[Aneurysm at the PCA posterior temporal artery junction: a case report]

Abstract

A case of saccular aneurysm located at the PCA posterior temporal artery junction (E portion of PCA) was reported. A 35-year-old man was referred to us for surgical treatment of intracerebral hematoma in the right temporo-parietal lobes. On admission, the patient was somnolent and there was right oculomotor palsy, left homonymous hemianopsia and left hemiparesis. Left vertebral angiograms revealed a saccular aneurysm at the quadrigeminal segment of the posterior cerebral artery on the right. The hematoma was immediately evacuated by temporal corticotomy, and three weeks later, trapping of the aneurysm was performed through subtemporal approach. Postoperative course was uneventful. However, the left homonymous hemianopsia persisted. This was the only symptom which did persist. The incidence of PCA aneurysm is 1% in all cerebral aneurysms, or 15% in aneurysms of the posterior circulation. The majority of those are located at the junction proximal to the PCA-anterior temporal artery, or proximal to the PCA-posterior lateral choroidal artery junction. In the present case, the aneurysm was located more distally at the PCA-posterior temporal artery junction, and aneurysm at this site has been reported only six times in the literature. In addition to the present case, we reviewed 41 cases (42 aneurysms) in the literature, concerning the operative method and postoperative neurological deficits for the aneurysms of PCA. Neck clipping was performed in 23 cases without any further neurological deficits and trapping or proximal clipping of the aneurysms was performed in 16 cases, in which new neurological deficits developed in 3 cases.