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Ruptured Infundibular dilatation of the posterior communicating artery

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Abstract

Objective

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.

Methods

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.

Results

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.

Conclusions

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.

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Abbreviations

PcomA:

posterior communicating artery,

ID:

infundibular dilatations

SAH:

subarachnoid hemorrhage

DSA:

digital subtraction angiography

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Acknowledgements

We would like to thank Editage (www.editage.co.kr) for the English language editing.

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Authors and Affiliations

  1. Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea

    Woosung Lee, Hyun Jin Han, Jin Young Choi, Keun Young Park, Yong Bae Kim & Joonho Chung

  2. Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Junhyung Kim

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  1. Woosung Lee
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Correspondence to Joonho Chung.

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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.

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For this type of retrospective study formal consent is not required.

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This article is part of the Topical Collection on Vascular Neurosurgery – Aneurysm

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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

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  • DOI: https://doi.org/10.1007/s00701-021-04716-3

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