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Shah R, Saraf R. Fusiform "True" Posterior Communicating Artery Aneurysm with Basilar Artery Occlusion: A Case Report. Neurointervention 2024; 19:57-60. [PMID: 38359946 PMCID: PMC10910176 DOI: 10.5469/neuroint.2023.00472] [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: 11/28/2023] [Revised: 02/06/2024] [Accepted: 02/06/2024] [Indexed: 02/17/2024] Open
Abstract
Isolated posterior communicating artery (PCoA) aneurysms are rare, predominantly fusiform in morphology, and rarely present with subarachnoid hemorrhage. Endovascular management of this pathology is technically challenging due to extreme tortuosity, the artery course in the subarachnoid space, sharp angulations at PCoA junctions with the parent artery, and, at times, associations with either internal carotid artery or basilar artery occlusions. We present a case of a ruptured fusiform PCoA at the junction of middle and distal third with concomitant proximal basilar artery occlusion. The PCoA reforms the posterior circulation, making it a vital artery. Stent-assisted coiling was performed with extreme difficulty in achieving distal positioning of the stents in the basilar artery/posterior cerebral artery/distal PCoA due to artery tortuosity. There was technical difficulty in the stent deployment. After changing strategies to a larger diameter laser-cut stent, endovascular treatment could be performed. There were good angiographic and clinical outcomes with stable occlusion at 6-month-follow-up.
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Affiliation(s)
- Ritu Shah
- Department of Radiology, King Edward Memorial Hospital, Seth Gordhandas Sunderdas Medical College, Mumbai, India
| | - Rashmi Saraf
- Department of Radiology, King Edward Memorial Hospital, Seth Gordhandas Sunderdas Medical College, Mumbai, India
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Napoletano G, Di Fazio N, Delogu G, Del Duca F, Maiese A. Traumatic Aneurysm Involving the Posterior Communicating Artery. Healthcare (Basel) 2024; 12:192. [PMID: 38255080 PMCID: PMC10815069 DOI: 10.3390/healthcare12020192] [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: 12/05/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
Traumatic intracranial aneurysms (TICAs) are rare, accounting for less than 1% of all intracranial aneurysms. However, they are associated with a mortality rate of over 50%. The case presented herein focuses on a posterior communicating artery TICA caused by violent aggression. A 41-year-old man with massive subarachnoid hemorrhage (SAH), on admission to hospital, had a CT angiography that showed a ruptured left posterior communicating artery aneurysm with continuous blood loss and underwent neurosurgical cooling. The CT scan also showed fractures of the mandible, mastoid and left styloid process, as well as brain contusions caused by blows and kicks. Despite medical treatment and surgery, after four days, he died. The assault dynamics were recorded by a camera in the bar. The damage was caused by kicks to the neck and head. The forensic neuropathological examination showed the primary injury (SAH, subdural hemorrhage, cerebral contusions, head-neck fractures), as well as secondary damage following the attack (cerebral infarcts, edema, supratentorial hernia, midbrain hemorrhage). The coil was intact and well positioned. In this case, circumstantial information, medical records, and the type of injury could shed light on the mechanism of the production of a TICA. In addition, the CT angiography and histological investigations helped to distinguish a recent and traumatic aneurysm from a pre-existing one. Following precise steps, the study of aneurysms can be helpful in clarifying their traumatic origin even when the victim was taking drugs. The aim of this study is also to share the diagnostic process that we used in the forensic field for the assessment of suspected traumatic aneurysms.
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Affiliation(s)
- Gabriele Napoletano
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (G.D.); (F.D.D.)
| | - Nicola Di Fazio
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (G.D.); (F.D.D.)
| | - Giuseppe Delogu
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (G.D.); (F.D.D.)
| | - Fabio Del Duca
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (G.D.); (F.D.D.)
| | - Aniello Maiese
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Section of Legal Medicine, University of Pisa, 56126 Pisa, Italy;
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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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Takeda M, Kashimura H, Chida K, Murakami T. Microsurgical clipping for the true posterior communicating artery aneurysm in the distal portion of the posterior communicating artery. Surg Neurol Int 2015; 6:101. [PMID: 26110082 PMCID: PMC4476138 DOI: 10.4103/2152-7806.158515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 05/06/2015] [Indexed: 12/02/2022] Open
Abstract
Background: Aneurysms arising from the posterior communicating artery (PCoA) itself are rare in which aneurysms usually located in the proximal portion of the PCoA. The authors report a case of the true PCoA ruptured aneurysm in the distal portion of the PCoA. Case Description: The patient was an 83-year-old man who suffered subarachnoid hemorrhage. Cerebral angiography revealed a saccular aneurysm arising on the fetal type right PCoA itself in the distal portion of the PCoA. 2 days after the onset of symptoms, the patient underwent right interfascial pterional craniotomy, with anterior temporal approach. The aneurysm was successfully clipped with the preservation of both the PCoA and the thalamoperforating artery. Conclusion: We speculated that blood flow into the PCoA gradually increased after occlusion of the left vertebral artery, which induced tortuosity of the PCoA. As a result, hemodynamic stress might increase near the curvature and cause aneurysm formation.
