True Posterior Communicating Artery Aneurysms: Report of 17 Surgically Treated Patients and Review of the Literature

Abstract

Background and aims: True posterior communicating artery (PCoA) aneurysms have been grouped simply in more common PCoA aneurysms traditionally and have not been well studied as a single entity. The present study was undertaken to describe our experience of diagnosis and surgical treatment of 17 patients and review the literature.

Methods: Between Jan 2010 and Dec 2015, we treated 17 true PCoA aneurysms. Diagnosis of these true PCoA aneurysms was confirmed by preoperative angiography and findings intraoperative. Of these 17 aneurysms, 13 were treated with endovascular intervention, the other 4 with microsurgical clipping. Follow-up outcomes were evaluated using the Glasgow Outcome Scale (GOS).

Results: All the 17 true PCoA aneurysms were distal to the junction of internal cerebral artery (ICA) and PCoA. Sixteen patients had fetal PCA. The procedure of microsurgery in 4 patients was uneventful. There were no surgery-related complications or subsequent hemorrhage. 12 aneurysms underwent complete embolization while one got near-complete embolization. There were no aneurysm recurrence as per the follow-up angiograms in all patients. 16 patients recovered well (GOS score 5), and the other one whose preoperative Hunt-Hess grade was IV was moderate disability (GOS score 4).

Conclusion: Diagnosis of a true PCoA aneurysm is difficult sometimes because of the vessel-complex visualization. Successful treatment of this entity requires a good apprehension of the location and three-dimensional configurations of the aneurysm, which is somewhat different in detail from a common ICA-PCoA conjunctional aneurysm.

Keywords: Clipping; diagnosis; endovascular embolization; true PCoA aneurysm.