Posterior Communicating Artery Aneurysm Research Articles

Mural destabilization after aneurysm treatment with a flow-diverting device: a report of two cases

BackgroundFlow-diverting stents have demonstrated great promise for the treatment of cerebral aneurysms; however, clinical experience with the devices remains very preliminary. We present two cases of spontaneous delayed complications—one fatal...

Preoperative Evaluation of Unruptured Cerebral Aneurysms by Fast Imaging Employing Steady-State Acquisition Image

In aneurysm surgery, understanding the microanatomy around the aneurysm such as perforating arteries and cranial nerves is mandatory. To assess the usefulness in determining the microanatomy around the cerebral aneurysms by the use of fast imaging employing steady-state acquisition (FIESTA) images of magnetic resonance imaging preoperatively, in addition to computed tomography and digital subtraction angiography. Between October 2006 and June 2009, 123 patients with 140 unruptured cerebral aneurysms were treated in our institution. Eighty-two patients were assessed with FIESTA by the operators on the workstation of the magnetic resonance image before surgical clipping of the aneurysms. The small vessels and cranial nerves were confirmed intraoperatively before or after obliteration of the aneurysms. Sensitivities and specificities of FIESTA imaging were 100% in detecting hypothalamic artery around anterior communicating artery aneurysms, oculomotor nerve attachment to the posterior communicating artery aneurysm domes, and anterior choroidal artery adhesion to the posterior communicating artery aneurysms. This technique was also useful for predicting adhesion between the aneurysm and adjacent main trunks or perforators. Although the specificity was 100%, sensitivity was 56% in detecting vessel adhesion around the middle cerebral aneurysms. This technique can provide limited information in large aneurysms or aneurysms located in minimal cerebrospinal fluid space. The overall outcomes of the patients included 120 excellent recoveries, 1 moderate deficit, 1 severe deficit, and 1 persistent vegetative state according to the Glasgow Outcome Scale. By giving information on the minute anatomical structure around the aneurysm, FIESTA can contribute to thorough preoperative evaluations of cerebral aneurysms.

Subarachnoid hemorrhage secondary to ruptured posterior communicating artery aneurysm in a child

Intracranial arterial aneurysms in children are very rare. The authors present the clinical and neuroradiological findings in a 12-year-old child with subarachnoid and intraventricular hemorrhage related to posterior communicating artery aneurysm. The aneurysm was successfully treated with endovascular coiling. The literature regarding this topic is reviewed and the management of subarachnoid hemorrhage in children is discussed.

Posterior communicating artery aneurysm rupture mimicking apoplexy

Background:Cerebral aneurysm rupture can lead to devastating neurological complications and present a complex problem to treat. We report a unique case of a ruptured posterior communicating artery (PCoA) aneurysm presenting with sudden and complete vision loss.Case Description:A 39-year-old man presented with the acute onset of severe headache and complete bilateral vision loss. The patient described headaches for several months prior to presentation. However, prior to the day of presentation, he had no visual disturbance. A CT angiogram (CTA) and magnetic resonance imaging (MRI) of the brain revealed a 1.6-cm, non-contrast enhancing suprasellar mass, eccentric to the left side, consistent with hemorrhagic mass. There was no obvious aneurysm or vascular malformation. The sella tursica was normal in appearance. The patient was taken for an immediate endoscopic endonasal transtuberculum approach for optic nerve decompression. Hematoma without an associated tumor was encountered and partially evacuated before aborting with resultant partial improvement in vision. A subsequent cerebral angiogram revealed an irregularly shaped, postero-laterally pointing, 2.5-mm left PCoA aneurysm. The patient was then taken for open clipping of the ruptured aneurysm. A large, fibrinous capsule was found over the superolateral aspect of the aneurysm. The ruptured aneurysm was secured with clips and the surrounding hematoma was evacuated.Conclusion:In the immediate postoperative period, the patient regained vision in the nasal field of his right eye. This case illustrates a unique presentation of a ruptured PCoA aneurysm, and thus must be considered in the differential diagnosis of a suprasellar hemorrhage resulting in visual loss in absence of a recognizable associated tumor.

