An infundibulum of the posterior communicating artery (PcomA) or infundibular dilatation (ID) is considered to be a benign anatomical variant. However, some evidence suggests that ID is a pre-aneurysmal state. This case series presents cases of ruptured IDs and aneurysms originating from the IDs.
Between April 2002 and June 2020, 1337 patients were treated for aneurysmal subarachnoid hemorrhage (SAH). Among them, 7 patients with ruptured PcomA IDs were identified. Rupture IDs of the PcomA were categorized into 1) direct rupture of IDs, and 2) rupture of aneurysms originating from IDs. The clinical and radiographic factors were retrospectively reviewed.
Two patients experienced direct rupture of IDs, while the other 5 patients presented with ruptured aneurysms originating from IDs. The 2 patients with direct rupture of IDs at presentation were relatively younger (< 50 years), while the other 5 patients with ruptured aneurysms originating from IDs were over 70 and had a history of aneurysmal SAH due to other intracranial aneurysms. Ruptured IDs were treated with microsurgery or endovascular treatment. There were no complications related to the procedure for securing ruptured IDs. Five (71.4%) patients showed favorable outcomes. One patient with initial Hunt and Hess grade 4 died due to initial brain damage with cerebral vasospasm and medical complications.
ID of the PcomA rarely causes SAH with or without aneurysm formation. Thus, patients with IDs of the PcomA should be carefully followed up for a long period, especially those with a history of aneurysmal SAH.
This is a preview of subscription content,to check access.
Access this article
posterior communicating artery,
digital subtraction angiography
Coupe NJ, Athwal RK, Marshman LA, Brydon HL (2007) Subarachnoid hemorrhage emanating from a ruptured infundibulum: case report and literature review. Surg Neurol 67:204–206. https://doi.org/10.1016/j.surneu.2006.05.066
Ebina K, Ohkuma H, Iwabuchi T (1986) An angiographic study of incidence and morphology of infundibular dilation of the posterior communicating artery. Neuroradiology 28:23–29. https://doi.org/10.1007/BF00341761
Edelsohn L, Caplan L, Rosenbaum AE (1972) Familial aneurysms and infundibular widening. Neurology 22:1056–1056
Endo S, Furuichi S, Takaba M, Hirashima Y, Nishijima M, Takaku A (1995) Clinical study of enlarged infundibular dilation of the origin of the posterior communicating artery. J Neurosurg 83:421–425. https://doi.org/10.3171/jns.1995.83.3.0421
Epstein F, Ransohoff J, Budzilovich GN (1970) The clinical significance of junctional dilatation of the posterior communicating artery. J Neurosurg 33:529–531
Fischer S, Hopf N, Henkes H (2011) Evolution from an infundibulum of the posterior communicating artery to a saccular aneurysm. Clin Neuroradiol 21:87–90. https://doi.org/10.1007/s00062-010-0038-1
Fox JL, Baiz TC, Jakoby RK (1964) Differentiation of aneurism from infundibulum of the posterior communicating artery. J Neurosurg 21:135–138
Gariel F, Ben Hassen W, Boulouis G, Bourcier R, Trystram D, Legrand L, Rodriguez-Regent C, Saloner D, Oppenheim C, Naggara O (2020) Increased wall enhancement during follow-up as a predictor of subsequent aneurysmal growth. Stroke 51:1868–1872
Hassler O, Saltzman G-F (1963) Angiographic and histologic changes in infundibular widening of the posterior communicating artery. Acta Radiologica Diagnosis 1:321–327
Itakura T, Ozaki F, Nakai E, Fujii T, Hayashi S, Komai N (1983) Bilateral aneurysm formation developing from junctional dilatation (infundibulum) of the posterior communicating arteries: case report. J Neurosurg 58:117–119
Kang SD (1997) True posterior communicating artery aneurysm. Journal of Korean Neurosurgical Society 26:1007–1010
Kim S, Chung J, Cha J, Kim BM, Kim DJ, Kim YB, Lee JW, Huh SK, Park KY (2020) Usefulness of high-resolution three-dimensional proton density-weighted turbo spin-echo MRI in distinguishing a junctional dilatation from an intracranial aneurysm of the posterior communicating artery: a pilot study. Journal of NeuroInterventional Surgery 12:315–319
Krayenbühl HA, Yaşargil MG, Flamm ES, Tew JM (1972) Microsurgical treatment of intracranial saccular aneurysms. J Neurosurg 37:678–686
Kuwahara S, Uga S, Mori K (2001) Successful treatment of a ruptured enlarged infundibular widening of the posterior communicating artery. Neurol Med Chir 41:25–28
Marshman LA, Ward PJ, Walter PH, Dossetor RS (1998) The progression of an infundibulum to aneurysm formation and rupture: case report and literature review. Neurosurgery 43:1445–1448
Martins C, Macanovic M, Costa e Silva IE, Griz F, Azevedo-Filho HR (2002) Progression of an arterial infundibulum to aneurysm: case report. Arq Neuropsiquiatr 60:478–480. https://doi.org/10.1590/s0004-282x2002000300026
Ohkuma H, Ebina K, Iwabuchi T (1985) Angiographic study on infundibular dilatation of the posterior communicating artery. Neurol Med Chir 25:907–914
Ohyama T, Ohara S, Momma F (1994) Fatal subarachnoid hemorrhage due to ruptured infundibular widening of the posterior communicating artery—case report—. Neurol Med Chir 34:172–175
Patrick D, Appleby A (1983) Infundibular widening of the posterior communicating artery progressing to true aneurysm. Br J Radiol 56:59–60
Punt J (1979) Some observations on aneurysms of the proximal internal carotid artery. J Neurosurg 51:151–154
Radulovic D, Nestorovic B, Rakic M, Janosevic V (2006) Enlargement to a saccular aneurysm and subsequent rupture of infundibular widening of posterior communicating artery. Neurochirurgie 52:525–528
Saltzman G-F (1959) Infundibular widening of the posterior communicating artery studied by carotid angiography. Acta Radiologica:415–421
Takahashi C, Fukuda O, Hori E, Kameda H, Endo S (2006) A case of infundibular dilatation developed into an aneurysm and rupturing after the rupture of an aneurysm 10 years ago. No shinkei geka Neurological surgery 34:613
Yu J, Wang H, Xu K, Wang B, Luo Q (2010) Endovascular embolization of ruptured infundibular dilation of posterior communicating artery: a case report. Case Rep Med 2010:210397. https://doi.org/10.1155/2010/210397
We would like to thank Editage (www.editage.co.kr) for the English language editing.
Conflict of interest
The authors have no relevant financial or non-financial interests to disclose.
All procedures performed in the studies involving human participants were in accordance with the ethical standards of our Institutional Review Board with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
For this type of retrospective study formal consent is not required.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Vascular Neurosurgery – Aneurysm
About this article
Cite this article
Lee, W., Han, H.J., Kim, J. et al. Ruptured Infundibular dilatation of the posterior communicating artery. Acta Neurochir 163, 797–803 (2021). https://doi.org/10.1007/s00701-021-04716-3