• Cindy X Wang, Katherine Cironi, Mansour Mathkour, Joseph Lockwood, Aimee Aysenne, Joe Iwanaga, Marios Loukas, C J Bui, Aaron S Dumont, and R Shane Tubbs.
• Tulane University School of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA.
• World Neurosurg. 2021 May 1; 149: e1098-e1104.

BackgroundThe posterior spinal arteries (PSAs), branches of the intracranial segment of the vertebral artery or posterior inferior cerebellar artery, run bilaterally along the spinal cord and are integral to the blood supply primarily to the posterior one third of this structure. However, a less well-described distribution of the PSAs is their supply to the posterior medulla. The purpose of this study is to examine the medullary branches of the PSA anatomically.MethodsWe conducted a cadaveric study to evaluate for branches of the PSA supplying the medulla oblongata.ResultsAll 14 sides had medullary branches arising from the PSAs. The average number of branches supplying the medulla oblongata on each side was 6. Most of these branches traveled laterally to anastomose with medullary branches arising from the anterior spinal artery. Additionally, lateral and ascending branches were noted.ConclusionsPhysicians who interpret imaging of the craniocervical junction, in particular arteriograms, should be aware of ascending medullary branches arising from the anterior spinal artery. Additionally, neurosurgeons operating this region must be careful in dissecting over the posterior medulla and manipulating the cerebellar tonsils, as in telovelar approaches to the fourth ventricle, in order to avoid iatrogenic injury to these vessels. Additionally, variable stroke patterns involving the vertebral artery or posterior inferior cerebellar artery might include ischemia to the medulla oblongata via PSA branches, and this anatomy should be kept in mind by interventionalists, radiologists, and neurologists alike.Copyright © 2021. Published by Elsevier Inc.

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