ObjectiveTo describe an anatomic variant of the anterior inferior cerebellar artery in a patient with Méniére's disease.Study DesignRetrospective case review and review of the literature.SettingTertiary referral clinic.InterventionVestibular nerve section and microvascular decompression.Main Outcome MeasuresAudiometric testing and control of vertigo.ResultsThe eighth nerve was identified via a retromastoid approach. The anterior inferior cerebellar artery was observed bisecting the eighth nerve. The vestibular nerve was sectioned, and microvascular decompression was performed on the cochlear division. At last follow-up, the patient had not experienced any vertiginous attacks but was observed to have progressive hearing loss.ConclusionsThe course of the anterior inferior cerebellar artery is highly variable and difficult to predict. Knowing the potential paths is a necessity in performing posterior fossa surgery. Although the patient's vertigo was controlled by the vestibular nerve section, microvascular decompression of the cochlear nerve did not result in hearing improvement or stabilization. This case report does not support a benefit of microvascular decompression in Méniére's disease. Vestibular nerve section remains the authors' treatment of choice for controlling disabling vertigo caused by Méniére's disease.