title: Successful endovascular treatment of a dissecting aneurysm of vertebral artery associated with double origin of the posterior inferior cerebellar artery.
abstract: BACKGROUND
  Double origin of the posterior inferior cerebellar artery (DOPICA) has been rarely reported in the literature, with a reported incidence of 1.45%. In contrast, a high concurrence rate of DOPICA and vertebral artery dissecting aneurysm has been reported.
  
  
  METHODS
  A 61-year old woman presented with vomiting and diplopia with preceding headache. Magnetic resonance imaging (MRI) showed fresh infarction of the left lateral medulla and a vertebral artery dissecting aneurysm of the left vertebral artery. The next day, she exhibited transient loss of consciousness and worsening of headache, and MRI depicted subarachnoid hemorrhage. Four-vessel digital subtraction angiography showed a posterior inferior cerebellar artery (PICA) arising both intracranially and extracranially from the left vertebral artery. Although the dissecting lesion involved the V3 and V4 portion, it did not involve an extracranially originating PICA. Internal trapping of the V3 and V4 portion was chosen as the extracranial channel was expected to supply the PICA territory. This procedure was safely performed.
  
  
  CONCLUSIONS
  Early endovascular intervention should be considered in the treatment of dissecting aneurysm of vertebral artery associated with DOPICA for patients with relatively long lesions even in unruptured cases.
authors.affiliation: Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Japan ykawabata-kyt@umin.net.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kawabata
authors.affiliation: Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Tsukahara
authors.affiliation: Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Japan.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Fukuda
authors.affiliation: Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Kawarazaki
authors.affiliation: Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Japan.
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Aoki
mesh_terms: D002531:Cerebellum / Q000098:blood supply; D002536:Cerebral Arteries / Q000002:abnormalities* / Q000000981:diagnostic imaging; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D014854:Lateral Medullary Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D008875:Middle Aged; D011859:Radiography; D016896:Treatment Outcome; D020217:Vertebral Artery Dissection / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*
keywords: Double origin of the posterior inferior cerebellar artery; internal trapping; subarachnoid hemorrhage; vertebral artery dissecting aneurysm