How I Do it: side to side posterior inferior cerebellar artery –posterior inferior cerebellar artery bypass procedure



An intracranial in situ side to side posterior circulation procedure is performed infrequently. The scope of treatment modalities of vertebral artery-PICA aneurysms and vertebral dissections is limited due to the lack of many representations of this procedure’s technical nuances.


To demonstrate the technical nuances of a PICA-PICA side to side bypass in a 50-year-old woman with a dissecting vertebral-PICA junction pseudoaneurysm.


Details of the pre-operative evaluation, decision process and operative nuances of side to side PICA-PICA bypass are described. Indications and limitations are emphasized. Vascular neurosurgeons should consider this elegant procedure in their treatment armamentarium.

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Correspondence to Amir R. Dehdashti.

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Dehdashti, A.R. How I Do it: side to side posterior inferior cerebellar artery –posterior inferior cerebellar artery bypass procedure. Acta Neurochir 155, 2121–2125 (2013) doi:10.1007/s00701-013-1874-y

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  • PICA
  • Revascularization
  • Side to side
  • Posterior fossa
  • Bypass