Morphogenesis of the posterior inferior cerebellar artery with three-dimensional reconstruction of the late embryonic vertebrobasilar system

The posterior inferior cerebellar artery (PICA) shows the most variable course among the cerebellar arteries, mainly at the level of the lateral medullary segment. Based on the correlation between the level of origin and the characteristics of the lateromedullary segment, we have proposed three patterns of course of the PICA. With the aim of understanding their embryological basis we review the interrelations between the developing cerebellum and the primitive hindbrain arterial plexus through the analysis of transverse serial sections of human embryos of 22.5 and 23 mm crown-rump length. Three-dimensional reconstruction of the vertebrobasilar system has been performed to study the morphology of the vascular networks. The cerebellar primordium is vascularized by the metencephalic plexus that will form the basilar artery and the superior cerebellar arteries. Due to the development of the pontine flexure the rhomboid lips approach and the cerebellum comes into contact with the myelencephalon; thus the myelencephalic plexus represents an acquired source of vascularization for the cerebellum with respect to the metencephalic plexus. The examination of the transverse sections shows that the vertebral and basilar arteries, superior cerebellar arteries, anterior inferior cerebellar arteries, and primitive lateral vertebrobasilar anastomoses are well recognizable. The three-dimensional reconstruction of the vessels shows that the PICA is not yet defined due to the persistence of a plexus of many thin vessels at the level of the lateral aspect of the myelencephalon, indicating that its origin and course are established at the end of the embryonic period. Based on the evolution of the primitive hindbrain plexus, we suggest that in synchrony with the progressive descent of the cerebellum the branches of the myelencephalic plexus succeed with a rostrocaudal progression in feeding the cerebellum and the morphogenesis of the PICA results from the selection of portions of this plexus. The high origin of the PICA from the basilar artery could be ascribed to its development from a rostral collateral of the plexus due to an early development of the vessel at the beginning of its embryonic lifetime. Moreover, the three patterns of course of the PICA could reflect the variable retention