"True" posterior communicating aneurysms: Three cases, three strategies

Abstract

Background:The authors provide a review of true aneurysms of the posterior communicating artery (PCoA). Three cases admitted in our hospital are presented and discussed as follows.Case Descriptions:First patient is a 51-year-old female presenting with a Fisher II, Hunt-Hess III (headache and confusion) subarachnoid hemorrhage (SAH) from a ruptured true aneurysm of the right PCoA. She underwent a successful ipsilateral pterional craniotomy for aneurysm clipping and was discharged on postoperative day 4 without neurological deficit. Second patient is a 53-year-old female with a Fisher I, Hunt-Hess III (headache, mild hemiparesis) SAH and multiple aneurisms, one from left ophthalmic carotid artery and one (true) from right PCoA. These lesions were approached and successfully treated by a single pterional craniotomy on the left side. The patient was discharged 4 days after surgery, with complete recovery of muscle strength during follow-up. Third patient is a 69-year-old male with a Fisher III, Hunt-Hess III (headache and confusion) SAH, from a true PCoA on the right. He had a left subclavian artery occlusion with flow theft from the right vertebral artery to the left vertebral artery. The patient underwent endovascular treatment with angioplasty and stent placement on the left subclavian artery that resulted in aneurysm occlusion.Conclusion:In conclusion, despite their seldom occurrence, true PCoA aneurysms can be successfully treated with different strategies.

<p>Traumatic Subarachnoid Hemorrhage Resulting from Posterior Communicating Artery Rupture</p>

“…Most PCoA aneurysms originate from the junction of internal carotid artery (ICA) with PCoA and few of them arise from PCoA itself. [14][15][16] Only 0.1%-2.8% of all intracranial aneurysm arises from PCoA itself like our cases. [14][15][16] And the size of our aneurysm was only 1.8 mm, which was not detectable on CT angiography.…”

Microsurgical Approach for True Posterior Communicating Artery Aneurysms: Literature Review and Illustrative Case

“…Including our own, we found 46 patients with 47 true PCoA aneurysms treated by direct surgery ( Table 1 ). 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 Thirty-nine patients (85%) presented with SAH. Thirty-four aneurysms arose on the fetal-type PCoA and 5 arose from a dilated PCoA, which supplies the principal collateral flow associated with the occlusion of major vessels.…”

Treatment of true posterior communicating artery aneurysms: Endovascular experience in a single center

“…10,22 Thus, microsurgical clipping of TPCoA aneurysms is still full of challenges and the potential risk of microsurgical clipping should be evaluated carefully. 5,6,8,9,23,24 Endovascular treatment should be considered as an alternative in aneurysms not amenable to microsurgical clipping, patients with high anesthesia/ surgical risk or in cases with endovascularly favorable anatomy. A thorough understanding of aneurysm location and configuration is essential in successful treatment of these lesions.…”

“…[1][2][3] Some of the authors prefer microsurgical management to endovascular treatment because of difficulty in navigation of microcatheter and potential risk of intraoperative rupture. 1,[4][5][6][7][8] However, microsurgical clipping for such lesions also maintains challenges due to anatomic complexity. 3,4,[6][7][8][9][10] Although advances in endovascular devices and techniques have revolutionized the management of complex aneurysms, the feasibility and efficacy of these methods in managing TPCoA aneurysms are yet to be determined.…”