Treatment of a giant complicated distal posterior inferior cerebellar artery aneurysm: A case report and literature review

Giant intracranial aneurysms, especially giant aneurysms of the distal posterior inferior cerebellar artery (PICA), remain the most difficult and challenging cerebrovascular lesions for neurosurgeons to treat. The morbidity and mortality rates of microsurgical clipping are relatively high, and endovascular embolization is also associated with many complications. In the present report, the case of a 46-year-old female patient who presented with headache and dizziness for 3 years, which was aggravated and combined with limb weakness for 1 day, is presented. A CT scan showed a lesion occupying the fourth ventricle, with slight bleeding. A MR scan also revealed a lesion occupying the fourth ventricle and compressing the brainstem, and there was distortion of the cisterns around the brainstem. CT angiography examination showed a giant irregular aneurysm located in the PICA. After evaluation, the PICA aneurysm was removed, and the PICA was clipped via a microsurgical technique without ischemia or neurological sequelae. Long-term follow-up demonstrated that the symptoms of headache and dizziness disappeared without relapse. Based on a review of the literature, this method may represent an alternative strategy for the treatment of giant PICA aneurysms, especially for aneurysms not suitable for direct clipping or endovascular embolization.