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Affiliation(s)
- Masaru Takeda
- Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan
| | - Hiroshi Kashimura
- Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan
| | - Kohei Chida
- Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan
| | - Toshiyuki Murakami
- Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan
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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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Velat GJ, Zabramski JM, Nakaji P, Spetzler RF. Surgical management of giant posterior communicating artery aneurysms. Neurosurgery 2012; 71:43-50; discussion 51. [PMID: 22278359 DOI: 10.1227/neu.0b013e31824c05a0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Giant posterior communicating artery (PCoA) aneurysms (> 25 mm) are rare lesions associated with a poor prognosis and high rates of morbidity and mortality. OBJECTIVE To review the clinical results of giant PCoA aneurysms surgically treated at our institution, focusing on operative nuances. METHODS All cases of giant PCoA aneurysms treated surgically at our institution were identified from a prospectively maintained patient database. Patient demographic factors, medical comorbidities, rupture status, neurological presentation, clinical outcomes, and surgical records were critically reviewed. RESULTS From 1989 to 2010, 11 patients (10 women) underwent surgical clipping of giant PCoA aneurysms. Presenting signs and symptoms included cranial nerve palsies, diminished mental status, headache, visual changes, and seizures. Five aneurysms were ruptured on admission. All aneurysms were clipped primarily except 1, which was treated by parent artery sacrifice and extracranial-to-intracranial bypass after intraoperative aneurysm rupture. Perioperative morbidity and mortality rates were 36% (4 of 11) and 18.3% (2 of 11), respectively. Excellent or good clinical outcomes, defined as modified Rankin Scale scores ≤ 2, were achieved in 86% (5 of 6) of patients available for long-term clinical follow-up (mean, 12.5 ± 13.6 months). CONCLUSION Giant PCoA aneurysms are rare vascular lesions that may present with a variety of neurological signs and symptoms. These lesions can be successfully managed surgically with satisfactory morbidity and mortality rates. To the best of our knowledge, this is the largest surgical series of giant PCoA aneurysms published to date.
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Affiliation(s)
- Gregory J Velat
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA
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He W, Gandhi CD, Quinn J, Karimi R, Prestigiacomo CJ. True Aneurysms of the Posterior Communicating Artery: A Systematic Review and Meta-Analysis of Individual Patient Data. World Neurosurg 2011; 75:64-72; discussion 49. [DOI: 10.1016/j.wneu.2010.09.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 09/13/2010] [Indexed: 11/30/2022]
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Endovascular stent-graft implantation for a cecum of an aberrant artery from a systemic arterial supply to the basal segment of the left pulmonary lobe. Gen Thorac Cardiovasc Surg 2010; 58:640-3. [PMID: 21170635 DOI: 10.1007/s11748-009-0572-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 11/16/2009] [Indexed: 10/18/2022]
Abstract
A 64-year-old man with a history of repeated pneumonia underwent left lower lobectomy with a diagnosis of a systemic arterial supply to the basal segment of the left pulmonary lobe. Three months after the operation, follow-up computed tomography revealed a large cecum of the stump of the feeding artery. We performed endovascular aortic repair for the cecum.
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MATSUMORI Y, KAYAMA T, KOKUBO Y, KONDO R, SATO S, SAITO S. A Case of Non-junctional Posterior Communicating Artery Aneurysm Forming Kissing Aneurysms with an IC-PC Aneurysm. ACTA ACUST UNITED AC 2003. [DOI: 10.2335/scs.31.365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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10
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Ishikawa T, Kazumata K, Ni-iya Y, Kamiyama H, Andoh M. Subarachnoid hemorrhage as a result of fungal aneurysm at the posterior communicating artery associated with occlusion of the internal carotid artery: case report. SURGICAL NEUROLOGY 2002; 58:261-5. [PMID: 12480238 DOI: 10.1016/s0090-3019(02)00839-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Fungal or "true" mycotic aneurysms of the intracranial circulation are very rare. Rupture of a fungal aneurysm is fatal in almost 100% of cases. CASE DESCRIPTION We report a 65-year-old woman with a ruptured fungal aneurysm on the posterior communicating artery associated with occlusion of the internal carotid artery. She had a past history of gastric malignant lymphoma and subsequent granulocytopenia. She survived after surgical treatment including trapping of the aneurysm and a superficial temporal artery-to-middle cerebral artery bypass. CONCLUSION Improved immune response at the time of the onset of subarachnoid hemorrhage, as well as additional vasoreconstructive surgery, may have contributed to favorable outcome after surgical treatment.
