Nishimura T, Fukuoka M, Ono Y
Department of Neurosurgery, Kaisei Hospital.
No Shinkei Geka. 1996 Nov;24(11):1011-4.
A case of a ruptured aneurysm located in the P3 portion of the posterior cerebral artery (PCA), which was not accessible through a subtemporal approach, was reported. In addition to the case presented here, alternative operative approaches to the distal P3 portion or higher ambient cistern were reviewed and discussed. A 64-year-old man was admitted because of sudden onset of headache. CT scan disclosed SAH which was recognized mainly in the left ambient cistern with intraventricular bleeding (Fisher Group 4, Hunt and Kosnik Grade 2). A left vertebral angiogram disclosed a small saccular aneurysm in the distal P3 portion of the left PCA, which was located as highly as the plexal point of the anterior choroidal artery. On day 4, neck clipping was tried via the left subtemporal approach. The distal P3 aneurysm, however, could not be reached by this approach, in spite of aspiration of the parahypocampal gyrus. On day 7, the patient died of massive bleeding from a Cushing ulcer. It was considered that an occipital interhemispheric approach might have been more suitable in the present case.
报道了一例位于大脑后动脉（PCA）P3段的破裂动脉瘤，经颞下入路无法到达该部位。除了这里介绍的病例外，还对P3段远端或更高的环池的替代手术入路进行了回顾和讨论。一名64岁男性因突发头痛入院。CT扫描显示蛛网膜下腔出血，主要位于左侧环池并伴有脑室内出血（Fisher 4级，Hunt和Kosnik 2级）。左侧椎动脉血管造影显示左侧PCA远端P3段有一个小囊状动脉瘤，其位置与脉络膜前动脉丛点一样高。第4天，尝试经左侧颞下入路进行颈部夹闭术。然而，尽管切除了海马旁回，该入路仍无法到达远端P3动脉瘤。第7天，患者死于库欣溃疡大出血。认为在本病例中枕部经半球间入路可能更合适。
