PMC9217146_01
Three-dimensional digital subtraction angiography showed a proximal posterior inferior cerebellar artery (PICA) fusiform aneurysm (arrowheads).
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Three-dimensional digital subtraction angiography showed a right proximal PICA fusiform aneurysm (Fig. 1).
Three-dimensional computed tomography angiography showed that the caudal loops of the left PICA (red arrowhead) and the right PICA (blue arrowhead) were positioned parallelly at some distance.
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We observed both PICAs, but there was some distance between the bilateral PICA caudal loops (Fig. 2).
(a) PICA and its exposed rupture point. (b) PICA-PICA side-to-side anastomosis was performed. (c) After anastomosis, the rupture point was trapped.
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Then, we easily identified the right PICA and the aneurysm (Fig. 3a). We made two stay sutures and running sutures on the posterior wall and intermittent sutures on the anterior wall (Fig. 3b). After anastomosis, the right PICA aneurysm was trapped (Fig. 3c).
Three-dimensional computed tomography angiography showed perfect patency of the PICA-PICA bypass and obliteration of the aneurysm (PICA-PICA anastomosed site showed by arrowhead).
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CT angiography on day 15 showed excellent bypass patency (Fig. 4).