Saccular aneurysm associated with posterior cerebral artery fenestration manifesting as a subarachnoid hemorrhage in a child

Abstract

Fenestrations of the cerebral arteries are uncommon, and aneurysms in association with fenestrations are even more uncommon. We report the case of a saccular aneurysm associated with a posterior cerebral artery fenestration in a child with subarachnoid hemorrhage. The patient was successfully treated with Guglielmi detachable coils. This case is unusual because of the patient's age and the location of the fenestration.

Fig 1.

Cerebral angiograms obtained with a left vertebral artery injection. A saccular aneurysm (arrow) is present at the proximal end of a duplication of the right posterior cerebral artery that bridges the P1-P2 segment and the right P2-P3 segment. The duplicated segment of the right posterior cerebral artery has a stepwise configuration (arrowhead in B). A, Anteroposterior view. B, Lateral view.

Fig 2.

Superselective angiograms of a duplicated right posterior cerebral artery. A laterally and inferiorly pointing saccular aneurysm (arrow) has a broad connection (arrowhead in B) to the parent artery. The proximal portion of the duplicated segment in the quadrigeminal cistern has a stepwise configuration. A, Anteroposterior view B, Lateral view.

Fig 3.

Cerebral angiogram obtained with a left vertebral artery injection. The aneurysm is totally obliterated (arrow). The right posterior cerebral artery duplication is patent. A, Anteroposterior view. B, Lateral view.

Fig 4.

Anteroposterior cerebral angiogram obtained with a left vertebral artery injection during aneurysm treatment. The aneurysm is obliterated (arrow). The duplicated segment of the right posterior communicating artery is not seen because the microcatheter is across the fenestration (arrowhead).