Ruptured de novo posterior communicating artery aneurysm associated with arteriosclerotic stenosis of the internal carotid artery at the supraclinoid portion

Background:Several de novo intracranial aneurysms have been described related to changes in hemodynamics after therapeutic occlusion of internal carotid artery (ICA); however, de novo aneurysms related to a supraclinoid arteriosclerotic stenosis of the ICA have not been described yet. Authors consider that it is important to bear in mind the possibility of developing an aneurysm in these special conditions.Case Description:The evolution of a 62-year-old patient with subarachnoid hemorrhage, intraparenchymal frontal hematoma with some atypical circumstances that were presented together as well as the treatment he received are shown in this report. We can see this patient suffered a right thalamic hemorrhage at the age of 51 years; this condition was associated to a severe atherosclerotic stenosis of right supraclinoid ICAy. A long term had elapsed since the diagnosis of the stenosis and the discovery of a ruptured ipsilateral de novo supraclinoid internal carotid artery-posterior communicating artery (ICA-PcomA) aneurysm.Conclusions:It seems like both conditions: the atherosclerotic supraclinoid ICA which tells of an Samano et at: Ruptured De Novo PcomA Aneurysm Associated with Arteriosclerotic Stenosis of Supraclinoid ICA. Altered vessel environment coupled to a long exposure time, hemodynamic changes, unbalance in the wall sheer stress could all of them lead to the development of the de novo aneurysm.

De novo basilar tip aneurysm. Case report and literature review

The de novo aneurysms are the formation of new aneurysms in a location previously observed to be normal by a cerebral angiography or direct microsurgical exploration. In this report, we present a review of the theme and describe a case of a ruptured de novo basilar tip aneurysm in a patient previously treated with carotid occlusion for a giant intracavernous aneurysm and microsurgical clipping of contralateral posterior communicating artery aneurysm.

True Posterior Communicating Artery Aneurysms

True Posterior Communicating Artery Aneurysms

Oculomotor nerve palsy in the setting of an anterior cerebral A2 segment aneurysm

IntroductionA case is presented which highlights a rare cause of oculomotor nerve palsy (third nerve palsy) in the setting of subarachnoid hemorrhage secondary to an A2 segment anterior cerebral aneurysm....

Microsurgical removal of Onyx HD-500 from an aneurysm for relief of brainstem compression

The authors report the successful removal of Onyx HD-500 from an aneurysm sac by means of ultrasonic aspiration. This 46-year-old woman presented with progressive spasms of her left arm and leg due to mass effect and compression on the right cerebral peduncle 5 years after endovascular treatment of an unruptured giant posterior communicating artery aneurysm with Onyx HD-500. No filling of the aneurysm was detected on angiography. The patient underwent a right pterional craniotomy and the aneurysm was opened to remove the Onyx mass. However, contrary to expectations, the aneurysm was still patent, filling with blood between the Onyx mass and the aneurysm wall. Under temporary clipping of the carotid artery, the Onyx mass within the aneurysm was removed in a piecemeal fashion using an ultrasonic aspirator and the aneurysm was then successfully clipped. The patient experienced significant improvement of the spasm after surgery. Angiography showed complete occlusion of the posterior communicating artery aneurysm. It is rarely necessary to remove embolization material such as Onyx HD-500, and little is known about the most appropriate surgical technique. This case report demonstrates that removal can be safely accomplished by means of ultrasonic aspiration.

Two cases of ruptured cerebral aneurysms presenting with contralateral hematomas

We present two cases of hematoma contralateral to the aneurysm. Case 1 is a 62-year-old woman presenting with a large left frontal intraparenchymal hematoma (IPH) and a right posterior communicating artery (PCoA) aneurysm. This is the first reported case of a contralateral frontal IPH from PCoA aneurysm rupture. Case 2 is a 58-year-old male with right PCoA aneurysm and left sylvian SAH. Both patients underwent coil embolization of offending lesions, with repeat angiograms revealing no other vascular anomalies.

Distal Embolism of Percutaneous Arterial Closure Device Resulting in Critical Limb Ischemia

Distal Embolism of Percutaneous Arterial Closure Device Resulting in Critical Limb Ischemia

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.

