Surgical Removal of a Large Distal Posterior Inferior Cerebellar Artery Aneurysm: Case Report

ABSTRACT

The authors report a rare case of right distal posterior inferior cerebellar artery(PICA) aneurysm arising from just distal to its vermian brance. A 36-year-old female patient presented with a sudden onset of headache, nausea, dizziness and ataxia without any other neurologic deficit. On brain computerized tomographic(CT) scan and magnetic resonance imaging(MRI), a well-defined round mass was detected just behind the fourth ventricle. On transfemoral vertebral angiogram(TFVAG), it was confirmed as a saccular aneurysm arising from the vermian brance of the right PICA. The aneurysm was initially directly clipped through bilateral suboccipital approach. Postoperative follow up angiogram after two weeks revealed a more enlarged aneurysm and an incompletely clipped neck. After making sufficient exposure of the aneurysm, the neck was reclipped and the sac removed. Postoperative results were uneventful.