INFERIOR

CEREBELLAR ARTERY

DR Eslam MoHMAD Abd EL-Ghaffar

Ahmed Maher Teaching Hospital

ANTEROINFERIOR CEREBELLAR
ARTERY
Overview
The AICA courses through the central part of the cerebellopontine
angle near the facial and vestibulocochlear nerve
The AICA usually originates from the basilar artery as a
single vessel, but may also arise as two (duplicate) or three
(triplicate) arteries, and encircles the pons near the abducent,
facial, and vestibulocochlear nerves. After coursing near and
sending branches to the nerves entering the acoustic meatus
and to the choroid plexus protruding from the foramen of
Luschka, it passes around the flocculus on the middle cerebellar
peduncle to supply the lips of the cerebellopontine
fissure and the petrosal surface. It commonly bifurcates near
the facial-vestibulocochlear nerve complex to form a rostral
and a caudal trunk.

The rostral trunk sends its branches laterally along

the middle cerebellar peduncle to the superior lip of
the cerebellopontine fissure and the adjoining part
of the petrosal surface
the caudal trunk supplies the inferior part of the
petrosal surface, including a part of the flocculus
and the choroid plexus. The AICA gives rise to
perforating arteries to the brainstem, choroidal
branches to the tela and choroid plexus,

SEGEMENTS
Segments

The AICA is divided into four segments:

anterior pontine,lateral pontine, flocculonodular, and cortical.

Anterior pontine segment

This segment, located between the clivus and the belly of

the pons, begins at the origin and ends at the level of a line
drawn through the long axis of the inferior olive and extending
upward on the pons. This segment usually lies in contact
with the rootlets of the abducent nerve.
Lateral pontine segment

This segment begins at the anterolateral margin of the pons

and passes through the cerebellopontine angle above, below,
or between the facial and vestibulocochlear nerves

related to the internal auditory meatus, the lateral

recess, and the choroid plexus protruding from the
foramen of
Luschka. This segment is divided into premeatal,
meatal, and postmeatal parts, depending on their
relationship
to the porus of the internal acoustic meatus These
nerve-related branches are the labyrinth artery, which
supplies
the facial and vestibulocochlear nerves and
vestibulocochlear
labyrinth; the recurrent perforating arteries, which pass
toward the meatus, but turn medially to supply the
brainstem;
and the subarcuate artery, which enters the subarcuate
fossa.

Flocculopeduncular segment
This segment begins where the artery passes rostral
or
caudal to the flocculus to reach the middle cerebellar
peduncle and the cerebellopontine fissure
Cortical segment
This segment supplies predominantly the petrosal
surface.

Labyrinthine (internal auditory) arteries

These arteries are the one or more branches of the AICA that
enter the internal auditory canal and send branches to the
bone and dura lining the internal auditory canal, to the
nerves within the canal, and terminate by giving rise to the
vestibular,
cochlear, and vestibulocochlear arteries that supply theorgans
of the inner ear
Recurrent perforating arteries
These perforating arteries arise from the nerve-related
vessels send branches to these
nerves and to the brainstem surrounding the entry zone of
those nerves. They also send branches, in decreasing order of
frequency, to the middle cerebellar peduncle and the adjacent
part of the pons

Occlusion of the AICA results in syndromes related

predominantly to softening of the lateral portions
of the brainstem and cerebellar peduncles, rather
than to involvement of the cerebellar hemisphere,
including palsies of the facial andvestibulocochlear
nerves caused by involvement of the nerves
and their nuclei; vertigo, nausea, vomiting, and
nystagmus caused by lesions of the vestibular
nuclei and their connections with the nuclei of the
vagus nerves; ipsilateral loss of pain and
temperature sensation on the face

POSTEROINFERIOR CEREBELLAR
ARTERY
The PICA has the most complex, tortuous, and variable
course and area of supply of the cerebellar arteries
The PICA, by definition, arises from the vertebral artery
near the inferior olive and passes posteriorly around the
medulla
Most PICAs bifurcate into a medial and a lateral trunk.
The medial trunk supplies the vermis and adjacent part
of the hemisphere,
the lateral trunk supplies the cortical surface of the
tonsil and the hemisphere.
The PICA gives off perforating, choroidal,and cortical
arteries. The cortical arteries are divided into vermian,
tonsillar, and hemispheric groups.

Segments
The PICA is divided into five segments
1) anterior medullary 2) lateral medullary
3) tonsillomedullary 4) telovelotonsillar 5) cortical
Anterior medullary segment
This segment lies anterior to the medulla. It begins at
the origin of the PICA anterior to the medulla and
extends backward past the hypoglossal rootlets

Lateral medullary segment

This segment begins where the artery passes the most
prominent point of the olive and ends at the level of the
origin of the glossopharyngeal, vagus, and accessory
rootlets. This segment is present in most PICAs

Tonsillomedullary segment
This segment begins where the PICA passes posterior to
the glossopharyngeal, vagus, and accessory nerves and
extends medially across the posterior aspect of the medulla
near thecaudal half of the tonsil
Telovelotonsillar segment
This is the most complex of the segments. It begins at the
midportion of the PICAs ascent along the medial surface
ofthe tonsil toward the roof of the fourth ventricle and
ends
where it exits the fissures between the vermis, tonsil, and
hemisphere to reach the suboccipital surface In most this
segment often forms a loop with a convex rostral curve,
called the cranial loop
Cortical segment
This segment begins where the trunks and branches leave
the groove between the vermis medially and the tonsil and
the hemisphere laterally