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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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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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Matsumoto H, Takechi A, Kohno K, Sasaki U. “Kissing Aneurysms” of the Anterior Communicating Artery Treated With Coil Embolization. J Endovasc Ther 2005; 12:750-4. [PMID: 16363906 DOI: 10.1583/05-1637r.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To present a case of kissing aneurysms of the anterior communicating artery treated with endovascular coil embolization and discuss the advantages and disadvantages of this technique compared with neck clipping. CASE REPORT A 48-year-old man became drowsy and was admitted to the hospital; he had right hemiparesis and aphasia. Computed tomography revealed diffuse subarachnoid hemorrhage; diagnostic angiography identified an aneurysm at the left A1-A2 junction of the anterior communicating artery and another in the distal anterior cerebral artery (ACA). Endovascular coil embolization was performed on the same day. During the procedure, the 3-mm-diameter junctional aneurysm was successfully packed with coils, but an additional aneurysm was suspected; right carotid angiography following embolization of the left aneurysm clearly showed a mirror image aneurysm of the right A1-A2 junction. The right aneurysm was treated using the same technique. The broad-necked ACA aneurysm was unsuitable for embolization, so neck clipping was performed 5 weeks later. The patient was discharged to his home following complete recovery 7 weeks after the coil embolization. CONCLUSIONS Kissing aneurysms are a rare and specific type of multiple aneurysms that require caution in diagnosis and surgical management. Endovascular treatment may be suitable because it does not involve dissection around the aneurysms.
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Affiliation(s)
- Hiroaki Matsumoto
- Department of Neurosurgery, Ehime Prefectural Central Hospital, Japan.
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