Where is it located and how does it run?
The superior cerebellar artery is a component of the vertebrobasilar system. Its topography is characterized by the following features:
- Origin: Branches off from the upper third of the basilar artery (a. basilaris) immediately before it divides into its two terminal branches — the posterior cerebral arteries.
- Course of the vessel: Runs parallel and inferior to the posterior cerebral artery. Along its path, the artery winds around the cerebral peduncles.
- Variant anatomy: Duplicated right superior cerebellar arteries have been described on angiograms.
What does it supply?
The artery supplies blood to the following areas:
- Cerebellum: Supplies the superior surface of the cerebellar hemispheres, the rostral part of the cerebellar hemisphere, the superior part of the vermis, and partially extends to the lateral margins of the hemispheres.
- Midbrain: Vascularizes the lateral and dorsolateral regions of the midbrain tegmentum; also gives off branches to the midbrain tegmentum.
- Pons: Supplies the upper part of the pons.
- Ventricular system: Gives off branches to the choroid plexus of the third ventricle.
Clinical significance: trigeminal neuralgia
The superior cerebellar artery plays a role in the pathophysiology of trigeminal neuralgia.
The vascular loop of this artery is a frequent cause of neurovascular conflict. The artery loops around the root of the trigeminal nerve (n. trigeminus) at its exit zone from the pons and compresses the vulnerable unmyelinated segment of the root. For the V nerve, the length of the sensitive/unmyelinated root is specified as 2.0–6.0 mm.
This irritation may be accompanied by a reflex facial muscle spasm in response to sharp pain; the historical name "painful tic" is considered a misnomer. Facial sensory disturbances are typically absent.
Treatment:
- Medical treatment: Carbamazepine is the drug of choice.
- Surgical treatment: In case of resistance to medical therapy, microvascular decompression is performed. The neurosurgeon relieves the nerve root from the compressing vascular loop and places an insulating pad between them; the use of a synthetic material sponge to prevent contact between the nerve and the pulsating artery has also been described.
Angiographic appearance and thrombosis
Digital subtraction angiography (DSA) or MR angiography can be used to assess vessel hemodynamics:
- In basilar artery occlusion: If the occlusion is located in the distal part of the basilar artery, blood flow in the upper part of the cerebellum is not visualized. The superior cerebellar artery anatomically branches distal to the site of obstruction, so contrast does not enter it.
- Retrograde filling of the upper part of the basilar artery: Under the described hemodynamic conditions, the upper part of the basilar artery fills with contrast media in a retrograde fashion. Contrast enters from the initial segment of the posterior cerebral artery; subsequently, the superior cerebellar arteries may fill from the basilar artery.
Class and exam questions
Which artery does the superior cerebellar artery branch from?
It is a branch of the upper third of the basilar artery and originates from it immediately before the bifurcation into the posterior cerebral arteries.
What role does it play in the development of trigeminal neuralgia?
The loop of the superior cerebellar artery frequently compresses the unmyelinated segment of the trigeminal nerve root at its exit from the pons, causing neurovascular conflict and pain attacks.
Does blood flow into it during an occlusion of the distal basilar artery?
In the described occlusion of the distal basilar artery, contrast does not enter the superior cerebellar artery because it originates distal to the site of obstruction.
What else to study on this topic
- Basilar artery (a. basilaris)
- Posterior cerebral artery (a. cerebri posterior)
- Trigeminal nerve (n. trigeminal)
- Vertebrobasilar system
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