We report a surgical case of a ruptured distal posterior inferior cerebellar artery (PICA) aneurysm, and the vetebral artery ended as PICA. A 50-year-old female was admitted to our hospital due to headache, vomiting and disturbance of conciousness. A CT-scan showed diffuse SAH, hydrocephalus and massive hemorrhage in the IVth ventricle. CT-angiography revealed a saccular aneurysm at the cranial loop of the left PICA, and the left vertebral artery (VA) was hypoplastic and ended as PICA. Emergency clipping of the aneurysm and removal of the hematoma in the VIth ventricle with a lateral ventricle drainage were performed. The branching vessel and distal VA were not detected in the surgery.