Abstract
Vertebral and posterior inferior cerebellar artery (PICA) aneurysms are rare and complex lesions that can be saccular, fusiform, or dissecting in morphology, and usually present with hemorrhage. Traditionally, surgical treatment is performed with a far lateral approach and then clipping for saccular aneurysms or trapping with occipital artery-PICA or PICA-PICA bypass for aneurysms not amenable to clipping. More recently, the endovascular armamentarium has been applied with good success and has notable advantage of avoiding possible manipulation of the brainstem and lower cranial nerves. Unquestionably, managing and treating PICA and vertebral artery aneurysms requires an interdisciplinary approach as endovascular and microsurgical approaches, or a combination of the two, may be best for the patient.
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