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Dzhindzhikhadze R, Gadzhiagaev V, Zaytsev A, Polyakov A, Ermolaev A, Bogdanovich I, Sultanov R. Microsurgical Clip Reconstruction of a True Posterior Communicating Artery Aneurysm. World Neurosurg 2024; 185:149. [PMID: 38382755 DOI: 10.1016/j.wneu.2024.02.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/10/2024] [Accepted: 02/12/2024] [Indexed: 02/23/2024]
Abstract
Approximately 25% of intracranial aneurysms originate at the internal carotid artery and posterior communicating artery (PCoA) junction.1 In contrast to typical PCoA aneurysms, which are usually saccular, a subset known as true PCoA aneurysms arise directly from the PCoA. These represent about 1.3% of all intracranial aneurysms and 6.8% of PCoA aneurysms.1 The first report of a true PCoA aneurysm was in 1979.2Video 1 illustrates the microsurgical clipping of a true PCoA aneurysm in a 27-year-old man with subarachnoid hemorrhage and left-sided ophthalmoplegia. Computed tomography angiography revealed a large true patient consent, Our surgical strategy included 1) an extended pterional approach, 2) early brain relaxation through basal cisterns and third ventricle opening, 3) Sylvian fissure dissection, 4) partial uncus resection, 5) tracing the PCoA to the aneurysm, 6) pilot clipping and thrombectomy, and 7) careful aneurysm dissection and definitive clipping. The patient had an uncomplicated recovery and was discharged on postoperative day 5 with resolved third nerve dysfunction. A literature review from 2022 documented only 47 cases of true PCoA aneurysms, predominantly manifesting with rupture.3 Some studies suggest that these aneurysms may have a higher rupture risk than typical internal carotid artery-PCoA junction aneurysms.4 Microsurgical clipping is a primary treatment, often in cases associated with a fetal posterior cerebral artery variant.5 Ensuring the patency of the PCoA and thalamoperforating arteries is crucial, with careful visualization of the clip's distal ends to avoid impacting nearby neurovascular structures.
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Affiliation(s)
- Revaz Dzhindzhikhadze
- Department of Neurosurgery, Moscow Regional Clinical Research Institute named after M.F. Vladimirsky, Moscow, Russian Federation
| | - Vadim Gadzhiagaev
- Department of Neurosurgery, Moscow Regional Clinical Research Institute named after M.F. Vladimirsky, Moscow, Russian Federation.
| | - Andrey Zaytsev
- Department of Neurosurgery, Moscow Regional Clinical Research Institute named after M.F. Vladimirsky, Moscow, Russian Federation
| | - Andrey Polyakov
- Department of Neurosurgery, Moscow Regional Clinical Research Institute named after M.F. Vladimirsky, Moscow, Russian Federation
| | - Anton Ermolaev
- Department of Neurosurgery, Moscow Regional Clinical Research Institute named after M.F. Vladimirsky, Moscow, Russian Federation
| | - Igor Bogdanovich
- Department of Neurosurgery, Moscow Regional Clinical Research Institute named after M.F. Vladimirsky, Moscow, Russian Federation
| | - Ruslan Sultanov
- Department of Neurosurgery, Moscow Regional Clinical Research Institute named after M.F. Vladimirsky, Moscow, Russian Federation
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2
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Masuoka J, Yoshioka F, Furukawa T, Koguchi M, Ito H, Inoue K, Ogata A, Nakahara Y, Abe T. Microsurgical Approach for True Posterior Communicating Artery Aneurysms: Literature Review and Illustrative Case. Asian J Neurosurg 2022; 17:156-164. [PMID: 36120635 PMCID: PMC9473828 DOI: 10.1055/s-0042-1750840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
True posterior communicating artery (PCoA) aneurysms are rare. Although true PCoA aneurysms have been reported to be located close to the internal carotid artery, at the middle part of PCoA, or close to the posterior cerebral artery; the best surgical approach to treat true PCoA aneurysms in each location remains unclear. We conducted a literature review using data from PubMed. Data on demographics, location, and projecting direction of the aneurysm, surgical approach, and surgical complications were collected. A total of 47 true PCoA aneurysms were included. Twenty-nine aneurysms originated from the proximal portion, 10 from the middle portion, and 6 from the distal portion; there were two giant aneurysms. The ipsilateral pterional approach was used for 37 true PCoA aneurysms (27 in proximal portion, 8 in middle portion, and 2 in distal portion of PCoA). The anterior temporal approach was used for two distal-portion aneurysms and one giant aneurysm. The anterior subtemporal approach was used for one distal-portion aneurysm. The subtemporal approach was used for two middle-portion aneurysms and one giant aneurysm. The contralateral pterional approach was used for two proximal-portion and one distal-portion aneurysms. Although most true PCoA aneurysms can be treated by the pterional approach, other means such as anterior temporal and subtemporal approaches can be applicable for aneurysms in the middle and distal portions of the PCoA or giant aneurysms. Surgeons should select an appropriate approach for each aneurysm while considering the advantages and disadvantages of each technique.
