Critical review of surgical techniques for posterior inferior cerebellar aneurysms

Objective: To review several aspects of posterior inferior cerebellar artery aneurysms regarding anatomy and approaches. Methods: A critical review of literature is performed with emphasis on the complications and surgical technical details. Results: the main approach advocated by the authors is the far-lateral approach and its variants. The indications of by-pass with saphenous or radial artery graft and endovascular treatment are also considered. The main complication is cerebrospinal fluid leakage, but brain stem ischemia, surgical bed hematoma, venous infarction, cerebellar contusion, bulbar nerve damage, condylar instability must also be mentioned. Conclusion: Knowledge of microsurgical anatomy is fundamental for any kind of procedure regarding clipping of posterior inferior cerebellar artery aneurysms. Endovascular treatment is a safe option in the majority of the cases.