Affiliation:
1. Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
2. Neurosurgeons of Cape Cod, and Cape Cod Hospital, Hyannis, Massachusetts
Abstract
ABSTRACT
OBJECTIVE
The posterior meningeal artery (PMA) normally arises from the vertebral artery; however, its origin varies considerably as the result of its embryological development. This gains clinical significance when associated with vascular pathology.
CLINICAL PRESENTATION
A 65-year-old man presented to his local hospital with a sudden-onset, severe headache. Computed tomography of the head revealed diffuse subarachnoid hemorrhage, mostly in the left posterior fossa. A computed tomographic angiogram demonstrated an anomalous origin of the PMA from the posteroinferior cerebellar artery (PICA). Cerebral angiography showed the PICA to be enlarged, with a reduced caliber at the takeoff of the PMA, which is consistent with possible dissection.
INTERVENTION
The patient was taken to the operating room for trapping of the dissecting segment of the PMA. A clip was placed across the PMA at its origin from the PICA, and the vessel was coagulated and transected. The PICA was wrapped in muslin gauze.
CONCLUSION
The variable origin of the PMA and PICA may be the result of the persistence of embryological anastomoses between the arteries, with regression of the normal channel. Physical stress at the junction of the anomalous PMA and the PICA may have contributed to the abnormality of the PMA, consistent with possible dissection. Because the PMA has multiple anastomoses with the arteries of the falx cerebri, the proximal PMA may be occluded with no compromise to its vascular territory.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Neurology (clinical),Surgery
Reference9 articles.
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2. Anomalous origin of the posterior inferior cerebellar artery from the posterior meningeal artery;Ogawa;AJNR Am J Neuroradiol,1991
3. Ruptured aneurysm at the bifurcation of the posterior meningeal artery from the proximal posterior inferior cerebellar artery;Okuno;Acta Neurochir (Wien),1998
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