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Affiliation(s)
- Jun Masuoka
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Fumitaka Yoshioka
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Takashi Furukawa
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Motofumi Koguchi
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Hiroshi Ito
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Kohei Inoue
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Atsushi Ogata
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Yukiko Nakahara
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Tatsuya Abe
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
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3
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Shin DG, Park J, Kim M, Kim BJ, Shin IH. True Posterior Communicating Artery Aneurysms with High Risk of Rupture despite Very Small Diameter. J Korean Neurosurg Soc 2022; 65:215-223. [PMID: 35203114 PMCID: PMC8918250 DOI: 10.3340/jkns.2021.0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 08/04/2021] [Indexed: 11/27/2022] Open
Abstract
Objective This retrospective study investigated the clinical and angiographic characteristics of ruptured true posterior communicating artery (PCoA) aneurysms in comparison with junctional PCoA aneurysms presenting with a subarachnoid hemorrhage.
Methods The medical records and radiological data of 93 consecutive patients who underwent three-dimensional rotational angiography and surgical or endovascular treatment for a ruptured junctional or true PCoA aneurysm over an 8-year period were examined.
Results The maximum diameter of the ruptured true PCoA aneurysm (n=13, 14.0%) was significantly smaller than that of the ruptured junctional PCoA aneurysms (n=80, 4.45±1.44 vs. 7.68±3.36 mm, p=0.001). In particular, the incidence of very small aneurysms <4 mm was 46.2% (six of 13 patients) in the ruptured true PCoA aneurysm group, yet only 2.5% (two of 80 patients) in the ruptured junctional PCoA aneurysm group. Meanwhile, the diameter of the PCoA was significantly larger in the true PCoA aneurysm group than that in the junctional PCoA aneurysm group (1.90±0.57 vs. 1.15±0.49 mm, p<0.001). In addition, the ipsilateral PCoA/P1 ratio was significantly larger in the true PCoA aneurysm group than that in the group of a junctional PCoA aneurysm (mean PCoA/P1 ratio±standard deviation, 2.67±1.22 vs. 1.14±0.88; p<0.001). No between-group difference was identified for the modified Fisher grade, clinical grade at admission, and 3-month modified Rankin Scale score.
Conclusion A true PCoA aneurysm was found to be associated with a larger PCoA and ruptured at a smaller diameter than a junctional PCoA aneurysm. In particular, the incidence of a ruptured aneurysm with a very small diameter <4 mm was significantly higher among the patients with a true PCoA aneurysm.
