Posterior Inferior Cerebellar Artery Aneurysm: Microsurgical Clipping of a Ruptured Posterior Inferior Cerebellar Artery (PICA) Aneurysm Not Well Suited to Endovascular Treatment, Far-Lateral Transcondylar Approach to the Anterior Medullary Segment of the PICA, Complete Exclusion of the Aneurysm with Preservation of the Parent Artery

  • Silvia Hernández-DuránEmail author
  • Veit Rohde
Living reference work entry


A 43-year-old female patient suffered a spontaneous subarachnoid hemorrhage (SAH), Hunt and Hess grade IV, Fisher grade 4, due to a ruptured left-sided posterior inferior cerebellar artery (PICA) aneurysm, arising from the anterior medullary segment of the PICA. The aneurysm had a wide neck, and the parent vessel was shown to supply part of the left anterior inferior cerebellar artery (AICA) territory. For these reasons, endovascular treatment was considered hazardous with respect to PICA preservation, and the patient underwent microsurgical clipping via a far-lateral transcondylar surgical approach. Clipping of the aneurysm was achieved without compromising the left PICA. The patient was discharged to a rehabilitation facility with a Glasgow Outcome Score of 4 (due to sequelae of the SAH). This case demonstrates that a well-tailored surgical approach to the PICA can yield good outcomes both clinically and radiologically. The microsurgical management of ruptured PICA aneurysms is the main topic of this chapter.


Posterior inferior cerebellar artery, PICA Clipping Far-lateral transcondylar approach 


  1. Al-Khayat H, Al-Khayat H, Beshay J, Manner D, White J. Vertebral artery-posteroinferior cerebellar artery aneurysms: clinical and lower cranial nerve outcomes in 52 patients. Neurosurgery. 2005;56(1):2–10. Discussion 11CrossRefGoogle Scholar
  2. Alokaili RN, Ahmed ME. Flow-diverter stent for the treatment of a non-origin posterior inferior cerebellar artery aneurysm. A case report. Neuroradiol J. 2014;27(4):456–60. Scholar
  3. Atallah E, Saad H, Li J, Kumar A, Tjoumakaris S, Chalouhi N, Hasan D, Zarzour H, Herial N, Gooch MR, Rosenwasser RH, Jabbour P. The experience with flow diverters in the treatment of posterior inferior cerebellar artery aneurysms. Oper Neurosurg (Hagerstown). 2019; Scholar
  4. Bhogal P, Chudyk J, Bleise C, Lylyk I, Henkes H, Lylyk P. The use of flow diverters to treat aneurysms of the posterior inferior cerebellar artery: report of three cases. Interv Neuroradiol. 2018;24(5):489–98. Scholar
  5. Ciappetta P, Occhiogrosso G, Luzzi S, D’Urso PI, Garribba AP. Jugular tubercle and vertebral artery/posterior inferior cerebellar artery anatomic relationship: a 3-dimensional angiography computed tomography anthropometric study. Neurosurgery. 2009;64(5 Suppl 2):429–36. Discussion 436. Scholar
  6. Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, Sandercock P, International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet. 2005;366(9488):809–17. Scholar
  7. Peluso JP, van Rooij WJ, Sluzewski M, Beute GN, Majoie CB. Posterior inferior cerebellar artery aneurysms incidence, clinical presentation, and outcome of endovascular treatment. AJNR Am J Neuroradiol. 2008;29(1):86–90. Scholar
  8. Petr O, Sejkorová A, Bradáč O, Brinjikji W, Lanzino G. Safety and efficacy of treatment strategies for posterior inferior cerebellar artery aneurysms: a systematic review and meta-analysis. Acta Neurochir. 2016;158(12):2415–28. Scholar
  9. Rhoton AL Jr. The cerebellar arteries. Neurosurgery. 2000;47(3 Suppl):S29–68.PubMedGoogle Scholar
  10. Richardson AE. The natural history of patients with intracranial aneurysm after rupture. Prog Brain Res. 1968;30:269–73. Scholar
  11. Singh RK, Behari S, Kumar V, Jaiswal AK, Jain VK. Posterior inferior cerebellar artery aneurysms: anatomical variations and surgical strategies. Asian J Neurosurg. 2012;7(1):2–11. Scholar
  12. Yamaura A, Ise H, Makino H. Radiometric study on posterior inferior cerebellar aneurysms with special reference to accessibility by the lateral suboccipital approach. Neurol Med Chir (Tokyo). 1981;21(7):721–33.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Neurological SurgeryUniversitätsmedizin GöttingenGöttingenGermany

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