Internal Carotid-posterior Communicating Artery Aneurysm Research Articles

Bypass-Assisted Microsurgical Clipping for an Endovascular Treatment-Resistant Ruptured Internal Carotid-Posterior Communicating Artery Aneurysm, Recurring Two Decades Postinitial Clipping: 2-Dimensional Operative Video.

Salvage treatment of postclipping recurrent aneurysms remains challenging.1,2 The salvage microsurgical clipping is a possible intervention but sometimes difficult because of tissue adhesions around the aneurysm and previously installed clips; therefore, salvage coil embolization may have certain advantages.1-5 However, when coil embolization is not applicable,6 microsurgical clipping is a stand-alone curative treatment, requiring proficient and reliable microsurgical techniques. This article describes a unique case of a 70-year-old female patient complaining of a severe headache with subarachnoid hemorrhage due to a recurrent ruptured left internal carotid-posterior communicating artery aneurysm after microsurgical clipping 23 years ago. An initial attempt at coil embolization proved unsuccessful because of the aneurysm shape. Consequently, the salvage microsurgical clipping was planned. Given the additional time for trapping the internal carotid artery for the old clip removal, a superficial temporal artery-middle cerebral artery bypass was also planned. The operation entailed a superficial temporal artery-middle cerebral artery bypass, a Sylvian fissure dissection, the old clip removal, and aneurysm clipping. Intraoperatively, the complete aneurysm neck clipping was successfully performed without any complication, and patient postoperative course was uneventful. A wide surgical field should be obtained to be able to manipulate the aneurysm and old clip safely under a microscope. It is also important to temporarily trap the main artery to ensure removal of old clips and to prepare for intraprocedural ischemia using bypass after a precise assessment of hemodynamics before surgery. The patient provided informed consent for the procedure and the publication of the case along with its pertinent imaging, and this report was approved by the institutional review board at our hospital.

Posterior Communicating Artery-incorporated Internal Carotid-Posterior Communicating Artery Aneurysms Prone to Recur After Coil Embolization

The objective was to clarify predisposing factors of recurrence after coil embolization for internal carotid-posterior communicating artery (IC-Pcom) aneurysms. The medical records were retrospectively reviewed and patients harboring IC-Pcom aneurysms treated with coil embolization between June 2004 and June 2020 were identified. Aneurysms whose 3-dimensional images were available, whose initial treatment was performed during the study period, and whose follow-up term was more than 1 year were included. Information of the patients, the aneurysms and Pcoms, the initial treatment, and angiographic outcomes were collected. The IC-Pcom aneurysms were divided into Pcom-incorporated when their neck mainly rode on the Pcom or non-Pcom-incorporated when their neck mainly rode on the internal carotid arteryor the classification was equivocal. Relationship between these factors and recurrence was analyzed. Fifty-seven IC-Pcom aneurysms from 55 patients were recruited. Fifteen of the 57 aneurysms were categorized into Pcom-incorporated. Eighteen of the 57 aneurysms recurred. Mean follow-up term was 74.3 months and mean duration between the initial treatment and recurrence was 47.9 months. On univariate analyses, ruptured (P= 0.004), fetal-type Pcom (P= 0.002), and Pcom-incorporated (P < 0.001) were significantly correlated with recurrence. Multivariate analysis demonstrated that Pcom-incorporated aneurysms were significantly associated with recurrence (P < 0.001) along with ruptured (P= 0.027). Kaplan-Meier estimate demonstrated that cumulative recurrence-free rate was significantly lower in Pcom-incorporated aneurysms compared with non-Pcom-incorporated aneurysms (log-rank P < 0.001). Pcom-incorporated IC-Pcom aneurysms were susceptible to recur after coil embolization, especially when ruptured and the incorporated Pcom was fetal-type.

A Surgical Case of a Ruptured Internal Carotid-Posterior Communicating Artery Aneurysm Forming Kissing Aneurysms with an Unruptured C2 Aneurysm

A Surgical Case of a Ruptured Internal Carotid-Posterior Communicating Artery Aneurysm Forming Kissing Aneurysms with an Unruptured C2 Aneurysm

Retrograde T-Stent Technique for Large, Wide-Necked Internal Carotid-Posterior Communicating Artery Aneurysm.

