PMC4322380_01
Time-of-flight (TOF-3D) magnetic resonance angiography processed by maximum intensity projection (MIP) on sagittal (a) and oblique (b) reconstruction. Left postero-inferior cerebellar artery (PICA) from its origin moves cranially describing a long intracisternal route (red arrows)
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F1
The vessel from its origin moved cranially [Figure 1] describing a long intracisternal route.
Axial constructive interference in steady-state (CISS-3D) image (a, b). Axial TOF-3D source image (c, d). (a, b) Left PICA (red arrows) impacts IX, X, and XI cranial nerves at root entry or exit zone (REZ) and along the nerves intracisternal tract (black arrows). Vascular and nervous structures are all hypointense. (c, d) Only the tortuous left postero-inferior cerebellar artery (PICA) is visible (red arrows)
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F2
A double anomalous contact between PICA and IX, X, and XI nerves was present: At root entry or exit zone (REZ) and along the intracisternal tract of the nerve itself [Figure 2].
Axial CISS-3D/TOF-3D bidimensional image fusion. Simultaneous display of the offending vessel (red color) and nerves (blue color)
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F3
This complex neurovascular assessment was well depicted on fusion images [Figure 3].
Intraoperative view: (a) Left PICA offending IX, X, and XI nerves in the intracisternal tract (b, c) The PICA and its loop impacting the IX nerve (d) Insertion of autologous muscle
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F4
The intraoperative findings showed a loop of the PICA compressing the inferior surface of the IX c.n. and the superior surface of the X and XI c.n. [Figure 4].