Non-Giant Aneurysms of the Vertebral Artery: 181 Patients

  • Charles G. Drake
  • Sydney J. Peerless
  • Juha A. Hernesniemi


The vertebral artery may give rise to saccular aneurysms throughout its intracranial course, but two-thirds occurred at the distal crotch of origin of posterior-inferior cerebellar artery (PICA). The notorious tortuosity of the vertebral artery and the varying level of origin of PICA have placed vertebral aneurysms anywhere from positions near the intracranial entry of the vertebral artery under the first dentate ligament, even in the upper lateral cervical canal, to that portion of the vertebral artery under the middle of the medulla. Right vertebral aneurysms have even been seen and operated on the left side of the midline. Most vertebral aneurysms project upward, lying shallowly on the medulla, either laterally or in front. A few project more posteriorly into the medulla, while others may have a dome adherent to the clivus. There is often an intimate relationship to the twelfth nerve, which usually lies across the upper side of the neck (Illustration 14.VIII, C), although it has been seen to be split in two by the growth of the sac and thus lie on both sides of the neck, but only seven patients had hypoglossal paresis and three of them were redoaneurysms. Peculiar to vertebral aneurysms (and superior cerebellar aneurysms) is for PICA (or superior cerebellar artery (SCA)) to emerge more from the side of the neck than from the parent artery.


