Microsurgical Treatment of Posterior Cerebral Artery Aneurysm (P2P Segment): Case Report and Review of the Literature

Abstract

Introduction Aneurysms of the posterior cerebral artery (PCA) represent ∼ 1% of all intracranial aneurysms and usually present with subarachnoid hemorrhage.

Objective The aim of the present study is to describe the case of an adult man presenting a saccular aneurysm of the right PCA at the posterior half of the postcommunicating (P2P) segment, and to discuss the technical nuances of the approach and of the clipping process.

Case Report An investigation of a chronic headache in a 55-year-old man found a saccular aneurysm located just posterior to the most lateral portion of the right cerebral peduncle. A digital subtraction arteriography revealed a 7.8 mm × 5.6 mm × 4.8 mm posterior-medial projecting aneurysm of the right PCA at the P2P segment. A subtemporal approach was performed with partial aspiration of the right parahippocampal gyrus for a better exposure of the vascular structures. A proximal temporary occlusion of the PCA was performed at the anterior half of the postcommunicating P2A segment. The aneurysm was clipped with two semi-curved clips. The patient presented an uneventful recovery and was discharged from the hospital on the third postoperative day without any additional neurological deficits.

Conclusion Aneurysms of the PCA are an uncommon vascular disease that challenges the ability of the neurosurgeons due to their many anatomical nuances, to their vast number of perforators, and to the risk of bleeding. However, the operative management of aneurysms of the PCA is technically feasible, safe and effective when performed respecting microsurgical principles.

Resumo

Introdução Aneurismas da artéria cerebral posterior (PCA) representam aproximadamente 1% de todos os aneurismas intracranianos e usualmente apresentam hemorragia subaracnoidea.

Objetivo O objetivo do presente estudo é descrever o caso de um homem adulto portador de aneurisma sacular da PCA direita, segmento P2P, e discutir as nuances técnicas da abordagem e do processo de clipagem.

Relato de caso Um homem de 55 anos investigando cefaléia crônica descobriu a presença de um aneurisma sacular localizado logo após a porção mais lateral do pedúnculo cerebral direito. A arteriografia de subtração digital revelou um aneurisma de projeção póstero-medial de 7,8 mm x 5,6 m x 4,8 mm da PCA direita, segmento P2P. Uma abordagem subtemporal foi realizada com aspiração parcial do giro para-hipocampal direito para melhor exposição das estruturas vasculares. A oclusão temporária proximal do PCA foi realizada no segmento P2A. O aneurisma foi clipado com dois clipes semi-curvos. A paciente apresentou uma recuperação sem complicações e recebeu alta hospitalar no terceiro dia pós-operatório sem apresentar nenhum déficit neurológico adicional.

Conclusão O aneurisma da PCA é uma doença vascular incomum que desafia a capacidade do neurocirurgião devido às inúmeras nuances anatômicas, grande número de perfurantes e risco de sangramento. Entretanto, o manejo cirúrgico do aneurisma da PCA é tecnicamente viável, seguro e eficaz quando realizado respeitando-se os princípios microcirúrgicos.

Keywords

posterior cerebral artery (PCA) - aneurysm

Palavras Chave

artéria cerebral posterior - aneurisma

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