ABSTRACT
Aneurysms arising from the posterior inferior cerebellar artery (PICA) are uncommon, with a reported incidence ranging between 0.5 and 2% of all the aneurysms in the brain. Most of them arise at the PICA origin from the vertebral artery, whereas distal PICA aneurysms are exceptional. We have experienced two consecutive cases of distal PICA aneurysms. Both patients were female and the first patient was 48 years old and the second patient was 60 years old. Cerebral angiography was performed immediately after admission and it showed an aneurysm located on the distal PICA. One patient was treated by a combined endovascular and surgical approach, and the other patient was treated by a surgical approach only. The former patient expired 8 days from the ictus. The latter patient had a good outcome during admission. Distal PICA aneurysms are exceptionally rare and they may be successfully treated with surgical or endovascular techniques. The therapeutic strategy, either surgical or endovascular, should be selected according to the condition of the patient and the arterial and aneurysmal morphology.