title: Surgical treatment for a ruptured true posterior communicating artery aneurysm arising on the fetal-type posterior communicating artery--two case reports and review of the literature.
abstract: Only a small number of aneurysms arising on the posterior communicating artery itself (true Pcom aneurysm) have been reported. We report two cases of ruptured true Pcom aneurysms with some characteristic features of true Pcom aneurysm. A 43 year old man suffering from subarachnoid hemorrhage (SAH) had an aneurysm arising on the fetal-type Pcom artery itself, and underwent surgery for clipping. Most of the aneurysm was buried in the temporal lobe, so retraction of the temporal lobe was mandatory. During the retraction, premature rupture was encountered. After tentative dome clipping and the control of bleeding, complete clipping was achieved. Another patient, a 71 year old woman presenting with consciousness disturbance due to SAH, had an aneurysm on the fetal-type Pcom artery itself, and underwent surgery for clipping. It has been generally considered that hemodynamic factor plays an important role in the formation, the growth, and the rupture of the cerebral aneurysm. This factor is especially significant in true Pcom aneurysm formation and rupture. According to the literature, a combination of fetal type Pcom and formation of the true Pcom aneurysm has been reported in most cases (81.8%). Most of the aneurysm can be buried in the temporal lobe, and the retraction of the temporal lobe during the dissection of the neck would be necessary, which causes premature rupture of the true Pcom aneurysm. In the surgery for a true Pcom aneurysm, we should be aware of possible premature rupture when temporal lobe retraction is necessary.
authors.affiliation: Department of Neurosurgery, School of Medicine, University of Occupational and Environmental Health, Japan. Yahatanishi-ku, Kitakyushu 807-8555, Japan.
authors.forename: Yoshiteru
authors.initials: Y
authors.lastname: Nakano
authors.forename: Takeshi
authors.initials: T
authors.lastname: Saito
authors.forename: Junkoh
authors.initials: J
authors.lastname: Yamamoto
authors.forename: Mayu
authors.initials: M
authors.lastname: Takahashi
authors.forename: Daisuke
authors.initials: D
authors.lastname: Akiba
authors.forename: Takehiro
authors.initials: T
authors.lastname: Kitagawa
authors.forename: Ryo
authors.initials: R
authors.lastname: Miyaoka
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Ueta
authors.forename: Toru
authors.initials: T
authors.lastname: Kurokawa
authors.forename: Shigeru
authors.initials: S
authors.lastname: Nishizawa
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery*; D007430:Intraoperative Care / Q000379:methods; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D020769:Posterior Cerebral Artery / Q000002:abnormalities* / Q000601:surgery*; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000601:surgery; D014656:Vascular Surgical Procedures / Q000379:methods