Vertebral Artery Superior Cerebellar Artery Pica Origin Pica Aneurysm Dacron Patch 
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  1. 1.
    Andoh T, Itoh T, Yoshimura S, Shirakami S, Nakashima T, Nishimura Y, Sakai N, Yamada H, Ohkuma A, Tanabe Y: Peripheral aneurysms of the posterior inferior cerebellar artery; analysis of 15 cases. No Shinkei Geka 20: 683–90, 1992PubMedGoogle Scholar
  2. 2.
    Azzam CJ: Growth of multiple peripheral high flow aneurysms of the posterior inferior cerebellar artery associated with a cerebellar arteriovenous malformation. Neurosurgery 21: 934–939, 1987PubMedCrossRefGoogle Scholar
  3. 3.
    Beyerl BD, Heros RC: Multiple peripheral aneurysms of the posterior inferior cerebellar artery. Neurosurgery 19: 285–289, 1986PubMedCrossRefGoogle Scholar
  4. 4.
    Crockard HA, Koksel T, Watkin N: Transoral transclival clipping of anterior inferior cerebellar artery aneurysm using new rotating applier. Technical note. J Neurosurg 75: 483–485, 1991PubMedCrossRefGoogle Scholar
  5. 5.
    Dernbach PD, Sila CA, Little JR: Giant and multiple aneurysms of the distal posterior inferior cerebellar artery. Neurosurgery 22: 309–312, 1988PubMedCrossRefGoogle Scholar
  6. 6.
    Drake CG: The surgical treatment of vertebral-basilar aneurysms. Clin Neurosurg 16: 114–169, 1969PubMedGoogle Scholar
  7. 7.
    Drake CG: Management of aneurysms of the posterior circulation. In: Youmans JR (ed) Neurological surgery, 1st ed, vol 2. Philadelphia: Saunders, 1973, pp 787–806Google Scholar
  8. 8.
    Drake CG: Ligation of the vertebral (unilateral or bilateral) or basilar artery in the treatment of large intracranial aneurysms. J Neurosurg 43: 255–274, 1975PubMedCrossRefGoogle Scholar
  9. 9.
    Drake CG: Giant intracranial aneurysms: Experience with surgical treatment in 174 patients. Clin Neurosurg 26: 12–95, 1979PubMedGoogle Scholar
  10. 10.
    Drake CG: The treatment of aneurysms of the posterior circulation. Clin Neurosurg 26: 96–144, 1979PubMedGoogle Scholar
  11. 11.
    Fox JL: Intracranial aneurysms, vol I-III. New York, Berlin, Heidelberg, Tokyo: Springer, 1983, pp 63–117Google Scholar
  12. 12.
    Friedman AH, Drake CG: Subarachnoid hemorrhage from intracranial dissecting aneurysms. J Neurosurg 60: 325–334, 1984PubMedCrossRefGoogle Scholar
  13. 13.
    Gacs G, Vinuela F, Fox AJ, Drake CG: Peripheral aneurysms of the cerebellar arteries. Review of 16 cases. J Neurosurg 58: 63–68, 1983PubMedCrossRefGoogle Scholar
  14. 14.
    Hammon WM, Kempe LG: The posterior fossa approach to aneurysms of the vertebral and basilar arteries. J Neurosurg 37: 339–347, 1972PubMedCrossRefGoogle Scholar
  15. 15.
    Hernesniemi JA, Vapalahti MP, Niskanen M, Kari A: Management outcome in vertebrobasilar artery aneurysms by early surgery. Neurosurgery 31: 857–862, 1992PubMedCrossRefGoogle Scholar
  16. 16.
    Hiscott P, Crockard A: Multiple aneurysms of the distal posterior inferior cerebellar artery. Neurosurgery 10: 101–102, 1982PubMedCrossRefGoogle Scholar
  17. 17.
    Hudgins RJ, Day AL, Quisling RG, Rhoton AL Jr, Sypert GW, Garcia-Bengochea F: Aneurysms of the posterior inferior cerebellar artery. A clinical and anatomical analysis. J Neurosurg 58: 381–387, 1983PubMedCrossRefGoogle Scholar
  18. 18.
    Karasawa J, Kikuchi H, Furuse S, Sakaki T, Yoshida Y: Surgery of vertebral aneurysms at the origin of PICA. No Shinkei Geka 4: 1157–1163, 1976PubMedGoogle Scholar
  19. 19.
    Kempe LG: Aneurysms of the vertebral artery. In: Pia HW, Langmaid C, Zierski J (eds) Cerebral aneurysms. Advances in diagnosis and therapy. Berlin, Heidelberg, New York: Springer, 1979, pp 199–120Google Scholar
  20. 20.
    Krayenbühl HA, Yaprgil MG: The cerebral arteries. In: Cerebral angiography. London: Butterworths, 1968, pp 20–84Google Scholar
  21. 21.
    Meguro K, Rowed DW: Traumatic aneurysm of the posterior inferior cerebellar artery caused by fracture of the clivus. Neurosurgery 16: 666–668, 1985PubMedCrossRefGoogle Scholar
  22. 22.
    Morard M, de Tribolet N: Traumatic aneurysm of the posterior inferior cerebellar artery: case report. Neurosurgery 29: 438–441, 1991PubMedCrossRefGoogle Scholar
  23. 23.
    Nishino A, Sakurai Y, Satoh H, Niizuma H, Kayama T, Ogawa A, Ohtoh T: Aneurysms of the distal posterior inferior cerebellar artery; the report of 10 cases. No Shinkei Geka 19: 925–932, 1991PubMedGoogle Scholar
  24. 24.
    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 16: 829–832, 1985PubMedCrossRefGoogle Scholar
  25. 25.
    Ogura K, Hara M, Kageyama N: Distal aneurysm of the posterior inferior cerebellar artery — report of 3 cases. No Shinkei Geka 13: 211–215, 1985PubMedGoogle Scholar
  26. 26.
    Peerless SJ, Drake CG: Posterior circulation aneurysms. In: Wilkins RH, Rengachary SS (eds) Neurosurgery. New York: McGraw-Hill, 1985, pp 1422–1437Google Scholar
  27. 27.
    Pelz DM, Vinuela F, Fox AJ, Drake CG: Vertebrobasilar occlusion therapy of giant aneurysms. Significance of angiographic morphology of the posterior communicating arteries. J Neurosurg 60: 560–565, 1984PubMedCrossRefGoogle Scholar
  28. 28.
    Pia HW: Classification of vertebro-basilar aneurysms. Acta Neurochir (Wien) 47: 3–30, 1979CrossRefGoogle Scholar
  29. 29.
    Quattrocchi KB, Nielsen SL, Poirier V, Wagner FC Jr: Traumatic aneurysm of the superior cerebellar artery: case report and review of the literature. Neurosurgery 27: 476–479, 1990PubMedCrossRefGoogle Scholar
  30. 30.
    Rhoton AL Jr, Saeki N, Perlmutter D, Zeal A: Micro-surgical anatomy of common aneurysm sites. Clin Neurosurg 26: 248–306, 1979PubMedGoogle Scholar
  31. 31.
    Salcman M, Rigamonti D, Numaguchi Y, Sadato N: Aneurysms of the posterior inferior cerebellar artery-vertebral artery complex: variations on a theme. Neurosurgery 27: 12–21, 1990PubMedCrossRefGoogle Scholar
  32. 32.
    Sasaki O, Ogawa H, Koike T, Koizumi T, Tanaka R: A clinicopathological study of dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 75: 874–882, 1991PubMedCrossRefGoogle Scholar
  33. 33.
    Shintani A, Zervas NT: Consequence of ligation of the vertebral artery. J Neurosurg 36: 447–450, 1972PubMedCrossRefGoogle Scholar
  34. 34.
    Yamada K, Hayakawa T, Ushio Y, Iwata Y, Koshino K, Bitoh S, Takimoto N: Therapeutic occlusion of the vertebral artery for unclippable vertebral aneurysm: relationship between site of occlusion and clinical outcome. Neurosurgery 15: 834–838, 1984PubMedCrossRefGoogle Scholar
  35. 35.
    Yamamoto I, Tsugane R, Ohya M, Sato O, Ogura K, Hara M: Peripheral aneurysms of the posterior inferior cerebellar artery. Neurosurgery 15: 839–845, 1984PubMedCrossRefGoogle Scholar
  36. 36.
    Yamaura A: Diagnosis and treatment of vertebral aneurysms. J Neurosurg 69: 345–349, 1988PubMedCrossRefGoogle Scholar
  37. 37.
    Yaargil MG: Vertebrobasilar aneurysms. In: Micro-neurosurgery in 4 volumes, vol II. Stuttgart, New York: Thieme, 1986, pp 232–295Google Scholar
  38. 38.
    Yasui T, Yagura H, Komiyama M, Fu Y, Nagata Y, Tamura K, Kim A: Therapeutic occlusion of unilateral vertebral artery for unclippable aneurysms; special reference to postoperative brainstem ischemia. No Shinkei Geka 20: 325–32, 1992PubMedGoogle Scholar
  39. 39.
    Yeh HS, Tomsick TA, Tew JM Jr: Intraventricular hemorrhage due to aneurysms of the distal posterior inferior cerebellar artery. Report of three cases. J Neurosurg 62: 772–775, 1985PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag/Wien 1996

Authors and Affiliations

  • Charles G. Drake
    • 1
    • 2
  • Sydney J. Peerless
    • 2
  • Juha A. Hernesniemi
    • 3
  1. 1.Department of SurgeryUniversity of Western Ontario, University HospitalLondonCanada
  2. 2.Division of NeurosurgeryUniversity of Western Ontario, University HospitalLondonCanada
  3. 3.Department of NeurosurgeryUniversity Hospital of KuopioKuopioFinland

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