Anat Cell Biol.  2023 Sep;56(3):394-397. 10.5115/acb.23.036.

An unusual arrangement between the highest denticulate ligament and posterior inferior cerebellar artery

• Patel A
• Baudoin J
• Chaiyamoon A
• Cardona JJ
• Carrera A
• Reina F
• Iwanaga J
• Dumont AS
• Tubbs RS

• KMID: 2546468
• DOI: http://doi.org/10.5115/acb.23.036

Abstract

The posterior inferior cerebellar artery (PICA) is often involved in pathologies of the posterior cranial fossa. Therefore, a good understanding of the vessel’s normal and variant courses is important to the neurosurgeon or neurointerventionalist. During the routine microdissection of the craniocervical junction, an unusual arrangement between the highest denticulate ligament and PICA was observed. On the right side, the PICA was given rise to by the V4 segment of the vertebral artery 9 mm after the artery entered the dura mater of the posterior cranial fossa. The artery made an acute turn around the lateral edge of the highest denticulate ligament to then recur 180 degrees and travel medially toward the brainstem. Invasive procedures that target the PICA should be aware of the variant as described herein.

Keyword

Artery; Posterior cranial fossa; Ligament; Vertebral artery; Aneurysms

Figure

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  Fig. 1 Schematic drawing of the craniocervical junction (posterior view with the posterior elements of the atlas removed) noting the right-sided highest denticulate ligament (*) and its typical relationships with, for example, the vertebral artery (VA), posterior spinal artery and spinal accessory nerve (circle), and C1 spinal nerve. Note the usual course of the posterior inferior cerebellar artery (arrow) medially toward the brainstem (indicated here by the 4th ventricle) and cerebellum (not shown). The hypoglossal nerve rootlets are seen at the yellow arrow.

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  Fig. 2 (A) Right cadaveric findings of the highest denticulate ligament (*) and the variant course of the PICA (arrows). Also note the hypoglossal nerve rootlets (XII) and rootlets of the C1 spinal nerve. (B) Zoomed in view with the PICA retracted laterally with forceps. PICA, posterior inferior cerebellar artery.

Reference

References

1. Polak-Kraśna K, Robak-Nawrocka S, Szotek S, Czyż M, Gheek D, Pezowicz C. 2019; The denticulate ligament - tensile characterisation and finite element micro-scale model of the structure stabilising spinal cord. J Mech Behav Biomed Mater. 91:10–7. DOI: 10.1016/j.jmbbm.2018.11.017. PMID: 30529981.

2. Tubbs RS, Mortazavi MM, Loukas M, Shoja MM, Cohen-Gadol AA. 2011; The intracranial denticulate ligament: anatomical study with neurosurgical significance. J Neurosurg. 114:454–7. DOI: 10.3171/2010.9.JNS10883. PMID: 20932099.

3. Iwanaga J, Singh V, Takeda S, Ogeng'o J, Kim HJ, Moryś J, Ravi KS, Ribatti D, Trainor PA, Sañudo JR, Apaydin N, Sharma A, Smith HF, Walocha JA, Hegazy AMS, Duparc F, Paulsen F, Del Sol M, Adds P, Louryan S, Fazan VPS, Boddeti RK, Tubbs RS. 2022; Standardized statement for the ethical use of human cadaveric tissues in anatomy research papers: recommendations from Anatomical Journal Editors-in-Chief. Clin Anat. 35:526–8. DOI: 10.1002/ca.23849. PMID: 35218594.

4. Lister JR, Rhoton AL Jr, Matsushima T, Peace DA. 1982; Microsurgical anatomy of the posterior inferior cerebellar artery. Neurosurgery. 10:170–99. DOI: 10.1227/00006123-198202000-00004. PMID: 7070615.

5. Miao HL, Zhang DY, Wang T, Jiao XT, Jiao LQ. 2020; Clinical importance of the posterior inferior cerebellar artery: a review of the literature. Int J Med Sci. 17:3005–19. DOI: 10.7150/ijms.49137. PMID: 33173421. PMCID: PMC7646108.

6. Ballesteros-Acuña LE, Estupiñan HY, Gómez-Torres FA. 2022; Morphologic characterisation of the posterior inferior cerebellar artery. A direct anatomic study. Folia Morphol (Warsz). 81:559–66. DOI: 10.5603/FM.a2021.0064. PMID: 34219215.

7. Park JS, Lee TH, Seo EK, Cho YJ. 2008; Aneurysms of distal posterior inferior cerebellar artery. J Korean Neurosurg Soc. 44:205–10. DOI: 10.3340/jkns.2008.44.4.205. PMID: 19096678. PMCID: PMC2588322.

8. Iwanaga J, Singh V, Ohtsuka A, Hwang Y, Kim HJ, Moryś J, Ravi KS, Ribatti D, Trainor PA, Sañudo JR, Apaydin N, Şengül G, Albertine KH, Walocha JA, Loukas M, Duparc F, Paulsen F, Del Sol M, Adds P, Hegazy A, Tubbs RS. 2021; Acknowledging the use of human cadaveric tissues in research papers: recommendations from anatomical journal editors. Clin Anat. 34:2–4. DOI: 10.1002/ca.23671. PMID: 32808702.