Giant Serpentine Aneurysm of the Posterior Cerebral Artery

Abstract We are reporting an unusual case of a giant serpentine aneurysm of the posterior cerebral artery (PCA). We were unable to find a report in the literature of a similar aneurysm. The microsurgical pterional approach was used for temporary clipping of the P-2 segment of the PCA, and the aneurysm was trapped successfully and excised. The discussion includes the operative approach to the giant serpentine aneurysm.

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Bilateral posterior cerebral artery territory infarction in a SARS-Cov-2 infected patient: discussion about an unusual case

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2020.105095 ◽

2020 ◽

Vol 29 (9) ◽

pp. 105095 ◽

Cited By ~ 1

Author(s):

Claire Bonardel ◽

Mathieu Bonnerot ◽

Marie Ludwig ◽

Wilfried Vadot ◽

Gaspard Beaune ◽

...

Keyword(s):

Cerebral Artery ◽

Infected Patient ◽

Unusual Case ◽

Posterior Cerebral Artery

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Giant serpentine aneurysm of the posterior cerebral artery

Neurosurgery ◽

10.1097/00006123-198208000-00014 ◽

1982 ◽

Vol 11 (2) ◽

pp. 271???6 ◽

Cited By ~ 1

Author(s):

A Fukamachi ◽

M Hirato ◽

T Wakao ◽

J Kawafuchi

Keyword(s):

Cerebral Artery ◽

Posterior Cerebral Artery ◽

Serpentine Aneurysm

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Aneurysms of the Posterior Cerebral Artery: Report of Ten Cases

Neurosurgery ◽

10.1227/00006123-198612000-00017 ◽

1986 ◽

Vol 19 (6) ◽

pp. 1006-1011 ◽

Cited By ~ 40

Author(s):

Han Soo Chang ◽

Takanori Fukushima ◽

Kintomo Takakura ◽

Tsuneo Shimizu

Keyword(s):

Cerebral Artery ◽

Collateral Circulation ◽

Nerve Palsy ◽

Posterior Cerebral Artery ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

Cerebral Revascularization ◽

Neurological Deficits ◽

Serpentine Aneurysm ◽

Ischemic Events

Abstract Ten cases of posterior cerebral artery (PCA) aneurysm are presented. There were 13 aneurysms in the 10 patients: 6 saccular, 5 fusiform, 1 broad-based, and 1 giant fusiform serpentine aneurysm. Eight patients underwent operation: clipping for 2 saccular aneurysms, trapping for 1 saccular and 3 fusiform aneurysms, and coating for 2 fusiform or broad-based aneurysms. Microsurgical cerebral revascularization techniques were attempted in 2 cases: after a fusiform aneurysm had been excised, end-to-end anastomosis of the residual two ends of the PCA was performed and, after a giant serpentine aneurysm had been trapped, the superficial temporal artery was anastomosed transcortically to the distal PCA. Two patients died before operation because of rebleeding and vasospasm. Postoperative neurological deficits include contralateral hemiparesis, homonymous hemianopsia, hemihypesthesia, and ipsilateral 3rd nerve palsy. Our results suggest that, despite the good collateral circulation of the PCA, some ischemic events may occur after trapping procedures and that cerebral revascularization techniques may have some benefit in the treatment of unclippable aneurysms in this region.

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Endovascular Management of Posterior Cerebral Artery Aneurysms

Interventional Neuroradiology ◽

10.1177/159101990801400305 ◽

2008 ◽

Vol 14 (3) ◽

pp. 253-258 ◽

Cited By ~ 9

Author(s):

Z.-W. Zhao ◽

J.-P. Deng ◽

L. Gao ◽

G.-D. Gao

Keyword(s):

