OBJECTIVE To describe the management and outcomes of seven patients with fusiform aneurysms of the peripheral posteroinferior cerebellar artery (PICA). METHODS Medical records and neuroimaging studies of seven patients who underwent surgical treatment of fusiform aneurysms of the peripheral PICA were reviewed. Average follow-up time was 1.5 years, and no patient was lost to follow-up. RESULTS All patients presented with acute subarachnoid hemorrhage, and most had acute hydrocephalus. All underwent surgery, which entailed distal revascularization in six of the seven patients. Revascularization techniques included occipital artery-PICA bypass, side-to-side PICA-PICA anastomosis, and aneurysm excision with direct end-to-end PICA reanastomosis. Outcome was good in six patients and fair in one. CONCLUSION Fusiform, peripheral PICA aneurysms are rare lesions. Distal revascularization was used in most cases because of the uncertain adequacy of collateral supply. Careful, individualized management allows for a good outcome in the majority of cases.