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By Albert L. Rhoton

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Perforating branches arise from the great majority of main, rostral, and caudal trunks. Most trunks give rise to two to five perforating branches, although some may give rise to no perforators and others to as many as 10. The most common type of perforating artery arising from the main trunk is the long circumflex type, but it also gives rise to direct and short circumflex branches. In descending order, the main trunk branches terminate in the tegmentum in the region of the junction between the superior and middle cerebellar pe- Neurosurgery, Vol.

It or its branches may be exposed in surgical approaches to cerebellopontine angle, basilar or vertebral arteries, clivus, the fourth ventricle and cerebellum, and during approaches directed through the temporal and occipital bones. The AICA is intimately related to the pons, lateral recess, foramen of Luschka, cerebellopontine fissure, middle cerebellar peduncle, and petrosal cerebellar surface (Figs. 11). The AICA originates from the basilar artery, usually as a single trunk, and encircles the pons near the abducent, facial, and vestibulocochlear nerves.

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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