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Anatomical triangles defining surgical routes to posterior inferior cerebellar artery aneurysms.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Rodríguez-Hernández, Ana Lawton, Michael T.
Description	Country affiliation: United States Author Affiliation: Rodríguez-Hernández A ( Department of Neurological Surgery, University of California, San Francisco, California 94143-0112, USA.)
Abstract	OBJECT: Surgical routes to posterior inferior cerebellar artery (PICA) aneurysms are opened between the vagus (cranial nerve [CN] X), accessory (CN XI), and hypoglossal (CN XII) nerves for safe clipping, but these routes have not been systematically defined. The authors describe 3 anatomical triangles and their relationships with PICA aneurysms, routes for surgical clipping, outcomes, and angiographically demonstrated anatomy. METHODS: The vagoaccesory triangle is defined by CN X superiorly, CN XI laterally, and the medulla medially. It is divided by CN XII into the suprahypoglossal triangle (above CN XII) and the infrahypoglossal triangle (below CN XII). From a consecutive surgical series of 71 PICA aneurysms in 70 patients, 51 aneurysms were analyzed using intraoperative photographs. RESULTS: Forty-three PICA aneurysms were located inside the vagoaccessory triangle and 8 were outside. Of the aneurysms inside the vagoaccessory triangle, 22 (51%) were exposed through the suprahypoglossal triangle and 19 (44%) through the infrahypoglossal triangle; 2 were between triangles. The lesions were evenly distributed between the anterior medullary (16 aneurysms), lateral medullary (19 aneurysms), and tonsillomedullary zones (16 aneurysms). Neurological and CN morbidity linked to aneurysms in the suprahypoglossal triangle was similar to that associated with aneurysms in the infrahypoglossal triangle, but no morbidity was associated with PICA aneurysms outside the vagoaccessory triangle. A distal PICA origin on angiography localized the aneurysm to the suprahypoglossal triangle in 71% of patients, and distal PICA aneurysms were localized to the infrahypoglossal triangle or outside the vagoaccessory triangle in 78% of patients. CONCLUSIONS: The anatomical triangles and zones clarify the borders of operative corridors to PICA aneurysms and define the depth of dissection through the CNs. Deep dissection to aneurysms in the anterior medullary zone traverses CNs X, XI, and XII, whereas shallow dissection to aneurysms in the lateral medullary zone traverses CNs X and XI. Posterior inferior cerebellar artery aneurysms outside the vagoaccessory triangle are frequently distal and superficial to the lower CNs, and associated surgical morbidity is minimal. Angiography may preoperatively localize a PICA aneurysm's triangular anatomy based on the distal PICA origin or distal aneurysm location.
File Format	HTM / HTML
ISSN	00223085
e-ISSN	19330693
Journal	Journal of Neurosurgery
Issue Number	4
Volume Number	114
Language	English
Publisher	American Association of Neurological Surgeons
Publisher Date	2011-04-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Neurosurgery Cerebellum Surgery Cerebral Arteries Pathology Intracranial Aneurysm Neurosurgical Procedures Blood Supply Cerebral Angiography Cerebrovascular Circulation Cranial Nerves Glasgow Outcome Scale Medulla Oblongata Microsurgery
Content Type	Text
Resource Type	Article
Subject	Neurology (clinical) Surgery

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