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Fig. 1B —67-year-old woman with double origin of left posterior inferior cerebellar artery (PICA), trigeminal aneurysm, and vertebrobasilar junction fenestration. Anteroposterior angiogram of right (A) and lateral angiogram of left (B) vertebral arteries show two origins of left PICA (solid black arrows) converging at proximal aspect of anterior medullary segment of PICA (white arrow). Fenestrated vertebrobasilar junction (dashed arrow, A) and bulbous basilar tip–aneurysmal infundibuli of bilateral origins of posterior cerebral and superior cerebellar artery are evident (A). Double origin of PICA arises from nondominant vertebral artery.