Surgical management of fusiform aneurysms of the peripheral posteroinferior cerebellar artery

OBJECTIVE: To describe the management and outcomes of seven patients with fusiform aneurysms of the peripheral posteroinferior cerebellar artery (PICA). METHODS: Medical records and neuroimaging studies of seven patients who underwent surgical treatment of fusiform aneurysms of the peripheral PICA were reviewed. Average follow-up time was 1.5 years, and no patient was lost to follow-up. RESULTS: All patients presented with acute subarachnoid hemorrhage, and most had acute hydrocephalus. All underwent surgery, which entailed distal revascularization in six of the seven patients. Revascularization techniques included occipital artery-PICA bypass, side-to-side PICA-PICA anastomosis, and aneurysm excision with direct endto-end PICA reanastomosis. Outcome was good in six patients and fair in one. CONCLUSION: Fusiform, peripheral PICA aneurysms are rare lesions. Distal revascularization was used in most cases because of the uncertain adequacy of collateral supply. Careful, individualized management allows for a good outcome in the majority of cases.