Extracranial aneurysms of the distal posterior inferior cerebellar artery: Resection and primary reanastomosis as the preferred management approach
The patient is a 52-year-old right handed African-American woman who suffered a sudden onset of severe headache and neck pain with multiple episodes of vomiting. Head CT at an outside hospital showed mild amount of SAH in Sylvian fissures and temporoparietal cortical sulci bilaterally, and intraventricular blood within the fourth, and left lateral ventricles, and mild hydrocephalus. The patient had a magnetic resonance angiogram (MRA) done the following day, which was unremarkable for any vascular abnormality, however, a conventional cerebral angiogram done subsequently was suspicious for a left PICA aneurysm. She was transferred to our institution for further management. Upon admission to our center, she was a Hunt and Hess grade II SAH with only a very mild left-sided arm and leg weakness. A four vessel cerebral angiogram was performed, which showed an 8 × 6 mm fusiform left PICA aneurysm at the tonsillomedullary segment (caudal loop) behind the arch of C1, not amenable to endovascular coiling [Figure –].