title: Direct clip obliteration of a ruptured giant aneurysm of the posterior communicating artery: case report.
abstract: OBJECTIVE
  A review of the literature documents that giant posterior communicating artery (PCoA) aneurysms are rare. To our knowledge, this report is the first to describe a ruptured giant aneurysm arising from a PCoA that was successfully clipped.
  
  
  METHODS
  A 27-year-old man had a left oculomotor palsy and then suffered a subarachnoid hemorrhage. Cerebral angiography and three-dimensional computed tomographic angiography revealed a giant fusiform aneurysm of the left PCoA. These imaging techniques documented the rapid growth of the aneurysm from a moderate to a giant size in fewer than 3 days.
  
  
  METHODS
  The patient underwent a left subtemporal craniotomy. The neck was constructed and was successfully clipped, and the PCoA was reconstructed with five sequentially placed fenestrated clips in a tandem fashion. The patient experienced a good recovery.
  
  
  CONCLUSIONS
  This report describes the usefulness of three-dimensional computed tomographic angiography in planning the surgical approach to giant aneurysms originating from the PCoA and the use of fenestrated clips to obliterate giant fusiform aneurysms.
authors.affiliation: Department of Neurological Surgery, Okayama University Medical School, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Matsumoto
authors.forename: M
authors.initials: M
authors.lastname: Kuriyama
authors.forename: T
authors.initials: T
authors.lastname: Tamiya
authors.forename: T
authors.initials: T
authors.lastname: Ohmoto
mesh_terms: D000328:Adult; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D006801:Humans; D007091:Image Processing, Computer-Assisted; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000601:surgery*; D013525:Surgical Instruments; D014057:Tomography, X-Ray Computed; D017287:Ventriculoperitoneal Shunt