Distal posterior inferior cerebellar artery (PICA) displacement with end-to-side anastomosis to contralateral PICA: a novel bypass surgery for PICA aneurysm. Illustrative case

BACKGROUND: Posterior inferior cerebellar artery (PICA) aneurysms pose significant surgical challenges. The authors present a novel bypass technique involving distal PICA displacement and end-to-side anastomosis to the contralateral PICA. OBSERVATIONS: The authors describe a successful case in which the distal PICA was relocated, followed by an end-to-side anastomosis to the contralateral PICA, effectively bypassing the aneurysm and restoring normal blood flow. LESSONS: This innovative approach highlights the potential of bypass surgery for PICA aneurysms, particularly when traditional endovascular methods are unsuitable. Individual anatomical considerations are crucial for effective treatment planning. https://thejns.org/doi/10.3171/CASE24741.