Surgical Treatment for a Ruptured True Posterior Communicating Artery Aneurysm Arising on the Fetal-Type Posterior Communicating Artery －Two Case Reports and Review of the Literature－

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  • NAKANO Yoshiteru
    Department of Neurosurgery, School of Medicine, University of Occupational and Environmental Health
  • SAITO Takeshi
    Department of Neurosurgery, School of Medicine, University of Occupational and Environmental Health
  • YAMAMOTO Junkoh
    Department of Neurosurgery, School of Medicine, University of Occupational and Environmental Health
  • TAKAHASHI Mayu
    Department of Neurosurgery, School of Medicine, University of Occupational and Environmental Health
  • AKIBA Daisuke
    Department of Neurosurgery, School of Medicine, University of Occupational and Environmental Health
  • KITAGAWA Takehiro
    Department of Neurosurgery, School of Medicine, University of Occupational and Environmental Health
  • MIYAOKA Ryo
    Department of Neurosurgery, School of Medicine, University of Occupational and Environmental Health
  • UETA Kunihiro
    Department of Neurosurgery, School of Medicine, University of Occupational and Environmental Health
  • KUROKAWA Toru
    Department of Neurosurgery, School of Medicine, University of Occupational and Environmental Health
  • NISHIZAWA Shigeru
    Department of Neurosurgery, School of Medicine, University of Occupational and Environmental Health

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Other Title
  • 胎児型後交通動脈から生じた真性後交通動脈瘤破裂症例に対する外科的治療

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Abstract

Only a small number of aneurysms arising on the posterior communicating artery itself (true Pcom aneurysm) have been reported. We report two cases of ruptured true Pcom aneurysms with some characteristic features of true Pcom aneurysm. A 43 year old man suffering from subarachnoid hemorrhage (SAH) had an aneurysm arising on the fetal-type Pcom artery itself, and underwent surgery for clipping. Most of the aneurysm was buried in the temporal lobe, so retraction of the temporal lobe was mandatory. During the retraction, premature rupture was encountered. After tentative dome clipping and the control of bleeding, complete clipping was achieved. Another patient, a 71 year old woman presenting with consciousness disturbance due to SAH, had an aneurysm on the fetal-type Pcom artery itself, and underwent surgery for clipping. It has been generally considered that hemodynamic factor plays an important role in the formation, the growth, and the rupture of the cerebral aneurysm. This factor is especially significant in true Pcom aneurysm formation and rupture. According to the literature, a combination of fetal type Pcom and formation of the true Pcom aneurysm has been reported in most cases (81.8%). Most of the aneurysm can be buried in the temporal lobe, and the retraction of the temporal lobe during the dissection of the neck would be necessary, which causes premature rupture of the true Pcom aneurysm. In the surgery for a true Pcom aneurysm, we should be aware of possible premature rupture when temporal lobe retraction is necessary.

Journal

  • Journal of UOEH

    Journal of UOEH 33 (4), 303-312, 2011

    The University of Occupational and Environmental Health, Japan

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