the anterior inferior cerebellar and the superior cerebellar branches of the basilar artery.

Branches from this artery supply the choroid plexus of the fourth ventricle.

The ascending pharyngeal artery (APA) may, in very rare cases, supply the posterior inferior cerebellar artery (PICA). In reported cases, when such is the case, the ipsilateral vertebral artery (VA) does not supply the PICA, and most of the time it is hypoplastic.

Awareness of the existence of an extradural origin of the PICA and a direct connection of this vessel with the occipital artery (OA) is of great relevance to the muscular stage of surgical approaches to the posterior craniovertebral junction 1).

see Posterior inferior cerebellar artery aneurysm

Tayebi Meybodi A, Lawton MT, Benet A. Dual Origin of Extradural Posterior Inferior Cerebellar Artery From Vertebral and Occipital Arteries: Anatomic Case Report. Neurosurgery. 2015 Jul 31. [Epub ahead of print] PubMed PMID: 26237343.
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