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Background: Distal Posterior Inferior Cerebellar (PICA) aneurysms are quite rare. The infrequency of distal PICA aneurysms has limited our understanding of their underlying pathology, natural history, and clinical management. Moreover, vascular anomalies are frequently noted in association with distal PICA aneurysms. Case Description: We present a very unique case of a ruptured distal PICA aneurysm associated with an Arteriovenous Malformation (AVM) which was successfully identified by Intraoperative Indocyanin Green (ICG) video angiography. In the current era, we tend to perform Computed Tomographic Angiography (CTA) studies as the initial imaging for vascular lesions. CTA revealed the distal PICA aneurysm but failed to reveal the associated AVM. However, intraoperative ICG video angiography strongly suspected the existence of an AVM. Conclusion: Intraoperative ICG video angiography is very useful in detecting small vessel anomalies. DSA should be considered for all distal PICA aneurysms even in the era of advanced CTA.

journal of surgery

Ruptured Distal Posterior Inferior Cerebellar Artery Aneurysm Associated with an Arteriovenous Malformation Detected by Intraoperative Indocyanine Green Video angiography: Case Report and Literature Review