title: Anatomical study on the "perforator-free zone": reconsidering the proximal superior cerebellar artery and basilar artery perforators.
abstract: BACKGROUND
  The proximal superior cerebellar artery (pSCA) is often considered a perforator-free area. Precise anatomical knowledge of this region clarifies the pathophysiology underlying posterior fossa ischemic syndromes and helps avoid treatment-related complications.
  
  
  OBJECTIVE
  To anatomically evaluate perforating branches arising from the pSCA and the upper basilar artery (BA).
  
  
  METHODS
  Forty-four SCAs from 20 cadaveric heads were examined to determine patterns of the pSCA; its morphometry for medial and lateral branches; and frequency, number, diameter, distribution, and vascular territory of perforators arising from the pSCA and rostral BA.
  
  
  RESULTS
  SCA arose as a single trunk in 36 sides (90%): mean diameter at origin was 1.38 mm; mean length was 14.4 ± 7.9 mm. Ninety-nine pSCA perforator branches were present in 82% of specimens (mean, 2.3 ± 1.6; range, 0-7 perforators/side). Of these, 59% were direct, belonging to the interpeduncular group in 85% of cases; 28% were short circumflex, belonging to lateral and medial pontine group; and 13% were long circumflex, reaching the medullary perforation zone (basal cerebellar group). Median distance to the first perforator was 2.0 mm (range, 0.1-15 mm). There were 132 perforator branches in the last centimeter of the BA.
  
  
  CONCLUSIONS
  The pSCA should not be regarded as a perforator-free area. Although the pSCA territories likely overlap with the posterior cerebral artery, BA, and anterior inferior cerebellar artery, the pSCA segment cannot be surgically manipulated with impunity.
authors: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
authors: Ulises
authors: U
authors: Garcia-Gonzalez
authors: Daniel D
authors: DD
authors: Cavalcanti
authors: Abhishek
authors: A
authors: Agrawal
authors: Robert F
authors: RF
authors: Spetzler
authors: Mark C
authors: MC
authors: Preul
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001488:Basilar Artery / Q000033:anatomy & histology* / Q000601:surgery; D002545:Brain Ischemia / Q000473:pathology / Q000601:surgery; D001933:Brain Stem / Q000098:blood supply* / Q000601:surgery; D002102:Cadaver; D002531:Cerebellum / Q000098:blood supply* / Q000601:surgery; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000473:pathology / Q000601:surgery; D007840:Latex; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D020769:Posterior Cerebral Artery / Q000033:anatomy & histology* / Q000601:surgery
chemical_list: D007840:Latex