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Evolution from an Infundibulum of the Posterior Communicating Artery to a Saccular Aneurysm

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Abstract

Introduction

An infrequent case of a de novo aneurysm formation originating from an infundibulum at the origin of the posterior communicating artery (PcomA) is presented. The aneurysm developed within 7 years in a patient who initially presented with subarachnoid hemorrhage (SAH) from a saccular aneurysm of the vertebral artery.

Case summary

A 43-year-old female patient was admitted to our hospital on 16th June 2000 after an acute onset of massive occipital headache. A computed tomography (CT) scan showed a subarachnoid hemorrhage (SAH) around the brainstem and 4-vessel angiography revealed an aneurysm originating from the V4 segment of the right vertebral artery (VA) as the cause of the SAH. A small aneurysm at the basilar artery (BA)/superior cerebellar artery (SCA) bifurcation was also found. Injection of the left internal carotid artery (ICA) showed a diffuse enlargement at the origin of the left PcomA, which at this time was considered to be a so-called infundibulum. The VA aneurysm was treated by coil occlusion. Follow-up digital subtraction angiography (DSA) in 2005 showed a de novo aneurysm formation at the VA junction, again treated by coil occlusion. The PcomA infundibulum at the left ICA was not examined. Follow-up angiography performed in 2007 revealed a saccular de novo aneurysm of the left ICA arising from the origin of the left PcomA with a maximum diameter of 12 mm. Coil occlusion of the PcomA aneurysm was subsequently carried out.

Conclusion

Infundibular widening of cerebral arteries can develop into true aneurysms. Mid-term and long-term follow-up MRI (e.g., in yearly intervals) is advised for infundibula with a diameter of 3 mm or more. In patients with other aneurysm(s), with a documented de novo aneurysm formation or with a familial occurrence of aneurysms, the risk of evolution of an infundibulum to a saccular aneurysm may be increased and follow-up should be even more stringent.

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Conflict of Interest Statement

The authors declare that there is no actual or potential conflict of interest in relation to this article.

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Authors and Affiliations

  1. Klinik für Neuroradiologie, Klinikum Stuttgart, Kriegsbergstrasse 60, 70174, Stuttgart, Germany

    S. Fischer & H. Henkes

  2. Klinik für Neurochirurgie, Katharinenhospital Klinikum, Stuttgart, Germany

    N. Hopf

  3. Medizinische Fakultät, Universität Duisburg-Essen, Essen, Germany

    H. Henkes

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  1. S. Fischer
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  2. N. Hopf
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  3. H. Henkes
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Correspondence to H. Henkes.

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Fischer, S., Hopf, N. & Henkes, H. Evolution from an Infundibulum of the Posterior Communicating Artery to a Saccular Aneurysm. Clin Neuroradiol 21, 87–90 (2011). https://doi.org/10.1007/s00062-010-0038-1

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  • DOI: https://doi.org/10.1007/s00062-010-0038-1

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