A 5-year retrospective study assessing the association between seasonal and meteorological change and incidence of aneurysmal subarachnoid haemorrhage

Objective. Seasonal variation in incidence of spontaneous subarachnoid haemorrhage (SAH) is well recognised. This retrospective single-centre study aimed to characterise seasonality of SAH in the temperate climate of London, UK and to determine associations of incidence with meteorological variables. We further investigated whether associations vary according to location of aneurysm.Methods. Admission data on 647 patients admitted with spontaneous SAH from December 2003 to August 2008 was analysed using our neurosurgical referrals database. Average monthly incidence of SAH was correlated with local temperature, atmospheric pressure and humidity data. In a subset of 467 patients, impact of aneurysm location on seasonal variation was evaluated.Results. A non-significant bi-annual peak incidence was observed in Spring and Autumn with a trough in Summer (χ2 = 1.5, p = 0.47). This trend was particularly marked with middle cerebral and posterior communicating artery aneurysms. However, anterior communicating artery aneurysmal SAH peaked in Summer only. SAH incidence correlated significantly with average humidity (coefficient 0.213, CI (0.02–0.404), p = 0.035) and peak humidity (coefficient 0.128, CI (0.008–0.248), p = 0.041). Temperature and atmospheric pressure did not correlate with incidence.Conclusions. This study illustrates a pattern of variation in SAH incidence similar to that seen in other populations and climates. However, our data suggests that this pattern differs according to aneurysm location. Unusually, we also find that humidity, and not temperature or atmospheric pressure, correlates with SAH incidence. Seasonal variability in aneurysm rupture is likely to be multifactorial, but meteorological factors may play an important role.

Coiling versus Clipping for Posterior Communicating Artery Aneurysms Associated with Oculomotor Nerve Palsy: Only Time Will Tell

Coiling versus Clipping for Posterior Communicating Artery Aneurysms Associated with Oculomotor Nerve Palsy: Only Time Will Tell

E-062 True aneurysms of the posterior communicating artery: a systematic review and meta-analysis of individual patient data

IntroductionThe term ‘true’ posterior communicating artery (PCoA) aneurysm refers to an aneurysm that originates from the posterior communicating artery itself. Over the past decades, an increasing number of this type...

E-020 Circle of Willis anomalies are associated with ruptured cerebral aneurysms

Introduction and purposeCurrent methods to risk stratify patients with unruptured cerebral aneurysms are based on limited natural history data. Circle of Willis variations are thought to contribute to aneurysm development...

E-053 Anomalous origin of the middle meningeal artery from mid-basilar artery

IntroductionThe middle meningeal artery (MMA) most commonly originates from the maxillary artery and travels through the foramen spinosum. Most variants have been noted to originate from the ophthalmic artery or...

O-018 A new hemodynamic parameter: energy loss to anticipate aneurysm rupture

PurposeDifferent hemodynamic models have been studied for the need to estimate the rupture risk of cerebral aneurysms with variable success. We postulated that the transfer of energy by the interaction...

Posterior Communicating Artery Aneurysms

Objective The posterior communicating artery aneurysms correspond on 25% of all ruptured aneurysms. The clinical course is typically a subarachnoid hemorrhage and third nerve palsy. We intend to introduce a new classification for PComA aneurysms to help neurosurgeons in day-to-day practice present. We review our experience in PComA aneurysms and discuss the main factors involving morbidity, mortality, signs and symptoms, and prognosis of these aneurysms. Material and Methods We reviewed historical records, images, surgical videos, and CDs of 46 surgically clipped aneurysms in 39 patients from June 2000 to July 2009, in 2 Institutions: Hospital São Camilo and Santa Paula, São Paulo, Brazil. They were classified in 2 groups, the A group composed by patients who presented subarachnoid hemorrhage in acute phase and the B group composed by incidental aneurysms carriers. All patients were classified according to Hunt-Hess scale. Results The average age found was 53.6 years old (min 28 to Max 92). The incidence was higher among women (3.6:1). Worse outcomes were observed in group A. The mortality rate was 20% in group A and zero cases in group B. Similar rate was found for rupture cases (20% in A group vs zero in B group). Morbidity was similar for both groups. The mean aneurismal size for A group was 6 mm (ranging from 5 to 25 mm) and 5.3 mm (ranging from 3 to 10 mm) for B group. Conclusions Posterior communicating artery aneurysms occurred 3 to 4 times more frequently in women than man. Oculomotor palsy associated with severe headache were commonly related to posterior circulation aneurysms. Type II aneurysms (temporal) were the most frequently found in our study. The worst prognosis in cases with acute bleeding occurred with fetal variant circulation. Intratentorial aneurysms, mainly those with increased Hunt-Hess, have the worst prognosis. Infundibular aneurysms had the best results with surgical clipping.

True Posterior Communicating Artery Aneurysm Associated with Arteriovenous Malformation: First Report and Literature Review with Special Focus on Flow Alterations

True Posterior Communicating Artery Aneurysm Associated with Arteriovenous Malformation: First Report and Literature Review with Special Focus on Flow Alterations