It is the fourth segment of VA that gives off the PICA, which is the largest branch of VA 3 - 5. The first three segments were extracranial and the fourth segment is entirely intracranial and terminates with forming the basilar artery (BA). The VA, arising from the subclavian artery, is classically divided into 4 segments. The posterior inferior cerebellar artery (PICA) usually originates from the vertebral artery (VA) at an average distance of approximately 16 or 17 mm below the vertebrobasilar junction 1, 2. In conclusion, PICA is very important in clinical practice. The PICA can be exposed and injured during surgeries especially in telovelar approach, and it also plays an important role in bypass surgeries, hinting the surgical importance of PICA. The PICA supplies many brain tumors and can be used in intracerebellar chemotherapy. VA terminating in PICA probably cause Bow hunter's syndrome (BHS). PICA injured by head trauma can cause fatal SAH. Arteriovenous malformation (AVM) fed by PICA are associated with aneurysm and dissection which have high risk of rupture and worse outcome. The PICA frequently compresses the medulla and the cranial nerves resulting in various neurovascular compression syndromes (NVCS). The PICA infarct typically manifests lateral medullary syndrome (LMS) and is more likely to cause mass effects. Various aneurysms involving PICA were not uncommon, of which the treatment is challenging. The PICA has tortuous and variable course and territory, divided into 5 segments. In this study, we perform a literature review of PICA by searching all the associated papers in the PUBMED database hoping to provide a better understanding of the artery. However, a comprehensive systematic review of the importance of the PICA is currently lacking. The posterior inferior cerebellar artery (PICA), with its unique anatomical complexity, is of great clinical importance and involved in many diseases including aneurysm, ischemic stroke, neurovascular compression syndrome (NVCS), arteriovenous malformation (AVM), and brain tumor.
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