title: [Management and microsurgical treatment of infundibular dilatations of the posterior communicating artery. Series of nine cases and review of the literature].
abstract: BACKGROUND
  The infundibular dilatation (ID) of the posterior communicating (PCom) artery is defined as the conic, triangular or infundibular shaped, less than 3mm wide, origin of the PCom artery from the internal carotid artery. The purpose of this paper is to present the personal experience in the microsurgical management of the ID, to review the literature and to propose some algorithms to improve its clinical and microsurgical management.
  
  
  METHODS
  Nine cases of ID have been operated on through a pterional approach. In four patients with subarachnoid hemorrhage (SAH) the ID was considered as the potential source of the bleeding; in four cases the ID was treated after a SAH due to the rupture of an aneurysm; finally, an ID was treated in patient with diagnosis of pseudoxantoma elasticum.
  
  
  RESULTS
  In eight cases the ID was clipped and the Pcom artery subsequently occluded and in the remaining case the ID was associated with a fetal PComA and the ID was reinforced. There were no complications excepting a transitory third cranial nerve paresis. The Glasgow Outcome Scale was 5 in all cases at discharge and one year later.
  
  
  CONCLUSIONS
  The true significance of the ID remains unknown, but in some instances it is necessary to consider its management: 1. In patients with ruptured aneurysms submitted to microsurgical clipping and with an ipsilateral ID, the lesion must be explored and treated; 2. In patients with ruptured aneurysms treated with endovascular procedures or harbouring an ID contralateral to a microsurgically treated aneurysm, the microsurgical indication will be done after considering all risk factors; 3. In patients with SAH and an ID as the only potential source of the bleeding there would be an indication for microsurgical exploration; 4. The incidental finding of an ID should be indication for observation in absence of major risk factors.
authors.affiliation: Servicio de Neurocirugía. Hospital Clínico Universitario de Valencia. Servicio Valenciano de Salud. gonzalez_jos@gva.es
authors.forename: J M
authors.initials: JM
authors.lastname: González-Darder
authors.forename: F
authors.initials: F
authors.lastname: Verdú-López
authors.forename: V
authors.initials: V
authors.lastname: Quilis-Quesada
mesh_terms: D000328:Adult; D000465:Algorithms; D004108:Dilatation, Pathologic / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D066298:In Vitro Techniques; D002532:Intracranial Aneurysm / Q000473:pathology* / Q000601:surgery*; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010904:Pituitary Gland, Posterior / Q000473:pathology*; D012189:Retrospective Studies