小脑后下动脉（PICA）：解剖与临床分析。
The Posterior Inferior Cerebellar Artery (PICA): An Anatomical and Clinical Analysis.
机构信息
Albert Einstein Israeli Faculty of Health Sciences, Department of Medicine, São Paulo, Brazil.
出版信息
Turk Neurosurg. 2022;32(2):244-250. doi: 10.5137/1019-5149.JTN.33441-20.3.
AIM
To study the operative approaches for posterior inferior cerebellar artery (PICA) aneurysms or understanding the different pathologies that can affect this artery, and to present detailed knowledge of this artery?s anatomy.
MATERIAL AND METHODS
The present study analyzed the different variations of the PICA?s first two segments, the anterior medullary and lateral medullary segments, regarding the number of trunks, their emergency site, and the presence or absence of hypoplasia of this artery, through microsurgical dissection of 23 fresh cadaver brains.
RESULTS
Some striking variations were found, such as the absence of the left vertebral artery in one of the brains and the emergence of any PICA in another two brains studied. Moreover, variations such as hypoplastic arteries, missing trunks on one side and double or triple trunks, different emergence sites, significant PICA emergence from the superior part of the vertebral artery (59% of the trunks), and asymmetries between the right and left sides were recorded. The double origins of non-hypoplastic PICAs were found in 17% (n = 4) of patients.
CONCLUSION
The results obtained in the present study indicated the great importance of the studies and reviews on the different topographies of PICA; these studies and reviews expand the knowledge and consensus on the characteristics and implications of PICA?s variations. The clinical implication of this knowledge and consensus is obtaining the best surgical strategies for clipping aneurysms and, in addition, the best choices for occlusion of the vessel affected if the territory of the main vessel has an adequate collateral circulation. From the results of the present study, it is evident that there was a significant PICA emergence from the superior part of the vertebral artery and that the double origin of non-hypoplastic trunks was also found in some patients; the latter is associated with a greater chance of aneurysms and other additional complications.
目的
研究小脑后下动脉（PICA）动脉瘤的手术入路，或了解可能影响该动脉的不同病变，并详细了解该动脉的解剖结构。
材料和方法
本研究通过对 23 个新鲜尸体头颅进行显微解剖，分析了 PICA 的前两个节段（前髓质段和外侧髓质段）的前两个节段的不同变异，包括干数、紧急部位以及该动脉是否存在发育不良。
结果
发现了一些明显的变异，例如其中一个大脑中没有左侧椎动脉，另外两个大脑中出现了任何 PICA。此外，还发现了一些变异，如动脉发育不良、一侧缺干、双干或三干、不同的出现部位、椎动脉上部（59%的干）明显出现 PICA 以及右侧和左侧之间的不对称性。非发育不良的 PICA 双起源在 17%（n=4）的患者中发现。
结论
本研究的结果表明，对 PICA 不同拓扑结构的研究和综述非常重要；这些研究和综述扩展了对 PICA 变异的特征和意义的认识和共识。这方面知识和共识的临床意义是为夹闭动脉瘤获得最佳手术策略，并在主要血管的供血区有足够的侧支循环的情况下，为闭塞病变血管做出最佳选择。从本研究的结果可以明显看出，椎动脉上部有明显的 PICA 出现，非发育不良的非双干也在一些患者中发现；后者与动脉瘤和其他附加并发症的更大机会相关。
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