Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Management strategies for posterior cerebral artery aneurysms: A proposed new surgical classification

  • 273 Accesses

  • 59 Citations

Summary

In a period of 10 years fifteen patients bearing sixteen aneurysms arising at the posterior cerebral artery were operated at our institution. Based on the approaches selected for each location a division of the posterior cerebral artery into three surgical segments is proposed. The first segment (S1), or anterior extends from the basilar artery bifurcation to the point where the artery reaches the level of the most lateral edge of the cerebral peduncle, the second segment (S2), or middle extends from the posterior limit of S1 to a point located just before the most medial extent of the artery in the quadrigeminal cistern (collicular point), and the third segment (S3), or posterior corresponds to the collicular point and to the portions of the posterior cerebral artery distal to it.

Utilizing the concept of surgical segments all aneurysms in our series were satisfactorily exposed. Those arising at the S1 segment (8 cases) were operated either through a pterional or a pretemporal approaches; those from the S2 segment (6 cases) were operated either via the subtemporal or the subtemporal transventricular routes; and that arising from the S3 segment (1 case) was managed through the occipital interhemispheric approach. Among the aneurysms eleven were small, one was large, and four were large or giant. Ten of these aneurysms were surgically clipped, two coagulated, three treated by trapping and in one case the aneurysm was resected and the posterior cerebral artery was reconstructed by a termino-terminal anastomosis. The surgical results were considered good in all cases but one, where the patient died due to clinical complications three months after surgery.

It is our belief that the use of this classification can provide the means to best select the most appropriate surgical approach to treat aneurysms arising at the posterior cerebral artery.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Awasthi D, Leclerq T (1994) Distal posterior cerebral aneurysms: anatomical and surgical considerations. Contemp Neurosci 16 (18): 1–6

  2. 2.

    Chang HS, Fukushima T, Takakura K (1986) Aneurysms of the posterior cerebral artery: report of ten cases. Neurosurgery 19: 1006–1011

  3. 3.

    Chang HS, Fukushima T, Miyasaki S, Tamagawa T (1986) Fusiform posterior cerebral artery aneurysms treated with excision and end to end anastomosis: case report. J Neurosurg 64: 501–504

  4. 4.

    Drake CG, Amacher AL (1969) Aneurysms of the posterior cerebral artery. J Neurosurg 30: 468–474

  5. 5.

    Fukamachi Aet al (1982) Giant serpentine aneurysm of the posterior cerebral artery. Neurosurgery 11: 271–276

  6. 6.

    Gerber C, Glenn N (1992) A review of the management of 15 cases of aneurysms of the posterior cerebral artery. Br J Neurosurg 6: 521–527

  7. 7.

    Gerber Cet al (1993) An alternative surgical approach to aneurysms of the posterior cerebral artery. Neurosurgery 32: 928–931

  8. 8.

    Heros RC, Sun HL (1993) The combined pterional/anterior temporal approach for aneurysms of the upper basiliar complex: technical report. Neurosurgery 33: 244–251

  9. 9.

    Margolis Met al (1974) Gross and roentgenologic anatomy of the posterior cerebral artery. In: Newton TH, Potts PC (eds) Radiology of the skull and brain, Vol II, Book 2. Mosby, St Louis, pp 1551–1576

  10. 10.

    Oliveira E, Tedeschi H, Peace DA (1995) The pretemporal approach to the interpeduncular and petroclival regions: Technical note. Acta Neurochir (Wien) 136 (3–4): 204–211

  11. 11.

    Pedroza A, Dujovny M (1987) Microanatomy of the posterior communicating artery. J Neurosurg 20: 228–233

  12. 12.

    Peerles S, Drake C (1990) Management of aneurysms of the posterior circulation. Neurological surgery, 3rd Ed. Youmans, Vol III. Saunders, Philadelphia, pp 1787–1788

  13. 13.

    Pia HW, Fontana H (1977) Aneurysms of the posterior cerebral artery. Acta Neurochir (Wien) 8: 13–35

  14. 14.

    Saeki N, Rhoton A (1977) Microsurgical anatomy of the upper basilar artery and the posterior circle of Willis. J Neurosci 46: 563–578

  15. 15.

    Sakata S, Fujii K (1993) Aneurysms of the posterior cerebral artery: report of eleven cases. Surgical approaches and procedures. Neurosurgery 32: 163–168

  16. 16.

    Sano K (1980) Temporo-polar approach to aneurysm of the basilar artery at and around the distal bifurcation: Technical note. Neurol Res 2: 361–367

  17. 17.

    Scott Bet al (1988) Computed tomographic diagnosis of ruptured giant posterior cerebral artery aneurysms. Neuroscience 22: 533–558

  18. 18.

    Simpson R, Parker W (1986) Distal posterior cerebral artery aneurysms, case report. J Neurosci 64: 669–672

  19. 19.

    Spetzler RF, Carter LP (1995) Neurovascular surgery. Mc Graw-Hill, New York, p 630

  20. 20.

    Valle A, Vilalta J (1983) Giant calcified aneurysm on the posterior cerebral artery in a nine-year old child. Surg Neurol 20: 396–398

  21. 21.

    Yasargil MG (1976) Microsurgical pterional approach to aneurysms of the basilar bifurcation. Surg Neurol 6: 83–91

  22. 22.

    Yasargil MG (1984) Microneurosurgery, Vol II. Thieme, Stuttgart, pp 260–269

  23. 23.

    Zeal A, Rhoton AL Jr (1978) Microsurgical anatomy of the posterior cerebral artery. J Neurosurg 48: 534–559

Download references

Author information

Correspondence to E. de Oliveira.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Seoane, E.R., Tedeschi, H., de Oliveira, E. et al. Management strategies for posterior cerebral artery aneurysms: A proposed new surgical classification. Acta neurochir 139, 325–331 (1997). https://doi.org/10.1007/BF01808828

Download citation

Keywords

  • Aneurysm
  • posterior cerebral artery
  • microsurgical anatomy
  • surgical approach