Ruptured aneurysm of the PICA communicating artery: a case report

Area of Science:

• Neurosurgery
• Vascular Neurology
• Cerebrovascular Diseases

Background:

• Aneurysms of the posterior inferior cerebellar artery communicating artery (PICA com A) are exceptionally rare.
• These aneurysms can present with significant intracranial hemorrhage, posing diagnostic and therapeutic challenges.

Observation:

• A 47-year-old male presented with subarachnoid and intraventricular hemorrhage secondary to a ruptured PICA com A aneurysm.
• Cerebral angiography revealed the aneurysm arising from a communicating artery formed by the right PICA and right vertebral artery, supplying the left PICA territory.
• The imaging also identified a small, unruptured fusiform aneurysm adjacent to the ruptured lesion.

Findings:

• The patient underwent successful surgical trapping of both aneurysms.
• Vascular reconstruction was achieved using an occipital artery (OA)-PICA bypass procedure.
• This represents the first reported case of a ruptured PICA com A aneurysm treated with surgical trapping and concurrent vascular reconstruction.

Implications:

• The case highlights the efficacy of OA-PICA bypass in managing complex PICA com A aneurysms, especially when clipping is challenging.
• Hemodynamic factors and inherent arterial wall weakness are likely contributors to the formation of these rare aneurysms.
• This surgical approach offers a viable option for preserving PICA territory perfusion when direct aneurysm repair compromises the parent vessel.