Ahead of Print: Microsurgery for PCoA Aneurysms

Background: Many neurosurgeons feel competent clipping posterior communicating artery (PCoA) aneurysms and include this lesion in their practice. However, endovascular therapy removes simple aneurysms that would have been easiest to clip with the best results. What remains are aneurysms with complex anatomy and technical challenges that are not well described.

Objective: A contemporary surgical series with PCoA aneurysms is reviewed to define the patients, microsurgical techniques, and outcomes in current practice.

Methods: 218 patients had 218 PCoA aneurysms that were treated microsurgically during 11 years. Complexities influencing aneurysm management included: (1) large/giant size; (2) fetal posterior cerebral artery (PCA); (3) previous coiling; (4) anterior clinoidectomy; (5) adherence of the anterior choroidal artery (AChA); (6) intraoperative aneurysm rupture; (7) complex clipping; and (8) atherosclerotic calcification.

VIDEO: Inappropriate Application of Yaşargil (Aesculap®) Aneurysm Clips Patient 2

This video demonstrates a microsurgical clipping of a right-sided MCA trifurcation and ACoA aneurysm via right LSO approach in a neurologically asymptomatic 58-year-old woman with unruptured multiple intracranial aneurysms.

Click here for a video and information on patient 1 in this series.

This information has been taken from Inappropriate Application of Yaşargil (Aesculap®) Aneurysm Clips: A New Observation and Technical Remark, a manuscript published in the first Operative Neurosurgery 2010 issue of Neurosurgery. This video was submitted by corresponding author Juha Hernesniemi, M.D. PhD, of the Department of Neurosurgery at the Helsinki University Central Hospital in Helsinki, Finland.