- Department of Surgery, Division of Neurosurgery, Notre Dame Hospital, University of Montreal Hospital Centre, 1560 rue Sherbrooke Est, Montreal, Quebec, Canada
Michel W. Bojanowski
Department of Surgery, Division of Neurosurgery, Notre Dame Hospital, University of Montreal Hospital Centre, 1560 rue Sherbrooke Est, Montreal, Quebec, Canada
DOI:10.4103/2152-7806.81733Copyright: © 2011 Weil AG. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Weil AG, McLaughlin N, Denis D, Bojanowski MW. Tentorial branch of the superior cerebellar artery. Surg Neurol Int 28-May-2011;2:71
How to cite this URL: Weil AG, McLaughlin N, Denis D, Bojanowski MW. Tentorial branch of the superior cerebellar artery. Surg Neurol Int 28-May-2011;2:71. Available from: http://sni.wpengine.com/surgicalint_articles/tentorial-branch-of-the-superior-cerebellar-artery/
Background:The tentorial branch of the superior cerebellar artery (SCA) is not well known and is underreported in the literature. In the present study, the authors report and describe a dural branch arising from the SCA that was encountered during the surgical treatment of a tentorial dural arteriovenous fistula (DAVF). The clinical relevance of this branch is discussed.
Case Description:A 53-year-old patient suffered a third recurrent right thalamic hemorrhage within 2 weeks rendering him comatose. Computed tomography scan revealed a right thalamic hematoma extending into the ventricles, producing acute hydrocephalus and midline shift. Cerebral angiography revealed a right-sided tentorial Borden type III DAVF fed primarily by the tentorial artery of Bernasconi and Cassinari and, to a lesser extent, the petrous branch of the middle meningeal artery. A small dural feeder originating from the SCA was suspected. Venous drainage was via the lateral mesencephalic vein, through an aneurysmal dilated basal vein of Rosenthal, to the straight sinus. The DAVF was approached surgically via a right subtemporal approach. Intraoperatively, after division of the tentorium, a tentorial branch originating from the SCA was identified. This artery was sectioned while preserving the SCA. The draining vein was ligated adjacent to the sinus. Postoperatively, the patient's neurological status improved and postoperative angiography demonstrated complete obliteration of the tentorial DAVF.
Conclusion:Knowledge of the tentorial branch of the SCA is important as it may potentially be sectioned during division of the tentorium or avulsed from its origin in the SCA during surgical manipulation in the ambient cistern.
Keywords: Dural arteriovenous fistula, dural artery, intracranial hemorrhage, malformation, superior cerebellar artery, tentorial artery
A thorough understanding of the arterial supply to the tentorium is essential for safe and effective endovascular or microsurgical treatment of lesions involving this area. Although a tentorial branch of the superior cerebellar artery (SCA) has been described in a cadaveric study,[
A 53-year-old previously healthy male patient was referred to our service after suffering a third recurrent right thalamic hemorrhage within 2 weeks, during which time he was treated for a presumed hypertensive thalamic hemorrhage. Following this third hemorrhage the patient became comatose. Computed tomography scan of the head revealed a hematoma in the right lateral thalamus, extending into the lateral ventricles, producing acute hydrocephalus and a midline shift toward the left [
Selective angiogram of the right internal carotid artery (a and b) revealing an arteriovenous fistula, Borden type III, involving the right tentorial leaf fed by the meningohypophyseal trunk. Venous drainage proceeds through the lateral mesencephalic vein to the basal vein of Rosenthal and the straight sinus. The basal vein of Rosenthal has a saccular dilatation of 2 cm on its superior surface representing a false aneurysm most probably responsible for the repetitive hemorrhages. Selective angiogram of the right external carotid artery (c) demonstrating minimal contribution by the petrous branch of the middle meningeal artery
Endovascular treatment was unsuccessful because of the inability to attain a secure site for embolization. The DAVF was approached surgically via a right subtemporal approach. Intraoperatively, after division of the tentorium, a tentorial branch originating from the SCA was identified [
Recent advances in endovascular and microsurgical techniques have warranted a thorough understanding of the vascular supply to the tentorium in order to safely treat lesions in this region. It is well recognized that the tentorium receives its arterial supply from the cavernous segment of the internal carotid artery (ICA) and the artery of Davidoff and Schecter (ADS), a meningeal branch of the posterior cerebral artery (PCA).[
The meningeal contribution of the SCA was first described in 1965 by Wollschlaeger and Wollschlaeger in their study of 10 barium-injected brain cadavers dissected with dural preservation. However, the SCA tentorial branch in question was only found in 1 cadaver and was in fact described as a small arterial anastomosis from the SCA to the ADS.[
In a microsurgical study of the tentorial area by Ono et al., a tentorial branch arising from the SCA in 28% of the 25 dissected cadaveric adult heads was described. This tentorial branch originates from the rostral trunk of the SCA as it crosses the middle incisural space under the free edge of the tentorium.[
Meningeal branches arising from cerebral arteries are known to be recruited feeders for DAVFs.[
In the present study, we report and describe a dural branch of the SCA, which was found during the surgical treatment of a tentorial DAVF. This branch originates near the free edge of the tentorium and courses rostrally to end in the inferior surface of the tentorium. In our case there was no anastomosis to the dural branch of the PCA. Knowledge of this branch's existence is important as it may potentially be sectioned during division of the tentorium or avulsed from its origin in the SCA during surgical manipulation in the ambient cistern. Before incising the tentorium, one must gently retract the free edge of the tentorium in order to identify and follow the SCA as it courses through the ambient cistern. This allows identification of the tentorial branch under the free edge of the tentorium. After visualizing the branch, it can be safely occluded before incising the tentorium.
This is a report of an SCA branch in a tentorial DAVF. This branch must be distinguished from the tentorial branch arising from the PCA, which is the ADS. Recognition of the SCA tentorial branch is relevant for angiographic diagnosis and endovascular management of tentorial DAVFs. Surgically, it is important to be aware of its possible existence in order to prevent damage to the SCA or profuse bleeding resulting from tearing of the branch itself.
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