Collaborative Treatment Using Surgical and Radiological Approaches for a Ruptured Dissecting Aneurysm Involving Proximal PCA (P1-2) and Posterior Communicating Artery: A Case Report

Abstract

We report a case of collaborative treatment using surgical and radiological approaches for a ruptured dissecting aneurysm around the proximal posterior cerebral artery (P1-P2) and the posterior communicating artery. A 37-year-old woman was admitted to our hospital with a severe headache for 3 days. On admission, a computed tomography scan revealed a subarachnoid hemorrhage and a cerebral angiogram showed a dissecting aneurysm involving the proximal posterior cerebral artery (P1-P2) and posterior communicating artery. Although parent artery occlusion was indispensable for complete treatment, it posed the risk of ischemic complications in the right posterior cerebral artery distribution. A preoperative assessment of her three-dimensional digital subtraction angiogram enabled the consideration of a more feasible approach of collaborative treatment using surgical and radiological techniques. A successful outcome was obtained at the right P1 occlusion using coils and by the placement of the superficial temporal artery-posterior temporal artery bypass, followed by proximal clipping of the right posterior communicating artery. She was discharged without any neurological complications after 38 days.