Minimally invasive single-stage hybrid strategy for ruptured dissecting fusiform proximal posterior inferior cerebellar artery aneurysm: how I do it

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BackgroundFusiform posterior inferior cerebellar artery (PICA) aneurysms are technically challenging for both microsurgical and endovascular approaches, particularly when PICA is at high risk for occlusion. Optimal outcomes may be achieved through a collaborative hybrid strategy.MethodsWe present a single-stage hybrid minimally invasive technique for fusiform PICA aneurysm management, involving microsurgical PICA-PICA revascularization and endovascular coil embolization for definitive aneurysm occlusion in the hybrid operating suite.ConclusionCombining microsurgical and endovascular modalities allows durable aneurysm exclusion while preserving PICA flow. This hybrid approach leverages the strengths of both techniques, offering a safe and effective option for complex PICA aneurysms.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00701-025-06761-8.