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THE ANTERIOR INFERIOR CEREBELLAR ARTERY ITS VARIATIONS, PONTINE DISTRIBUTION, and SIGNIFICANCE in the SURGERY of CEREBELLO-Pontline ANGLE TUMOURS* by W

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THE ANTERIOR INFERIOR CEREBELLAR ARTERY ITS VARIATIONS, PONTINE DISTRIBUTION, and SIGNIFICANCE in the SURGERY of CEREBELLO-Pontline ANGLE TUMOURS* by W J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.12.2.137 on 1 May 1949. Downloaded from J. Neurol. Neurosurg. Psychiat., 1949, 12, 137. THE ANTERIOR INFERIOR CEREBELLAR ARTERY ITS VARIATIONS, PONTINE DISTRIBUTION, AND SIGNIFICANCE IN THE SURGERY OF CEREBELLO-PONTlINE ANGLE TUMOURS* BY W. J. ATKINSON From the Department of Pathology, National Hospital. Queen Square, London The anterior inferior cerebellar artery arises immediately anterior to the eighth nerve and in constantly from the basilar artery on each side at this portion does not give off any branches. There the junction of its lowest and middle thirds and are therefore two parts of the artery which are passes laterally and downwards to cross the cere- responsible for pontine blood supply-the- main' bello-pontine angle and the eighth cranial nerve. part of the vessel proximally and the lateral branch At this point the internal auditory artery is usually which winds round the flocculus distally. In the given off, passing almost immediately into the past few years, Dr. J. G. Greenfield has pointed out internal auditory meatus. Either immediately be- that those cases of acoustic neurofibromata which fore or iimediately after crossing the eighth nerve, come to necropsy after operation frequently have the main artery divides into two. (1) One branch had occlusion of the anterior inferior cerebellar passes laterally and downwards on the medial and artery on the tumour side by a clip or a thrombus. Protected by copyright. anterior border of the cerebellar hemisphere. After He also noted that this was associated with infarction about a centimetre or so of tortuous course it sends of the pons on that side. In the past it has been a constant branch of very variable siize posteriorly thought that such a lesion was the result oflaceration along the medial surface of the hemisphere to of the pons by the surgeon-in spite of his usual anastomose with a cerebellar branch of the posterior denial; or it has been called malaciapontis. inferior cerebellar artery. Reference will be made It was therefore with this problem in mind that to this anastomosis later. (2) The other branch of a series of normal hind-brains was injected with the anterior inferior cerebellar artery passes directly dyed gelatin solutions in various ways designed to laterally and curls round the upper edge of the illustrate (1) exactly which area was supplied by the flocculus, where it lies on the surface of the middle anterior vessel in the pons: (2) which areas could cerebellar peduncle, and it then passes on to the be apportioned to the proximal and distal parts of cerebellar hemisphere proper and anastomoses with that vessel as far as the pons itself was concerned, all three main cerebellar arteries. This latter and (3) which anastomoses from the superior and branch of the main artery which passes immediately the posterior inferior cerebellar arteries could take laterally gives off small arteries which' supply the over the anterior inferior cerebellar arterial supply. middle cerebellar peduncle and adjoining part of The second question was considered the most http://jnnp.bmj.com/ the pons. The main artery itself also sends small important, because only by answering it would it vessels into the pons, supplying chiefly its lateral be possible to ascertain the effect on life of placing part as far superiorly as the junction of the upper a clip on the artery as it crossed the eighth nerve, and middle thirds and extending down to supply that is, at the point where in effect the acoustic the lateral third of the upper part of the medulla nerve tumour would tend to displace the vessel oblongata. most away from the angle. Plate Ha is taken from a specimen of the basilar arterial system which has been injected post-mortem Variations in the Anterior Inferior Cerebellar Artery on October 1, 2021 by guest. with red latex. The anterior inferior cerebellar It has repeatedly been observed that there is a artery on each side will be seen as described,'and considerable variation in the size and therefore in most significant is that part of the artery which the importance of the anterior inferior cerebellar crosses the cerebello-pontine angle, for here it lies artery. Fig. 1 shows the variations and findings *Read to the British Society of Neurological Surgeons in Dublin in in a series of consecutive necropsies, and it will July, 1948. be seen that not only may each case be different This work was carried out with the aid of a grant the National Hospital, Queen Square. froln but there is usually a difference between either 137 Pc. J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.12.2.137 on 1 May 1949. Downloaded from Protected by copyright. http://jnnp.bmj.com/ FIG. 1.