Flow diverter for a dissecting aneurysm of the AICA serving as a feeding artery to a transverse-sigmoid sinus DAVF

Involvement of the anterior inferior cerebellar artery (AICA) as a feeding artery in a transverse‑sigmoid sinus (TSS) dural arteriovenous fistula (DAVF) is uncommon, and the coexistence of a flow‑related aneurysm on this vessel is exceedingly rare. Flow diverter (FD) reconstruction of the AICA, followed by DAVF embolization, represents a feasible treatment strategy. Such a case is reported. A 53‑year‑old male patient presented with headache and dizziness. Computed tomography angiography (CTA) revealed a TSS DAVF, but neurological examination showed no positive signs. Endovascular treatment was performed. Under general anesthesia, digital subtraction angiography revealed a left TSS DAVF supplied by the well-developed left AICA, the bilateral middle meningeal arteries (MMAs), and the bilateral occipital arteries, among others. The DAVF drained into multiple cortical veins, with a Cognard grade of III. On the proximal AICA trunk, a dissecting aneurysm was identified. A Surpass Evolve FD was deployed to cover this lesion. Subsequently, the DAVF was obliterated with Onyx via the MMA. After the procedure, the patient exhibited no new neurological deficits. One month postoperatively, CTA confirmed complete DAVF obliteration and patency of the AICA with favorable reconstruction. Six months postoperatively, the patient had an uneventful recovery and returned to normal activities. The present findings, together with a review of similar cases from the literature, suggest that in carefully selected cases in which the AICA is sufficiently large, FD reconstruction of the AICA can be performed prior to DAVF embolization.