{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T07:54:51Z","timestamp":1776844491343,"version":"3.51.2"},"reference-count":45,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\"><jats:title>Background:<\/jats:title><jats:p>Vertebral artery dissecting aneurysm (VADA) involving the origin of the posterior inferior cerebellar artery (PICA) is a complex disease entity in which the dual goals of preventing future rebleeding and maintaining perfusion of the lateral medulla must be considered. We present an illustrative case and review the literature surrounding treatment strategies.<\/jats:p><\/jats:sec><jats:sec id=\"st2\" sec-type=\"cases\"><jats:title>Case Description:<\/jats:title><jats:p>We report a patient presenting with extensive subarachnoid hemorrhage due to rupture of an intracranial VADA involving the PICA origin. After consideration of the patient\u2019s cerebral vasculature and robustness of collaterals, a flow-diverting stent was placed with angiographic resolution of the lesion and maintenance of antegrade PICA flow. Ultimately, the patient experienced a contralateral intraparenchymal hemorrhage leading to death. Review of the literature identified 124 cases of VADA involving the PICA origin described over the past decade. The methods of surgical and endovascular treatment of these cases were reviewed, with particular focus on the rationale of treatment, outcomes, and complications.<\/jats:p><\/jats:sec><jats:sec id=\"st3\" sec-type=\"conclusions\"><jats:title>Conclusion:<\/jats:title><jats:p>Numerous treatment options for VADA involving PICA have been reported with different risk and benefit profiles. Flow-diverting stents appear to offer the most favorable balance of securing the aneurysm and avoiding medullary infarction, but the risks and optimal anti-thrombotic treatment strategy are incompletely understood. In select cases, in which the surgical risk is low or in which the anatomy is favorable (e.g., nondominant parent vessel or robust collateral circulation in the involved territories), parent artery trapping with or without microsurgical revascularization can be considered.<\/jats:p><\/jats:sec>","DOI":"10.25259\/sni-281-2019","type":"journal-article","created":{"date-parts":[[2019,8,25]],"date-time":"2019-08-25T11:55:34Z","timestamp":1566734134000},"page":"116","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Treatment of intracranial vertebral artery dissecting aneurysms involving the posterior inferior cerebellar artery origin"],"prefix":"10.25259","volume":"10","author":[{"given":"Jason A.","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of California, Los Angeles,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew C.","family":"Garrett","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California, Los Angeles,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anton","family":"Mlikotic","sequence":"additional","affiliation":[{"name":"Department of Radiology, Harbor-UCLA Medical Center, Torrance, California, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James I.","family":"Ausman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California, Los Angeles,"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2019,6,25]]},"reference":[{"key":"10.25259\/SNI-281-2019\/ref-1","first-page":"1","article-title":"Predictive factors of medullary infarction after endovascular internal trapping using coils for vertebral artery dissecting aneurysms","volume":"129","author":"Aihara","year":"2017","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI-281-2019\/ref-2","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1227\/01.NEU.0000145784.43594.88","article-title":"Vertebral artery-posteroinferior cerebellar artery aneurysms: Clinical and lower cranial nerve outcomes in 52 patients","volume":"56","author":"Al-khayat","year":"2005","journal-title":"Neurosurgery"},{"key":"10.25259\/SNI-281-2019\/ref-3","doi-asserted-by":"crossref","first-page":"1628","DOI":"10.1161\/01.STR.21.11.1628","article-title":"Rebleeding from intracranial dissecting aneurysm in the vertebral artery","volume":"21","author":"Aoki","year":"1990","journal-title":"Stroke"},{"key":"10.25259\/SNI-281-2019\/ref-4","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.3171\/2017.5.JNS162663","article-title":"The use of alternatives to clopidogrel in flow-diversion treatment with the pipeline embolization device","volume":"129","author":"Atallah","year":"2018","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI-281-2019\/ref-5","doi-asserted-by":"crossref","first-page":"462","DOI":"10.3171\/jns.1990.73.3.0462","article-title":"Posterior inferior to posterior inferior cerebellar artery anastomosis combined with trapping for vertebral artery aneurysm. 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