title: [Case of clipping of a ruptured aneurysm of the posterior cerebral artery (P2) via the transchoroidal-fissure approach].
abstract: A 59-year-old female was found to be drawn in a swimming pool and transferred to our hospital. The patient was comatose on admission (Hunt & Kosnk: Grade IV). Computed tomography (CT) showed diffuse subarachnoid hemorrhage (SAH) with thick hematoma in the left ambient cistern. Conventional cerebral angiography and 3D-digital subtraction angiography revealed aneurysms (ANs) of the left posterior cerebral artery (P2), and bifurcation of the left internal carotid and posterior communicating arteries (IC-PC). Successful neck clipping was performed the same day through the temporal horn via the insula for ruptured P2 AN, and the non-ruptured IC-PC AN was also obliterated using a pterional approach. Postoperative course was uneventful except for initial disturbance of consciousness and aphasia. The patient was discharged with no neurological deficit 1 month after surgery. This approach may be preferable in cases involving high positioned PCA AN in the ambient cistern, particularly in the acute phase of severe SAH, as the brain is protected from the detrimental effects of strong temporal retraction and a wider working space is provided.
authors.affiliation: Department of Neurosurgery, Ehime Prefectural Central Hospital, Kasugamachi 83, Matsuyama-shi, Ehime 790-0024, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Inoue
authors.forename: Kanehisa
authors.initials: K
authors.lastname: Kohno
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Takeda
authors.forename: Akihiko
authors.initials: A
authors.lastname: Takechi
authors.forename: Keiji
authors.initials: K
authors.lastname: Kohno
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Yamaguchi
authors.forename: Daizo
authors.initials: D
authors.lastname: Ishii
authors.forename: Ushio
authors.initials: U
authors.lastname: Sasaki
mesh_terms: D017542:Aneurysm, Ruptured / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000209:etiology; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*