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Affiliation(s)
- Dong Gyu Shin
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jaechan Park
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Myungsoo Kim
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Byoung-Joon Kim
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Im Hee Shin
- Department of Medical Statistics, School of Medicine, Daegu Catholic University, Daegu, Korea
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Liu J, Zhang Y, Li W, Wang K, Zhang Y, Yang X. Treatment of true posterior communicating artery aneurysms: Endovascular experience in a single center. Interv Neuroradiol 2019; 26:55-60. [PMID: 31488022 DOI: 10.1177/1591019919874603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The true posterior communicating artery (TPCoA) aneurysms are rare and endovascular treatment for such lesions is limited in literature. METHODS From January 2012 to March 2017, eight TPCoA aneurysms were treated endovascularly and included in our present study. The procedural complication and outcomes were assessed. RESULTS Seven of eight aneurysms (87.5%) were ruptured. Stent-assisted coiling was used in one case that a stent was deployed via PCoA-ipsilateral P2 segment. The dual-microcatheter technique was used in one case. The remaining six cases were treated by coiling alone. One patient (12.5%) suffered perioperative complication, of which a coil herniated into parent vessel during the procedure without symptomatic stroke or other adverse event after the procedure. The initial embolization results showed complete occlusion in five cases and residual neck in three. Six patients (75%) had a mean of 15-month angiographic follow-up and two of them revealed recurrence (33.3%). Clinical follow-up was available in seven patients (87.5%) and all patients showed favorable clinical outcome with mRS score 0. CONCLUSION TPCoA aneurysms are rare and challenging lesions with high rupture rate in literatures. Endovascular treatment may be a feasible alternative for TPCoA aneurysms. Primary coiling, as well as adjunctive strategies, such as stent-assisted coiling or dual catheter techniques may be considered. Further study in a larger population is necessary.
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Affiliation(s)
- Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Ying Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Wenqiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Kun Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Yisen Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
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Lee Y, Kim M, Park J, Kim BJ, Son W, Jung S. Mirroring with Indocyanine Green Angiography in Aneurysm Surgery: Technical Note and Case Presentations. World Neurosurg 2019; 132:e696-e703. [PMID: 31421297 DOI: 10.1016/j.wneu.2019.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The authors used a micromirror under a microscope with an indocyanine green (ICG) imaging system to assess clipped aneurysms and the blood flow in hidden regions during aneurysm surgery. This study then investigated the usefulness of such mirroring with ICG angiography (MICGA). METHODS A micromirror was used during aneurysm surgery on 25 patients, and MICGA was performed on 10 of these 25 patients to inspect the hidden region after clipping. The mirrored aneurysms were located at the posterior communicating artery (n = 4), anterior choroidal artery (n = 4), proximal A1 segment (n = 1), and middle cerebral artery (n = 1). RESULTS In all 10 cases, MICGA was successful in assessing the state of the clipped aneurysm and blood flow of the vessels in the hidden region after clipping. This led to clip repositioning in 3 patients (30.0%) because of incomplete clipping of a hidden aneurysm or occlusion of a hidden perforator. Complete occlusion of the aneurysm was achieved in 8 patients, and the other 2 patients showed near complete occlusion because of an intentional residual aneurysm to avoid a small vessel adherent to the posterior wall of the aneurysm base. CONCLUSIONS MICGA can provide useful and reliable information on the state of a clipped aneurysm and the blood flow of associated vessels and perforators in a hidden region after aneurysm clipping.
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Affiliation(s)
- Youngseop Lee
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Myungsoo Kim
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jaechan Park
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea; Research Center for Artificial Intelligence in Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea.