We report a case of a wide-necked internal carotid-posterior communicating (IC-Pcom) artery aneurysm treated by the retrograde T-stent technique in which a stent was also placed in the Pcom artery via the posterior circulation. A 35-year-old woman was diagnosed with an unruptured right IC-Pcom artery aneurysm (maximum diameter: 11 mm, neck diameter: 8.5 mm) during a detailed examination for vertigo. The Pcom artery (2.1 mm) branched from the aneurysmal dome. A microcatheter was guided in retrograde via the Pcom artery from the posterior circulation. A low-profile visualized intraluminal support (LVIS) Jr. 2.5 mm × 17 mm was deployed from the internal carotid artery (ICA) to the Pcom artery, and then, an LVIS 4.5 mm × 23 mm was deployed while pressing the flare of the LVIS Jr. protruding into the ICA. T configuration stenting was completed, and the coil was inserted as tightly as possible. The retrograde T-stent technique, which has the advantage of optimal stent positioning, is useful for preserving a Pcom artery branching from the aneurysmal dome.

Nasal pain as an aura: Amygdala origin?

PurposeNasal pain, as an epileptic aura, has been poorly recognized. This study aims to demonstrate clinical features of patients with epilepsy who have nasal pain as an aura. MethodsWe retrospectively investigated consecutive patients who visited the epilepsy clinic of tertiary hospital from April 2000 to September 2019. All included patients underwent epilepsy-dedicated, high-resolution magnetic resonance imaging (MRI) examinations. All MRI studies were analyzed by visual inspection. ResultsSeven patients who presented nasal pain as an aura, were identified. Four patients reported nasal pain as the first aura. Four patients had right amygdala enlargement (isolated amygdala enlargement in three patients; amygdala enlargement in addition to hippocampal sclerosis in one patient), and one patient with compression of an internal carotid-posterior communicating artery aneurysm to right amygdala on brain MRI. Interictal epileptiform or ictal discharges on EEG were found in the right temporal region in five patients. In all four patients with amygdala enlargement, amygdala enlargement was ipsilateral to EEG anomalies. In all patients, nasal pain was accompanied by ictal semiological features, such as autonomic, olfactory, abdominal, or psychic auras, and focal impaired awareness seizures, which are typically associated with mesial temporal lobe epilepsy. ConclusionsOur findings suggest that nasal pain can occur as an epileptic aura in patients with temporal lobe epilepsy with probable involvement of the amygdala.

Bilateral Acute Subdural Hematoma without Subarachnoid Hemorrhage from a Ruptured Internal Carotid-Posterior Communicating Artery Aneurysm: A Case Report

Bilateral Acute Subdural Hematoma without Subarachnoid Hemorrhage from a Ruptured Internal Carotid-Posterior Communicating Artery Aneurysm: A Case Report

Clinical Characteristics and Aneurysmal Images of Internal Carotid-Posterior Communicating Artery Aneurysm Cases Assessed as Impending Ruptures and Treated with Emergency Surgery

Clinical Characteristics and Aneurysmal Images of Internal Carotid-Posterior Communicating Artery Aneurysm Cases Assessed as Impending Ruptures and Treated with Emergency Surgery

A Ruptured Internal Carotid-Posterior Communicating Artery Aneurysm with Pure Acute Subdural Hematoma and Oculomotor Palsy without Subarachnoid Hemorrhage: A Literature Review

A Ruptured Internal Carotid-Posterior Communicating Artery Aneurysm with Pure Acute Subdural Hematoma and Oculomotor Palsy without Subarachnoid Hemorrhage: A Literature Review

Comparison between Clipping and Coiling in Terms of Recovery from Oculomotor Nerve Palsy Induced by Internal Carotid-Posterior Communicating Artery Aneurysms

Comparison between Clipping and Coiling in Terms of Recovery from Oculomotor Nerve Palsy Induced by Internal Carotid-Posterior Communicating Artery Aneurysms

The Microsurgical Relationships between Internal Carotid-Posterior Communicating Artery Aneurysms and the Skull Base.

