Distal Posterior Cerebral Artery Ruptured Aneurysm: A Rare Case Report and Review of Literature

Abstract

Distal posterior cerebral artery aneurysms consist of a rare vascular entity whose treatment approach remains challenging. Few studies exist scarcely in the literature reporting cases of P4 ruptured aneurysms. In this study, we present the case of a 49-year-old female patient who was admitted to our Neurosurgery Department with the World Federation of Neurological Surgeons grade IV, Fischer grade IV subarachnoid hemorrhage due to a right distal posterior cerebral artery aneurysm. She successfully underwent surgery via a posterior occipital interhemispheric approach. The patient recovered well from surgery, and the following days, she was successfully extubated and had a significant neurological improvement. However, she died during her rehabilitation due to sepsis and severe acute respiratory distress syndrome.

Keywords

posterior cerebral artery - ruptured distal PCA aneurysm - clipping - subarachnoid hemorrhage

Publication History

Article published online:
24 August 2022

• References

• 1 Gerber CJ, Neil-Dwyer G. A review of the management of 15 cases of aneurysms of the posterior cerebral artery. Br J Neurosurg 1992; 6 (06) 521-527
• 2 Sakata S, Fujii K, Matsushima T. et al. Aneurysm of the posterior cerebral artery: report of eleven cases—surgical approaches and procedures. Neurosurgery 1993; 32 (02) 163-167
• 3 Orita T, Tsurutani T, Izumihara A. et al. Distal posterior cerebral artery aneurysms—three case reports. Neurol Med Chir (Tokyo) 1994; 34 (10) 692-696
• 4 Zeal AA, Rhoton Jr AL. Microsurgical anatomy of the posterior cerebral artery. J Neurosurg 1978; 48 (04) 534-559
• 5 Kalamatianos T, Mavridis IN, Karakosta E. et al. The parieto-occipital artery revisited: a microsurgical anatomic study. World Neurosurg 2019; 126: e1130-e1139
• 6 Burton C, Velasco F, Dorman J. Traumatic Aneurysm of a Peripheral Cerebral Artery. J Neurosurg 1968; 28 (05) 468-74
• 7 Ishikawa M, Waga S, Moritake K. et al. Cerebral bacterial aneurysms: report of three cases. Surg Neurol 1974; 2 (04) 257-261
• 8 Pia HW, Fontana H. Aneurysms of the posterior cerebral artery. Locations and clinical pictures. Acta Neurochir (Wien) 1977; 38 1-2 13-35
• 9 Tanaka Y, Takeuchi K, Akai K. Intracranial ruptured aneurysm accompanying moyamoya phenomenon. Acta Neurochir (Wien) 1980; 52 (1-2): 35-43
• 10 Ishibashi Y, Onuma T. Peripheral branch (P4 segment) aneurysm of the posterior cerebral artery: a case report. No Shinkei Geka 1989; 17 (07) 659-662
• 11 Statham P, Johnston R, Coutinho C. et al. Double giant fusiform aneurysms of the posterior cerebral artery. Surg Neurol 1990; 33 (01) 48-51
• 12 Barker CS. Peripheral cerebral aneurysm associated with a glioma. Neuroradiology 1992; 34 (01) 30-32
• 13 Orita T, Tsurutani T, Izumihara A. et al. Distal posterior cerebral artery aneurysms-three case reports. Neurol Med Chir (Tokyo) 1994; 34 (10) 692-696
• 14 Ito N, Shiokawa Y, Ide K. et al. A case of ruptured P4 segment aneurysm of the posteior cerebral artery: therapeutic pitfalls encountered when dealing with the multiple intracranial aneurysms. No Shinkei Geka 1998; 26 (07) 639-643
• 15 Ramakrishnamurthy TV, Purohit AK, Sundaram C. et al. Distal calcarine fusiform aneurysm: a case report and review of literature. Neurol India 1999; 47 (04) 318-320
• 16 Hashimoto Y, Takayama K, Inoue M. et al. A case of distal posterior cerebral artery aneurysm associated with occlusion of the internal carotid artery. No Shinkei Geka 2000; 28 (08) 725-729
• 17 Ciceri EF, Klucznik RP, Grossman RG. et al. Aneurysms of the posterior cerebral artery: classification and endovascular treatment. AJNR Am J Neuroradiol 2021; 22 (01) 27-34
• 18 Andreou A, Ioannidis I, Mitsos A. et al. Endovascular treatment of peripheral intracranial aneurysms. AJNR Am J Neuroradiol 2007; 28 (02) 355-361
• 19 Yamahata H, Tokimura H, Hirabaru M. et al. Aneurysm on the cortical branch (P4 segment) of the posterior cerebral artery. Case report. Neurol Med Chir (Tokyo) 2010; 50 (12) 1084-1087
• 20 Mulero P, Nuñez E, Utiel E. et al. Atypical presentation of a distal cerebral aneurysm: Location and outcome in a young woman. Neurologia 2016; 31 (09) 641-642
• 21 Kawabata M, Kono K, Terada T. et al. Distal posterior cerebral artery aneurysm at the P4 segment: a case report. No Shinkei Geka 2014; 42 (09) 873-878