Management of the Anterior Inferior Cerebellar Artery Adherent to the Petrous Dura During Vestibular Schwannoma Surgery - Technical Note. Surgical Video.

Introduction: Anatomical variations involving the anterior inferior cerebellar artery (AICA) can be encountered during vestibular schwannoma surgery and may significantly increase the risk of vascular injury. One particularly challenging variation occurs when the AICA is densely adherent to the petrous dura, making conventional blunt dissection hazardous. Case Report: This surgical video demonstrates the microsurgical management of an AICA firmly adherent to the petrous dura encountered during vestibular schwannoma resection. Rather than attempting to separate the artery from the dura by blunt dissection—which carries a substantial risk of arterial avulsion or rupture—the petrous dura is sharply elevated from the temporal bone while maintaining the AICA attached to the dural layer. This maneuver preserves the integrity of the vessel, avoids unnecessary manipulation of the arterial wall, and creates a safe operative corridor for subsequent tumor dissection. Once the AICA has been adequately mobilized and protected together with the dural flap, microsurgical tumor resection can proceed safely. In the present case, complete tumor removal was achieved without vascular injury or ischemic complications. Results: The AICA was successfully mobilized together with the petrous dural flap, allowing safe continuation of the microsurgical dissection. Complete tumor resection was achieved with preservation of the artery, without vascular injury or ischemic complications. Conclusion: Recognition of an AICA adherent to the petrous dura is an important anatomical consideration during vestibular schwannoma surgery. The key technical principle is not to separate the artery from the dura by blunt dissection, but rather to mobilize the artery together with the petrous dura after careful dural elevation from the temporal bone. This simple microsurgical strategy minimizes the risk of arterial injury and facilitates safe continuation of tumor resection. The video highlights an important anatomical variation that skull base surgeons should recognize and manage appropriately.