title: Microneurosurgical Management of Posterior Communicating Artery Aneurysm: A Contemporary Series from Helsinki.
abstract: OBJECTIVE
  The objectives of this study were to analyze microsurgical techniques and to determine correlations between microsurgical techniques and the radiographic findings in the microneurosurgical treatment of posterior communicating artery aneurysms (PCoAAs).
  
  
  METHODS
  We retrospectively analyzed radiographic findings and videos of surgeries in 64 patients with PCoAAs who underwent microsurgical clipping by the senior author from August 2010 to 2014.
  
  
  RESULTS
  From 64 aneurysms, 30 (47%) had acute subarachnoid hemorrhage (SAH) that necessitated lamina terminalis fenestration (odds ratio [OR], 67.67; P < 0.001) and Liliequist membrane fenestration (OR, 19.62; P < 0.001). The low-lying aneurysms significantly necessitated the coagulation of the dura covering the anterior clinoid process (ACP) (OR, 7.43; P = 0.003) or anterior clinoidectomy (OR, 91.0; P < 0.001). We preferred straight clips in 45 (83%) of 54 posterolateral projecting aneurysms (OR, 45.0; P < 0.001), but preferred curved clips for posteromedial projecting aneurysms (OR, 6.39; P = 0.008). The mean operative time from the brain retraction to the final clipping was 17 minutes and 43 seconds. Postoperative computed tomography angiography revealed complete occlusion of 60 (94%) aneurysms. Three (4.6%) patients with acute SAH suffered postoperative lacunar infarction.
  
  
  CONCLUSIONS
  For ruptured aneurysms, lamina terminalis and Liliequist membrane fenestration are useful for additional cerebrospinal fluid drainage. For low-lying aneurysms, coagulation of the dura covering the ACP or tailored anterior clinoidectomy might be necessary for exposing the proximal aneurysm neck. Type of clips depends on the direction of projection. The microsurgical clipping of the PCoAAs can achieve good immediate complete occlusion rate with low postoperative stroke rate.
authors.affiliation: Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland; Department of Surgery, Naresuan University, Phitsanulok, Thailand. Electronic address: peeraphongt@gmail.com.
authors.forename: Peeraphong
authors.initials: P
authors.lastname: Thiarawat
authors.affiliation: Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Behnam Rezai
authors.initials: BR
authors.lastname: Jahromi
authors.affiliation: Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland; Department of Neurosurgery, North-Western State Medical University, Saint Petersburg, Russia.
authors.forename: Danil A
authors.initials: DA
authors.lastname: Kozyrev
authors.affiliation: Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland; Department of Anesthesiology, Naresuan University, Phitsanulok, Thailand.
authors.forename: Patcharin
authors.initials: P
authors.lastname: Intarakhao
authors.affiliation: Department of Neurosurgery, Bristol Institute of Clinical Neuroscience, North Bristol University Hospital, Bristol, United Kingdom.
authors.forename: Mario K
authors.initials: MK
authors.lastname: Teo
authors.affiliation: Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Joham
authors.initials: J
authors.lastname: Choque-Velasquez
authors.affiliation: Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Hernesniemi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography / Q000379:methods; D019468:Disease Management; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D055815:Young Adult
keywords: Microneurosurgical treatment; Operative technique; Posterior communicating artery aneurysm; Radiographic finding