| | - Byoung-Joon Kim
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Wonsoo Son
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Sungmoon Jung
- Biomedical Research Institute, School of Medicine, Kyungpook National University, Daegu, Republic of Korea; Research Center for Artificial Intelligence in Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
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Feasibility and midterm outcomes of endovascular embolization for true posterior communicating artery aneurysms. Neuroradiology 2019; 61:1191-1198. [PMID: 31401724 DOI: 10.1007/s00234-019-02277-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 07/31/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Endovascular treatment (EVT) of true posterior communicating artery (PcomA) aneurysms has been rarely reported. This study reports the outcomes on a single-center cohort with true PcomA aneurysms who underwent EVT. METHODS Between June 2011 and June 2017, clinical data from 42 patients with 43 true PcomA aneurysms who underwent EVT were retrieved from a prospectively maintained single-center database. Endovascular techniques, perioperative complications, clinical outcomes, and angiographic results were retrospectively evaluated. RESULTS All aneurysms were treated successfully. Treatment modalities included simple coiling in 30 aneurysms, balloon-assisted coiling in two, and stent-assisted coiling in 11 cases. Immediate angiograms showed complete occlusion in 23 aneurysms (53.5%), residual neck in 8 cases (18.6%), and residual sac in 12 (27.9%). No procedure-related complications or mortality were observed. Of the 34 aneurysms that underwent angiographic follow-up at an average duration of 7.1 months post-procedure, complete occlusion was achieved in 22 (64.7%), neck remnant in eight (23.5%), and residual sac in four (11.8%) aneurysms, respectively. Six aneurysms (18.2%) that underwent conventional coiling developed recanalization and required retreatment. Seven cases that received stent-assisted coiling did not develop recurrence. Clinical follow-up (mean, 24.3 months) of all patients demonstrated no neurologic deterioration or (re)bleeding. CONCLUSION EVT of the true PcomA aneurysm is a safe and feasible procedure but may be associated with recurrence in midterm follow-up, requiring close surveillance and potential retreatment.
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7
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Daou B, Atallah E, Chalouhi N, Starke RM, Oliver J, Montano M, Jabbour P, Rosenwasser RH, Tjoumakaris SI. Aneurysms with persistent filling after failed treatment with the Pipeline embolization device. J Neurosurg 2018:1-7. [PMID: 29726765 DOI: 10.3171/2017.12.jns163090] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 12/14/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe Pipeline embolization device (PED) has become a valuable tool in the treatment of cerebral aneurysms. Although failures with PED treatment have been reported, the characteristics and course of these aneurysms remain a topic of uncertainty.METHODSElectronic medical records and imaging studies were reviewed for all patients treated with the PED between July 2010 and March 2015 to identify characteristics of patients and aneurysms with residual filling after PED treatment.RESULTSOf 316 cases treated at a single institution, 281 patients had a long-term follow-up. A total of 52 (16.4%) aneurysms with residual filling were identified and constituted the study population. The mean patient age in this population was 58.8 years. The mean aneurysm size was 10.1 mm ± 7.15 mm. Twelve aneurysms were fusiform (23%). Of the aneurysms with residual filling, there were 20 carotid ophthalmic (CO) aneurysms (20% of all CO aneurysms treated), 10 other paraclinoid aneurysms (16.4% of all paraclinoid aneurysms), 7 posterior communicating artery (PCoA) aneurysms (21.9% of all PCoA aneurysms), 7 cavernous internal carotid artery (ICA) aneurysms (14.9% of all cavernous ICA aneurysms), 4 vertebrobasilar (VB) junction aneurysms (14.8% of all VB junction aneurysms), and 3 middle cerebral artery (MCA) aneurysms (25% of all MCA aneurysms). Eleven patients underwent placement of more than one PED (21.2%), with a mean number of devices of 1.28 per case. Eight of 12 aneurysms were previously treated with a stent (15.4%). Nineteen patients underwent re-treatment (36.5%); the 33 patients who did not undergo re-treatment (63.5%) were monitored by angiography or noninvasive imaging. In multivariate analysis, age older than 65 years (OR 2.65, 95% CI 1.33-5.28; p = 0.05), prior stent placement across the target aneurysm (OR 2.94, 95% CI 1.15-7.51; p = 0.02), aneurysm location in the distal anterior circulation (MCA, PCoA, and anterior choroidal artery: OR 2.72, 95% CI 1.19-6.18; p = 0.017), and longer follow-up duration (OR 1.06, 95% CI 1.03-1.09; p < 0.001) were associated with incomplete aneurysm occlusion.CONCLUSIONSWhile the PED can allow for treatment of large, broad-necked aneurysms with high efficacy, treatment failures do occur (16.4%). Aneurysm size, shape, and previous treatment may influence treatment outcome.
