Cervical Myelopathy Due to Direct Cord Compression by Posterior Inferior Cerebellar Artery Associated with Aberrant Vertebral Artery

The effectiveness of surgical microvascular decompression (MVD) of the vertebral artery (VA) for treating conditions such as trigeminal neuralgia or hemifacial spasm is well known. However, the use of MVD for a case in which the posterior inferior cerebellar artery (PICA) is directly compressing the high cervical cord has not been reported. A 48-year-old male was diagnosed with a rare case of myelopathy due to the PICA directly compressing the high cervical cord. The patient had a C-2 segmental type of VA that penetrated the intradural space at the C1 level. The VA-PICA portion was located just after where the intradural space was penetrated, and the branching PICA strongly and vertically compressed the high cervical cord. MVD of the PICA was performed, and the patient experienced rapid improvement of myelopathy. The patient immediately improved postoperative day 1 and was doing well at his 1-year follow-up. This is a rare case of the PICA directly compressing the cervical cord and causing myelopathy. MVD of the PICA resulted in good patient recovery.