Ruptured posterior inferior cerebellar artery aneurysm at fenestrated vertebral artery

Case contributed by Dr Victor Yang

Presentation

Subarachnoid hemorrhage.

Patient Data

Age: 55 years
Gender: Female

Fenestration at left vertebral artery just distal to the PICA origin. The aneurysm projects superio-medially into the brainstem. The left vertebral artery is dominant. The left PCA has a fetal origin. 

Intra-operative photo post clipping.

Far lateral approach to the PICA aneurysm after clipping.  Note the rootlets of cranial nerves (IX, X, XI).

Case Discussion

Posterior circulation aneurysms are a much less common cause of subarachnoid hemorrhage than anterior circulation aneurysms. 

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