Ruptured aneurysm arising at anterior spinal artery as the collateral circulation with bulbar artery supply to posterior inferior cerebellar artery treated by proximal occlusion and occipital artery-posterior inferior cerebellar artery bypass: a case report and literature review

The cases of aneurysms arising from collateral vessels that supply the posterior inferior cerebellar artery (PICA) are so exceptionally rare that there is no consensus on the optimal treatment. In this report, a patient was presented with subarachnoid hemorrhage caused by a fusiform aneurysm on the right anterior spinal artery, which formed an anastomosis network with bulbar artery and the vessels supplying to the right PICA. We chose to perform proximal occlusion on the anterior spinal and bulbar arteries, using occipital artery-PICA bypass. Our case was the first where proximal occlusion was used concurrently with vascular reconstruction to treat a ruptured aneurysm of collateral vessels supplying to PICA.