Microsurgical Clipping of a Posterior Inferior Cerebellar Artery Aneurysm Following Failed Pipeline Stent

Aneurysms of the posterior inferior cerebellar artery (PICA) are rare, with limited consensus on appropriate management. These aneurysms have been noted to have a faster growth rate and are more prone to rupture. Accessing these aneurysms for microsurgical clipping is challenging, and has traditionally required significant removal of the occipital condyle, putting the patient at risk for future complications. Therefore, some have opted to utilize minimally invasive techniques such as a pipeline stent, though these methods can fail to cause complete occlusion of the aneurysm. The current case describes a patient who was found to have a PICA aneurysm that was initially managed with a pipeline stent. However, upon further follow up, the aneurysm showed continued filling, leading to the decision to clip the aneurysm. In this case, we describe the use of a far lateral approach for accessing and clipping a PICA aneurysm with minimal removal of the occipital condyle. The patient successfully tolerated the surgery and was discharged home.