Large Aneurysm Arising from the Inferior Wall of the Segment of the Posterior Communicating Artery

Hwang, Kwang Ho; Kang, Sung Don; Kim, Jong Mun

Abstract

Seven patients with large aneurysm of the inferior wall of the internal carotid artery were treated during a recent six-year period; this report presents the findings. In this type of aneurysm, the neck arises from the ventral surface of the internal carotid artery at the level of the segment of the posterior communicating artery(PComA). As is the case with the ventral paracliniod type, the treatment of the this aneurysms presents the surgeon with technical problems involving safe exposure and clipping. The incidence of female patients was high, and aneurysms were large; in all cases, the clinical presentation was subarachnoid hemorrhage. In three cases, clipping was incomplete. During surgery, the neck of the aneurysms was hidden by the segment of PComA, and the dome adhered to the PComA and to the anterior choroidal artery. The outcome was considered good in five patients; one, however, was moderately disabled, and one died. We classified these aneurysms as separate from those of the internal carotid artery-PComA junction, and described their surgical treatment and related problems.