Ruptured aneurysms at the distal superior cerebellar artery successfully treated by combining occipital artery–superior cerebellar artery anastomosis and endovascular therapy: illustrative case

BACKGROUND: Distal superior cerebellar artery (SCA) aneurysms are rare and are treated using various treatment strategies. Treatment often requires parent artery occlusion, which raises concerns regarding the potential risk of ischemia in the distal territory. OBSERVATIONS: An 81-year-old woman presented with subarachnoid hemorrhage. Diagnostic cerebral angiography revealed two tiny distal SCA aneurysms. Because significant ischemic damage following parent artery occlusion was concerned, two bypasses between the occipital artery and SCA branches were first performed with the patient in the prone position in a hybrid operating room. Each aneurysm was successively treated in the same position with endovascular internal trapping and intra-aneurysmal embolization. After adequate hemostasis was confirmed, the wound was closed. Both aneurysms were successfully occluded without symptomatic ischemic complications. LESSONS: This combined surgical and endovascular approach would be helpful in cases with notable concerns regarding ischemia after sacrificing the parent artery.