Posterior Inferior Cerebellar Artery Origin Thrombosis With Aneurysm of Collateralized Posterior Meningeal Artery Presenting as Subarachnoid Hemorrhage: Case Report

OBJECTIVE: This is the first report of a ruptured aneurysm involving a collateral branch to the posterior inferior cerebellar artery (PICA) in a patient who had a subarachnoid hemorrhage. CLINICAL PRESENTATION: A 56-year-old man initially presented with a subarachnoid hemorrhage and underwent 2 catheter-based 4-vessel angiograms with negative results. A delayed angiogram 4 weeks later revealed a dissecting aneurysm of the posterior meningeal artery, a branch of the vertebral artery. INTERVENTION: A 3-dimensional reconstruction of the vertebral angiogram showed proximal occlusion of the proximal left PICA and distal filling via a collateral branch from the posterior meningeal artery. A far-lateral approach was used for this patient. The aneurysm was found along the course of the collateral posterior meningeal artery and was clipped successfully. CONCLUSION: Aneurysms involving collateral branches of the PICA are rare. It is important to recognize such collateral flow preoperatively because inadvertent sacrifice of these vessels during a surgical approach could lead to stroke and neurological deficits of the PICA territory. Copyright © by the Congress of Neurological Surgeons