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Affiliation(s)
- Badih Daou
- 1Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and
| | - Elias Atallah
- 1Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and
| | - Nohra Chalouhi
- 1Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and
| | - Robert M Starke
- Departments of2Neurosurgery and.,3Radiology, University of Miami, Florida
| | - Jeffrey Oliver
- 1Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and
| | - Maria Montano
- 1Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and
| | - Pascal Jabbour
- 1Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and
| | - Robert H Rosenwasser
- 1Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and
| | - Stavropoula I Tjoumakaris
- 1Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and
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Nery B, Araujo R, Burjaili B, Smith TR, Rodrigues JC, Silva MN. "True" posterior communicating aneurysms: Three cases, three strategies. Surg Neurol Int 2016; 7:2. [PMID: 26862441 PMCID: PMC4722528 DOI: 10.4103/2152-7806.173307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 11/24/2015] [Indexed: 11/25/2022] Open
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.
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Affiliation(s)
- Breno Nery
- Department of Neurosurgery, Hospital Heliópolis, São Paulo, Brazil
| | - Ricardo Araujo
- Department of Neurosurgery, Hospital Heliópolis, São Paulo, Brazil
| | - Bruno Burjaili
- Department of Neurosurgery, Hospital Heliópolis, São Paulo, Brazil
| | - Timothy R Smith
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard University School of Medicine, Boston, MA, USA
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Mitsuhashi T, Takeda N, Oishi H, Arai H. Parent artery occlusion for ruptured "true" posterior communicating artery aneurysm. Interv Neuroradiol 2015; 21:171-4. [PMID: 25953771 DOI: 10.1177/1591019915583000] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A case of a patient with a ruptured true posterior communicating artery (PCoA) aneurysm is reported, who had been managed by early endovascular parent artery occlusion with coils. The small blister aneurysm was located at the proximal PCoA itself and directed superiorly. Postoperative course was uneventful. During 1-month follow-up, the patient recovered well and could care for herself. Aneurysms of the PCoA itself are very rare. As reported to date, surgical procedures would favor microsurgical clipping over endovascular coil embolization. Endovascular treatment may be a good alternative to surgical trapping for true PCoA blister aneurysm.
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Affiliation(s)
- Takashi Mitsuhashi
- Department of Neurosurgery, Tamananbu Chiiki Hospital, Tokyo, Japan Department of Neurosurgery, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Nobuaki Takeda
- Department of Neurosurgery, Juntendo University, Faculty of Medicine, Tokyo, Japan Department of Neurosurgery, Kichijojiminami Hospital, Tokyo, Japan
| | - Hidenori Oishi
- Department of Neurosurgery and Neuroendovasular Therapy, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Hajime Arai
- Department of Neurosurgery, Juntendo University, Faculty of Medicine, Tokyo, Japan
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10
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Munarriz PM, Castaño-Leon AM, Cepeda S, Campollo J, Alén JF, Lagares A. Endovascular treatment of a true posterior communicating artery aneurysm. Surg Neurol Int 2014; 5:S447-50. [PMID: 25422786 PMCID: PMC4235117 DOI: 10.4103/2152-7806.143273] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 08/22/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Posterior communicating artery (PCoA) aneurysms are most commonly located at the junction of the internal carotid artery and the PCoA. "True" PCoA aneurysms, which originate from the PCoA itself, are rarely encountered. Most previously reported cases were treated surgically mainly before the endovascular option became available. CASE DESCRIPTION A 53-year-old male presented with sudden onset of right hemiparesis and aphasia. Left middle cerebral artery stroke was diagnosed. Further studies revealed a 3 mm left PCoA aneurysm arising from the PCoA itself, attached to neither the internal carotid artery nor the posterior cerebral artery. Endovascular treatment was performed and the aneurysm was coiled completely. CONCLUSION Technical advances in endovascular interventional technology have permitted an additional approach to these lesions. The possible endovascular significance of the treatment of true PCoA aneurysms is discussed.