-Variations of the branches of the basilar artery. on October 1, 2021 by guest. (1) The "classical" and a fairly common arrange- (2) The anterior varying inversely with the posterior ment. inferior artery (common). (3) Both posterior vessels small, their areas of supply (4) Both anterior vessels small, their areas of supply being chiefly fed by the anterior vessels (un- being chiefly from the posterior vessels (un- common). common). (5) Anomalous importance ofvessel from the junction (6) Rare-posterior vessel being continuation of of vertebral arteries. vertebral artery. (7) Pathological-long-standing thrombosis of lower third of basilar, vertebral, and posterior arteries. Both area of supply of posterior vessels supplied by right anterior inferior artery. (Patient died from other causes.) Pc.-posterior cerebral artery; Sc.-superior cerebellar artery A. I.C.-anterior inferior cerebellar artery; P.I.C.-posterior inferior cerebellar artery; B.-basilar artery; V.-vertebral artery; Sp.-spinal artery; A.-internal auditory artery; VIII.-acoustic nerve; An.-anastomotic vessel; Anom.-anomalous vessel. ANTERIOR INFERIOR CEREBELLAR ARTERY J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.12.2.137 on 1 May 1949. Downloaded from Protected by copyright. --swFSli rw il 4 9 __ ___ __ http://jnnp.bmj.com/ on October 1, 2021 by guest. [Facinig page 138 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.12.2.137 on 1 May 1949. Downloaded from .4NTERIOR INFERIOR CEREBELLAR ARTERY 139 SUPERIOR, _FEtRELl.AR k~~~~~~~:,F.~~~~1x i~~~~ ATIERtATRAIO0R 3RANCWNFERI3P t5,.~~:: ~ ~ ~~~~~ZARXANCT 3.A H-C ..e.X~... ~ ~ CREELA AR F.RY Protected by copyright. .- ,ml .. .. :.. I V E_ R wL CEREBELRRTERLA http://jnnp.bmj.com/ PLATE 1I a.-The basilar arterial system. I on October 1, 2021 by guest. PLATE 11 b.-Case 1. Infarction of pons. Section through lower third of pons. F J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.12.2.137 on 1 May 1949. Downloaded from 14() W. J. A TKINSON ::1 .4 ''p~~*-.. a' i- * 4 ; X S .4e itq*. I-~~~- Se :. :... sse eiw '. S: .::.^.: :: Itx* Protected by copyright. < .. http://jnnp.bmj.com/ ; t&)f+ . k: t A on October 1, 2021 by guest. III \11 III scct on ,, ot lllltt-lll.''Iil POIIS- ".111d llledllll.t ('1ilinctl 1,% ", .::, III .2 I II od J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.12.2.137 on 1 May 1949. Downloaded from ANTERIOR INFERIOR CEREBELLAR ARTERY 14.l 10 Of , ..,- .O > jf.R :! iP ;: j:8, > Protected by copyright. t..'''/tag¢,N,.is .,;........,.n £.r .a. ;I ;z 4e http://jnnp.bmj.com/ :,' .. k i.P'.. 4t , r: 0 4 11 11 on October 1, 2021 by guest. PLATE IV.-Case 3. Sections of mid-brain, pons, and medulla (stained by Loyez method). J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.12.2.137 on 1 May 1949. Downloaded from -4 Protected by copyright. http://jnnp.bmj.com/ ( ..: ii l.i 11 II I. on October 1, 2021 by guest. AILI<EIOIR IN l<lROR CEIREBLLLAIR lAli'LRY 143 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.12.2.137 on 1 May 1949. Downloaded from U1tRiIk 1) 10 1 Jj 111z 1!j E111'i 1''\ *wlJ1\I I,., O1 e8 F.' 1i, 1 5' Protected by copyright. http://jnnp.bmj.com/ t.I tic on October 1, 2021 by guest. G J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.12.2.137 on 1 May 1949. Downloaded from 144 II " T I [A IN, -. 0 Al .1:.i t ': I , - ) ,( " III xII \ ,I , I., . t--, 1. k-,.1 u ik Protected by copyright. http://jnnp.bmj.com/ on October 1, 2021 by guest. PLA IL \ 11(1 cC, t1.iSetI1 l hlI'(II)-.SlCIII 01 SitIIcJC cac (ScU 'lat.e Ji) SI (n%U1g disllibUtio II o i't'lIt1 incfrior eci-ebellar iarter\ atter- ilitc latter's injeetiol witlit blue dyc. J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.12.2.137 on 1 May 1949. Downloaded from ANTERIOR INFERIOR CtREBELLAR ARTERY 145 1- side in the individual case. It was also found bellar arteries over the cerebellar cortex, injection that usually this variation in size was in inverse of the anterior inferior cerebellar artery from the proportion to the size of the posterior inferior basilar artery always stains the artery's distribution artery and sometimes to that of the vertebral selectively. This is comparable with Bolton's (1939) artery. An anastomotic vessel between the anterior work on the anterior spinal artery. She found that inferior and the posterior inferior vessels was found dye injected into a segmental spinal artery passed constantly on the medial aspect of the cerebellum chiefly in a caudal direction along the anterior and was large where there was any marked degree spinal artery, and, although a little passed rostrally of difference between these arteries on each side; by anastomosis, it did not penetrate into the its possible importance in surgery will be mentioned capillary distribution of arteries entering at a more later.
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