Dissecting aneurysms of the posterior cerebral artery: current endovascular/surgical evaluation and treatment strategies.

BACKGROUND

Posterior cerebral artery (PCA) aneurysms are relatively rare, making up 1% to 2% of all intracranial aneurysms. To date, most clinical series are heterogeneous in nature, with few reports of isolated PCA dissecting aneurysms. Their clinical presentation can vary greatly, and the potential for long-term sequelae during or after treatment remains relatively high.

OBJECTIVE

To report our recent experience in 9 consecutive patients with PCA dissecting aneurysms with a discussion of the unique clinical challenges of their evaluation and treatment.

METHODS

We conducted a retrospective review of 9 consecutive patients with PCA dissecting aneurysms from November 2003 to February 2010. Their hospital charts and follow-up records were reviewed and summarized.

RESULTS

: We identified 6 male and 3 female patients ranging in age from 7 months to 69 years (median age, 53 years). None had any associated trauma. Four patients presented with subarachnoid hemorrhage. Three presented with intraventricular and intracerebral hemorrhage. The remaining 2 presented with headache and acute onset of right-sided numbness, respectively. Four underwent endovascular embolization; 2 underwent surgical clipping; and the remaining 3 were managed medically and followed up conservatively. The dissecting aneurysms involved P1 (n = 2), P1-2 junction (n = 1), P2 (n = 4), and P2-3 junction (n = 1). At a mean follow-up of 3 months, 6 patients had excellent functional outcome with modified Rankin Scale score of 0 or 1. The remaining 3 patients who presented in deep coma did poorly (1 died and 2 had severe disabilities).

CONCLUSION

PCA dissecting aneurysms pose a unique challenge and have many unresolved issues regarding treatment modalities.