Lekovic Gregory P, Ooi Yinn Cher, Jahan Reza
Division of Neurosurgery, House Institute, Los Angeles, California.
Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California.
Oper Neurosurg (Hagerstown). 2021 Feb 16;20(3):E234-E238. doi: 10.1093/ons/opaa424.
Aneurysms of the posterior cerebral artery (PCA) are uncommon, estimated at less than 1% of all cerebral aneurysms, and less than half occur distal to the P1/2 junction. Unfortunately, the conventional bypass approach for PCA aneurysms-primarily occipital artery to distal PCA cortical branches-has a history of unsatisfying results.
A 42-yr-old female presented with Fisher 3 Hunt-Hess 2 subarachnoid hemorrhage secondary to ruptured distal PCA aneurysm. She was initially evaluated by the endovascular service, but due to recent subarachnoid hemorrhage, endovascular treatment with flow diversion and/or vessel sacrifice was felt to be relatively contraindicated and the patient was referred for surgical evaluation for possible bypass. The patient subsequently underwent surgery for trapping of aneurysm and concomitant superficial artery to distal PCA bypass.
A novel approach for the treatment of a ruptured distal PCA aneurysm is described, consisting of posterior transpetrosal exposure and division of the tentorium with superficial temporal artery to P3 bypass.
大脑后动脉（PCA）动脉瘤并不常见，估计占所有脑动脉瘤的比例不到1%，且不到半数发生于P1/2交界处远端。不幸的是，PCA动脉瘤的传统搭桥方法——主要是枕动脉与PCA皮质远端分支搭桥——一直以来效果不尽人意。
一名42岁女性因远端PCA动脉瘤破裂导致Fisher 3 Hunt-Hess 2级蛛网膜下腔出血。她最初由血管内治疗团队进行评估，但由于近期发生蛛网膜下腔出血，血管内分流和/或血管牺牲治疗被认为相对禁忌，该患者被转诊进行手术评估以考虑可能的搭桥手术。该患者随后接受了动脉瘤夹闭术及颞浅动脉至PCA远端搭桥术。
本文描述了一种治疗破裂的远端PCA动脉瘤的新方法，包括经后颞下入路、切开小脑幕并进行颞浅动脉至P3搭桥。
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