Objective This study aimed to review the anatomical and clinical characteristics of internal carotid-posterior communicating artery (IC-PC) aneurysms, especially those located close to the skull base. Methods The microsurgical anatomy around the posterior communicating artery (PComA) was examined in a dry skull and five formalin-fixed human cadaveric heads. The clinical characteristics of 37 patients with 39 IC-PC aneurysms, who were treated microsurgically between April 2008 and July 2016, were retrospectively reviewed. Results The anterior clinoid process (ACP), as well as the anterior petroclinoidal dural fold (APF), which forms part of the oculomotor triangle, are closely related to the origin of the PComA. Among the 39 IC-PC aneurysms, anterior clinoidectomy was performed on 4 (10.3%) and a partial resection of the APF was performed on 2 (5.1%). Both of these aneurysms projected inferior to the tentorium, or at least part of the aneurysm's dome was inferior to the tentorium. Conclusion Proximally located IC-PC aneurysms have an especially close relationship with the ACP and APF. We should be familiar with the anatomical relationship between IC-PC aneurysms and the structures of the skull base to avoid hazardous complications.

Delayed ischemic stroke due to stent marker band occlusion after stent-assisted coiling

A middle-aged patient with an internal carotid-posterior communicating artery aneurysm and basilar artery tip aneurysm was treated by stent-assisted coiling. One ischemic infarction and two transient ischemic attacks occurred with...

Microsurgical Relationships between Internal Carotid-Posterior Communicating Artery Aneurysms and Skull Base

Microsurgical Relationships between Internal Carotid-Posterior Communicating Artery Aneurysms and Skull Base

三叉神経痛にて発症した大型血栓化内頚動脈－後交通動脈瘤の1例

We report a case of a large thrombosed internal carotid-posterior communicating artery aneurysm presenting with atypical trigeminal neuralgia. A 67-year-old woman presented with atypical trigeminal neuralgia of the left ophthalmic nerve territory. The patient underwent several nerve block therapies for the pain, and the symptoms got better each time. The patient considered neurosurgery after a left oculomotor palsy occurred. Magnetic resonance imaging revealed a left partially thrombosed large internal carotid-posterior communicating artery aneurysm distorting the left trigeminal nerve. The aneurysm was successfully treated using the neck clipping method, following which, both the trigeminal neuralgia and oculomotor nerve palsy improved.

Infundibular dilatationから発生して破裂したと思われた内頚動脈-後交通動脈瘤の1例

Infundibular dilatationから発生して破裂したと思われた内頚動脈-後交通動脈瘤の1例

内頚動脈先端部より高位の内頚動脈-後交通動脈分岐部動脈瘤に対するクリッピング術─2症例報告─

内頚動脈先端部より高位の内頚動脈-後交通動脈分岐部動脈瘤に対するクリッピング術─2症例報告─

Relationship between Aging and Enlargement of Intracranial Aneurysms

To predict possible enlargement of cerebral aneurysms with aging, we retrospectively analyzed aneurysm size in relation to patient age and aneurysm site. We included 1332 unruptured and 2362 ruptured aneurysms detected in patients from the Yamaguchi Prefecture, Japan, from 1995 to 2005. Age-specific site distribution was not found in the unruptured aneurysms. In the ruptured aneurysms, the incidence of anterior communicating artery (AComA) aneurysms was higher than that of internal carotid posterior communicating (ICPC) artery aneurysms among the patients aged 40-49 years (32.6% versus 14.4%), whereas the difference was small among the elderly patients aged 70-79 years (25.8% versus 24.9%). In the AComA aneurysms, either in the unruptured or ruptured cases, no age-related change in size was found. In the ICPC aneurysms, either in the unruptured or in the ruptured cases, the size of the aneurysms 7 mm or larger increased with age. The sizes of AComA aneurysms may remain stable with aging. Therefore, the risk of rupture may be similar in young and elderly patients. Meanwhile, ICPC artery aneurysms may continue to grow throughout the patient's life, with an increasing risk of rupture.

Retreatment of Recurrent Internal Carotid-Posterior Communicating Artery Aneurysm after Coil Embolization.

