• You-Sub Kim, Tae-Sun Kim, In-Chul Yang, and Sung-Pil Joo.
• Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea.
• World Neurosurg. 2019 Aug 1; 128: 444-447.

BackgroundRuptured vertebral artery dissecting aneurysms (VADAs) involving the posterior inferior cerebellar artery (PICA) are the most difficult to treat among variations of VADAs but require prompt treatment. The major challenge is to preserve the PICA while occluding the aneurysm. Despite advances in the management of ruptured VADAs involving the PICA, each treatment, whether it is combined or not, is associated with a significant degree of risk.Case DescriptionThis study presents 4 cases of ruptured VADAs involving the PICA that were successfully treated using a staged, combined method. Embolization of the rupture point in the acute stage was followed 3-4 weeks later by occlusion of the proximal vertebral artery (VA) and PICA origin after occipital artery-PICA bypass in the chronic stage.ConclusionsAlthough it is sometimes very difficult to determine the exact rupture point of VADAs, ruptures tend to occur at distal segments of a dissecting aneurysm presenting as bleb. Also, when planning a trapping of the VA, careful examination of angiography is needed to assess the contralateral VA and rupture point. Our staged and combined strategy may provide another valuable treatment option for treating VADAs involving the PICA with special emphasis on the safety and efficacy in our method.Copyright © 2019 Elsevier Inc. All rights reserved.

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