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. 2018 Jul 12;58(8):341–349. doi: 10.2176/nmc.oa.2018-0076

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© 2018 The Japan Neurosurgical Society

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/

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Fig. 3 — Case 2: Magnetic resonance angiography (a: frontal view) and conventional angiography of the right VA (b: lateral view) showed a pearl-and-string sign at the right VA and the right PICA origin. Via the right lateral suboccipital approach (c), we performed a right OA-PICA bypass (d) followed by surgical clipping of the right PICA at the distal site of the aneurysmal dilation and the right VA at a site proximal to the dissecting aneurysm (e). Postoperative magnetic resonance angiography- (f) and magnetic resonance imaging studies (g) confirm complete aneurysmal obliteration without brain stem- or cerebellar infarction. OA: occipital artery, PICA: posterior inferior cerebellar artery, VA: vertebral artery.