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Affiliation(s)
- Pablo M Munarriz
- Department of Neurosurgery, "12 de Octubre" University Hospital, Complutense University of Madrid, Madrid, Spain
| | - Ana M Castaño-Leon
- Department of Neurosurgery, "12 de Octubre" University Hospital, Complutense University of Madrid, Madrid, Spain
| | - Santiago Cepeda
- Department of Neurosurgery, "12 de Octubre" University Hospital, Complutense University of Madrid, Madrid, Spain
| | - Jorge Campollo
- Division of Neuroradiology, "12 de Octubre" University Hospital, Complutense University of Madrid, Madrid, Spain
| | - Jose F Alén
- Department of Neurosurgery, "12 de Octubre" University Hospital, Complutense University of Madrid, Madrid, Spain ; Division of Neuroradiology, "12 de Octubre" University Hospital, Complutense University of Madrid, Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, "12 de Octubre" University Hospital, Complutense University of Madrid, Madrid, Spain
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11
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Guo J, Chen Q, Miao H, Feng H, Zhu G, Chen Z. True posterior communicating artery aneurysms with or without increased flow dynamical stress: report of three cases. Clin Neurol Neurosurg 2013; 116:93-5. [PMID: 24275337 DOI: 10.1016/j.clineuro.2013.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 10/17/2013] [Accepted: 10/27/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Jing Guo
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Qianwei Chen
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Hongping Miao
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Hua Feng
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Gang Zhu
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Zhi Chen
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
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Almeida-Pérez R, Espinosa-García H, Alcalá-Cerra G, de la Rosa-Manjarréz G, Orozco-Gómez F. [Endovascular coiling of a «true» posterior communicating artery aneurysm]. Neurocirugia (Astur) 2013; 25:90-3. [PMID: 23831341 DOI: 10.1016/j.neucir.2013.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 05/19/2013] [Indexed: 10/26/2022]
Abstract
True posterior communicating artery aneurysms originate exclusively from the wall of this artery and should be differentiated from aneurysms of the posterior communicating segment of the distal carotid artery. As these lesions are rare, their anatomical relationships have been poorly described; likewise, reports concerning their endovascular treatment are extremely rare and the technical aspects poorly detailed. A case of a patient with a true aneurysm of the left posterior communicating artery treated by endovascular coiling is presented. A literature review was also conducted to illustrate the anatomical and technical details relevant to achieving its successful treatment.
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Affiliation(s)
- Rafael Almeida-Pérez
- Sección de Neurocirugía, Universidad de Cartagena, Cartagena de Indias, Colombia; Servicio de Neurocirugía Endovascular y Neurorradiología Intervencionista, Neurodinamia S.A., Cartagena de Indias, Colombia
| | - Héctor Espinosa-García
- Servicio de Neurocirugía Endovascular y Neurorradiología Intervencionista, Neurodinamia S.A., Cartagena de Indias, Colombia
| | - Gabriel Alcalá-Cerra
- Sección de Neurocirugía, Universidad de Cartagena, Cartagena de Indias, Colombia; Grupo de Investigación en Ciencias de la Salud y Neurociencias (CISNEURO), Cartagena de Indias, Colombia.
| | - Ginna de la Rosa-Manjarréz
- Servicio de Neurocirugía Endovascular y Neurorradiología Intervencionista, Neurodinamia S.A., Cartagena de Indias, Colombia
| | - Fernando Orozco-Gómez
- Servicio de Neurocirugía Endovascular y Neurorradiología Intervencionista, Neurodinamia S.A., Cartagena de Indias, Colombia
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