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Affiliation(s)
- Tatsuya Ishikawa
- Department of Neurosurgery, Asahikawa Red-Cross Hospital, Asahikawa, Japan
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Santoro A, Passacantilli E, Guidetti G, Dazzi M, Guglielmi G, Cantore G. Bypass combined with embolization via a venous graft in a patient with a giant aneurysm in the posterior communicating artery and bilateral idiopathic occlusion of the internal carotid artery in the neck. J Neurosurg 2002; 96:135-9. [PMID: 11794595 DOI: 10.3171/jns.2002.96.1.0135] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors describe the case of a patient with a symptomatic giant aneurysm of the posterior communicating artery (PCoA) associated with bilateral idiopathic occlusion of the internal carotid artery (ICA). The presence of severe tortuosity of the vertebral arteries (VAs), both at their origin from the subclavian artery and at the level of the third segment, impeded navigation of the catheter for embolization of the aneurysm with Guglielmi detachable coils (GDCs). A direct surgical approach was considered to be a high-risk procedure because of the bilateral occlusion of the ICAs and the size of the aneurysm. The following therapeutic strategy was therefore adopted: 1) balloon occlusion test of the left VA; 2) vertebro-vertebral bypass with saphenous vein graft to provide a pathway for subsequent embolization; 3) ICA-left middle cerebral artery bypass to ensure blood flow in the event that embolization resulted in closure of the PCoA; and 4) GDC embolization of the aneurysm via the posterior circulation graft to ensure complete exclusion of the lesion from the arterial circulation and preservation of the PCoA. At 3-month follow-up review the patient did not present with any neurological deficits; at 1-year control examination, magnetic resonance (MR) imaging and MR angiography both confirmed complete exclusion of the aneurysm and patency of the two bypasses.
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Affiliation(s)
- Antonio Santoro
- Dipartimento di Scienze Neurologiche, Neurochirurgia, Rome, Italy.
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Kubo M, Kuwayama N, Hirashima Y, Ohi M, Takami M, Endo S. Endovascular treatment of unusual multiple aneurysms of the internal carotid artery-posterior communicating artery complex--case report. Neurol Med Chir (Tokyo) 2000; 40:476-9. [PMID: 11021081 DOI: 10.2176/nmc.40.476] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 79-year-old female presented with subarachnoid hemorrhage due to rupture of a rare true posterior communicating artery (PCoA) aneurysm and with poor general condition. Endovascular therapy was performed in the chronic stage. Right carotid angiography just before embolization demonstrated unusual multiple aneurysms of the internal carotid artery (ICA)-PCoA complex. Superselective angiography and aneurysmography using microcatheter revealed two separate aneurysms arising from the PCoA and the ICA-PCoA junction. Endovacular embolization using Guglielmi detachable coils (GDCs) was successfully performed for both aneurysms and complete occlusions were achieved with the PCoA fully patent. Embolization with GDCs is a good alternative to surgical clipping for PCoA aneurysm after careful evaluation of superselective angiography.
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Affiliation(s)
- M Kubo
- Department of Neurosurgery, Toyama Medical and Pharmaceutical University
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Matsumoto K, Kuriyama M, Tamiya T, Ohmoto T. Direct clip obliteration of a ruptured giant aneurysm of the posterior communicating artery: case report. Neurosurgery 1997; 41:939-42; discussion 942-3. [PMID: 9316057 DOI: 10.1097/00006123-199710000-00032] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE AND IMPORTANCE A review of the literature documents that giant posterior communicating artery (PCoA) aneurysms are rare. To our knowledge, this report is the first to describe a ruptured giant aneurysm arising from a PCoA that was successfully clipped. CLINICAL PRESENTATION A 27-year-old man had a left oculomotor palsy and then suffered a subarachnoid hemorrhage. Cerebral angiography and three-dimensional computed tomographic angiography revealed a giant fusiform aneurysm of the left PCoA. These imaging techniques documented the rapid growth of the aneurysm from a moderate to a giant size in fewer than 3 days. INTERVENTION The patient underwent a left subtemporal craniotomy. The neck was constructed and was successfully clipped, and the PCoA was reconstructed with five sequentially placed fenestrated clips in a tandem fashion. The patient experienced a good recovery. CONCLUSION This report describes the usefulness of three-dimensional computed tomographic angiography in planning the surgical approach to giant aneurysms originating from the PCoA and the use of fenestrated clips to obliterate giant fusiform aneurysms.
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Affiliation(s)
- K Matsumoto
- Department of Neurological Surgery, Okayama University Medical School, Japan
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