Internal carotid-posterior communicating artery (IC-PC) aneurysms account for more than 20% of all intracranial aneurysms. As a result of the increase in coiling, there has also been an increase in recurrent IC-PC aneurysms after coiling. We present our experience of 10 recurrent IC-PC aneurysms after coiling that were retreated using surgical or endovascular techniques in order to discuss the choice of treatment and the points of clipping without removal of coils. From 2007 to 2014, 10 recurrent IC-PC aneurysms after coiling were retreated. When the previous frames covered the aneurysms all around or almost around except a part of the neck, coiling was chosen. In other cases, clipping was chosen. Clipping was attempted without removal of coils when it was technically feasible. Among the 10 IC-PC aneurysms retreated, 3 were retreated with coiling and 7 were retreated with clipping. In all three cases retreated with coiling, almost complete occlusion was accomplished. In the seven cases retreated with clipping, coil extrusion was observed during surgery in six cases. In most of them, it was necessary to dissect strong adhesions around the coiled aneurysms and to utilize temporary occlusion of the internal carotid artery. In all seven cases, neck clipping was accomplished without the removal of coils. There were no neurological complications in any cases. The management of recurrent lesions of embolized IC-PC aneurysms requires appropriate choice of treatment using both coiling and clipping. Clipping, especially without the removal of coils, plays an important role in safe treatment.

Post-ischemic hyperperfusion after clipping of a ruptured internal carotid-posterior communicating artery aneurysm under suction decompression

Abstract A 64-year-old woman presenting with subarachnoid hemorrhage (World Federation of Neurosurgeons grade IV) from the rupture of a right large internal carotid-posterior communicating artery aneurysm suffered neuronal damage associated with post-ischemic hyperperfusion after neck clipping of the aneurysm under suction decompression. She did not completely recover consciousness after the operation. Diffusion-weighted imaging (DWI) performed on the first postoperative day showed subtle cortical hyperintensity in the parietal lobe. Arterial spin-labeling (ASL) and 123 I-iodoamphetamine ( 123 I-IMP) single photon emission computed tomography (SPECT) demonstrated hyperperfusion in the right temporo-parietal lobes. Delayed 123 I-iomazenil ( 123 I-IMZ) SPECT images showed a reduced IMZ uptake in the right temporo-parietal lobe corresponding to the hyperperfusion area on ASL images. DWI repeated on postoperative day 3 revealed progression of a hyperintensity lesion in the right parietal lobe. Blood pressure control and the use of a free radical scavenger relieved her symptoms. One month later, the area of reduced IMZ uptake was further expanded. Our findings suggest that post-ischemic hyperperfusion after suction decompression may result in neuronal damage demonstrated on 123 I-IMZ SPECT images.

くも膜下出血を伴わない急性硬膜下血腫で発症した内頸動脈－後交通動脈分岐部破裂脳動脈瘤の1 例

くも膜下出血を伴わない急性硬膜下血腫で発症した内頸動脈－後交通動脈分岐部破裂脳動脈瘤の1 例

Morphological differences between the aneurysmal and normal artery in patients with internal carotid–posterior communicating artery aneurysm

The aim of this study was to identify image-based morphological parameters that correlated with the formation of internal carotid artery–posterior communicating artery (ICA–PcomA) aneurysms. Morphological parameters obtained from 3-dimensional digital subtraction angiography (3D-DSA) were evaluated from nine patients with ICA–PcomA aneurysms, including the diameter of the ICA (Dica) and PcomA (Dpcom), the angle between the ICA and the origin of the PcomA (Apcom), and the angle between the ophthalmic and communicating segments of the ICA (Aica). Measurements were performed on both sides of each patient. Parameters were analyzed with a paired-samples t-test for significance. In additional, receiver operating characteristic (ROC) analysis was performed on the significant parameter. Statistically significant differences were found between the aneurysmal (45.28±29.07°) and control sides (79.22±17.83°) for Apcom (p=0.020). In the ROC analysis, the area under the curve value of Apcom was 0.852, and the threshold for optimal sensitivity and specificity was 52.25°. Therefore, the Apcom parameter was correlated with the formation of an ICA–PcomA aneurysm, and seems to be a promising morphological parameter for risk assessment of aneurysm formation.