A dissecting aneurysm of the posteroinferior cerebellar artery: case report.
OBJECTIVE
We present a patient who experienced a subarachnoid hemorrhage secondary to a dissecting aneurysm of the right posteroinferior cerebellar artery (PICA). The use of an encircling clip in treating the aneurysm while preserving supply to brain stem perforators originating near the dissecting segment and the distal PICA territory was key in the operative management.


METHODS
A 48-year-old patient with a history of hypertension presented with subarachnoid hemorrhage confirmed by computed tomography of the brain. Successive cerebral angiography revealed a dynamic change in the configuration of the dissection, with expansion of the associated focal ectasia.
At surgery, three brain stem perforators adjacent to the aneurysm were visualized. The dissecting segment was reconstructed with an encircling Sundt clip and muslin wrap, which preserved the flow through the PICA and brain stem perforators.


CONCLUSIONS
A patient suffering from a dissecting PICA aneurysm and subarachnoid hemorrhage was successfully treated with direct surgical reconstruction of the parent artery, sparing the perforators to the medulla.
Department of Neurosurgery, New York University Medical Center, New York 10016, USA.
J J
JJ
Jafar
T
T
Kamiryo
B W
BW
Chiles
P K
PK
Nelson
D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D001158:Arteries / Q000601:surgery; D001933:Brain Stem / Q000098:blood supply*; D002531:Cerebellum / Q000098:blood supply*; D002533:Cerebral Angiography; D003097:Collateral Circulation / Q000502:physiology; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000601:surgery; D013525:Surgical Instruments; D014057:Tomography, X-Ray Computed