![]() ![]() The path for transarterial embolisation or a path through which to monitor theĭegree of dural arteriovenous fistula embolisation. Occurring near the posterior fossa, and the posterior meningeal artery can be The posterior meningeal artery is often involved in dural arteriovenous fistulas Paramedial and medial portions of the dura covering the cerebellar convexity. ![]() The posterior meningeal artery provides the main blood supply to the Posterior meningeal artery to increase our understanding of its role in vascular Study, we used the PubMed database to perform a review of the literature on the Importance of the posterior meningeal artery is currently lacking. Partial MIP images are useful for identifying rare cerebral arterial variation.The posterior meningeal artery, which arises from the vertebral artery, is aĬritical artery in neurological lesions. Correct diagnosis should be made during interpretation of cerebral MR angiograms. 11 These variations were previously confused with fenestrations. In such cases, one of the channels may play an important role in collateral circulation after coil embolization.ĭouble or duplicate origin of the cerebral artery has been reported by MR angiography in the middle cerebral artery 10 and in the posterior communicating artery. This additional sequence, however, may not be acceptable in daily clinical practice.Īlthough the clinical significance of these arterial variations is limited, arterial dissection 7 or aneurysm 4 may be seen at the arterial ring. If the phase-contrast technique is also used, flow direction in the cranial channel might be confirmed. We used the time-of-flight technique for MR angiography. Blood in the cranial channel flows toward the terminal segment of the VA (arrow), because the caudal channel is larger than the PICA. B) PICA arising from the VA fenestration. Possible direction of blood flow in the cranial channel is toward the distal PICA (arrow), because the distal segment is larger than proximal two channels. Schematic illustrations of 2 variations of the arterial ring at the V4 segment of the vertebral artery (VA). In contrast, PICA arising from the VA fenestration has a large caudal channel. In case of PICA of double origin, the distal segment of the PICA is larger than proximal two channels. 4 – 9 Figure 3 is a schematic illustration of these two arterial variations. Several reports describe catheter angiographic findings of PICA of double origin, but no reports mention this important hemodynamics. Thus, blood in the cranial channel must flow toward the distal PICA. The distal segment of the PICA of double origin should be supplied by both caudal and cranial channels as shown in Figures 1B and and2B. 1 If blood in the cranial channel flows toward the basilar artery, the variation should be diagnosed as PICA arising from the fenestrated segment of the VA and not PICA of double origin. Fenestration of the VA at the V4 segment is not so rare, with a reported prevalence of 0.54% and PICA arising from the fenestrated segment in 10 of 18 VA fenestrations (56%). The PICA usually arises from the V4 segment of the VA and supplies the postero-inferior part of the ipsilateral cerebellum. We treated the patient’s aneurysm using Guglielmi detachable coils (GDCs) without complications. These images clearly demonstrated the double origin of the right PICA ( Figure 1B). To confirm the anomalous right PICA, we created partial MIP MR angiographic images of the vertebrobasilar system using the SYNAPSE® VINCENT (Fujifilm Medical Company, Tokyo, Japan) picture archiving and communication system (PACS). We also found an anomalously originating right PICA, but superimposition of several arterial branches prevented observation of the variation. The maximum-intensity-projection (MIP) MR angiographic images showed an unruptured aneurysm at the junction between the right internal carotid artery (ICA) and the posterior communicating artery, the so-called IC-PC junction ( Figure 1A). The patient was examined preoperatively by MR angiography using a 3-Tesla system and standard time-of-flight technique without contrast media. A 61-year-old woman with an unruptured aneurysm was transferred to our institution for treatment. ![]()
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