Cerebral Artery ◽

Posterior Cerebral Artery ◽

Cerebral Aneurysms ◽

Artery Occlusion ◽

Uneventful Recovery ◽

Parent Artery ◽

Efficacy And Safety ◽

Endovascular Management ◽

Parent Artery Occlusion ◽

Serpentine Aneurysm

The purposes of this study were to evaluate the efficacy and safety of the endovascular management of posterior cerebral artery aneurysms and compare the efficacy and safety of selective aneurysmal coiling and parent artery occlusion. We reviewed all cases with cerebral aneurysms and attention was paid to the patients with posterior cerebral artery aneurysms. Among 550 aneurysms, eight aneurysms in eight patients were located on the posterior cerebral artery, three of which presented with SAH, whereas five presented with different degrees of headache. Seven were located at the P2 segment and one at the P3 segment. One was a giant serpentine aneurysm, two were giant sac aneurysms, two were large and three were small. All aneurysms were successfully treated, five with selective aneurysmal coiling and three with parent artery occlusion. Two patients presenting with headache with giant aneurysms had suffered an aggravated headache for two weeks which then resolved. Others had an uneventful recovery. All patients were followed from 12 months to 56 months. Four selective aneurysmal coiling aneurysms received digital subtraction angiography, two of which needed another treatment and one was treated with parent artery occlusion, one of which recanalized slightly and one of which had further thrombosis. No rebleeding or any other symptom occurred. Whether selective aneurysmal coiling or parent artery occlusion was performed, endovascular management of PCA aneurysms was a safe and effective method. Under some conditions, parent artery occlusion was better than selective aneurysmal coiling.

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Double Aneurysms at Distal Basilar Artery: Report of Nine Cases

Neurosurgery ◽

10.1097/00006123-200009000-00010 ◽

2000 ◽

Vol 47 (3) ◽

pp. 587-593 ◽

Cited By ~ 2

Author(s):

Yuichiro Tanaka ◽

Kazuhiro Hongo ◽

Hisashi Nagashima ◽

Tsuyoshi Tada ◽

Shigeaki Kobayashi

Keyword(s):

Cerebral Artery ◽

Basilar Artery ◽

Coil Embolization ◽

Posterior Cerebral Artery ◽

Superior Cerebellar Artery ◽

Pterional Approach ◽

Anterior Circulation ◽

Simple Method ◽

Bifurcation Aneurysm ◽

Choice Of Treatment

ABSTRACT OBJECTIVE Double aneurysms at the basilar bifurcation and the basilar artery-superior cerebellar artery (BA-SCA) junction have not been well investigated previously. We analyzed nine patients with double basilar aneurysms to evaluate their radiological characteristics and suitable treatment. METHODS Between 1978 and 1999, the incidence of double aneurysms was 5.3% in our 169 consecutive surgical cases of distal BA aneurysms. Seven (77.8%) of the nine patients with double aneurysms had associated aneurysms in the anterior circulation. Open surgery was performed in eight patients and coil embolization in one. The patients' radiological findings, choice of treatment, and surgical results were analyzed retrospectively. RESULTS The size of the basilar bifurcation aneurysms ranged from 2 to 8 mm (mean, 4.4 ± 2.0 mm), and the size of the BA-SCA aneurysms ranged from 2 to 12 mm (mean, 5.6 ± 3.6 mm). Diagnosis of double basilar aneurysms was difficult when the basilar trunk had twisted or when size differences between the two aneurysms were apparent. The angle between the posterior cerebral artery and SCA appeared to be wider on the same side as the BA-SCA aneurysms (101 ± 42 degrees) than on the opposite side (26 ± 24 degrees). The P1 segment of the posterior cerebral artery originated in an upright direction from the basilar bifurcation between the two basilar aneurysms in seven patients. The pterional approach was used in eight patients; 14 basilar aneurysms were successfully clipped and 2 were wrapped. Nonstraight clips with short blades were used frequently. Coil embolization of double aneurysms was required twice in one patient because the initial angiogram was misinterpreted as a single aneurysm and its bleb. CONCLUSION Measurement of the posterior cerebral artery-SCA angle is a simple method to estimate the presence of BA-SCA aneurysms and to differentiate double aneurysms from a bilocular aneurysm at the basilar bifurcation. The pterional approach is suitable for clipping double basilar aneurysms because anterior circulation aneurysms often coexist, and the upstanding P1 segment is an obstacle in the subtemporal approach to the basilar bifurcation aneurysm. Nonstraight clips with short blades are convenient to avoid conflicting clips in the narrow surgical space.

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