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By Albert L. Rhoton

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Additional resources for The posterior cranial fossa: microsurgical anatomy & surgical approaches

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Nerve-related branches The nerve-related branches are those that course in or near the porus of the meatus and by the facial and vestibulocochlear nerves (Figs. 14) (34). Each nerve-related segment is composed of one or two arterial trunks. One was most common. The single nerve-related segments were formed from either the main or a rostral trunk, which arise, in decreasing order of frequency, from a solitary AICA, a rostral duplicate AICA, or a caudal duplicate AICA. The double segments result from the presence of one of two anatomic configurations: a) both the rostral and caudal trunks of a solitary AICA or of one duplicate AICA are nerve-related, or b) one trunk from each of duplicate AICAs or one trunk from two of three triplicate AICAs is nerve related.

Often a few fascicles of the nerve are indented or distorted by the vessel 3 to 4 mm, but as much as 12 mm peripheral to the point of entry into the pons. In 6 of the 50 specimens we examined, the contact was located at the pontine root entry zone, usually by a loop tucked into the axilla formed between the brainstem and the medial side of the trigeminal nerve. There is no correlation between the configuration of the SCA at its origin and the presence or absence of loops impinging upon the trigeminal nerve; however, the point of bifurcation of the SCA did affect the caliber of the vessel that made contact with the nerve.

Both AICAs pass below the abducens nerves and loop laterally toward the internal acoustic meatus. The left PICA loops upward in front of the pons between the facial and vestibulocochlear nerves and the AICA before turning downward to encircle the medulla. D, enlarged view. The right AICA loops laterally into the porus of the internal acoustic meatus, as occurs in approximately half of cases. The AICA has a premeatal segment that passes toward the meatus, a meatal segment that loops into the porus in about half of cerebellopontine angles, and a postmeatal segment that loops back to the brainstem.

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