Giant Aneurysm of the Distal Posterior Cerebral Artery: Case Report

Abstract

Intracranial aneurysms arising from the posterior cerebral artery are rare. A 36-year-old female was brought to Hatano Red Cross Hospital as an emergency case following a sudden onset of severe headache, nausea, and numbness in the left half of the body. On admission, she was slightly delirious and presented nuchal stiffness, left-sided hemiparesis, hemianopsia, and hemihypesthesia associated with hyperpathia, which was elicited even by the lightest touch on the left upper limb. A computed tomography scan showed in the right ambient cistern a round high density lesion which was enhanced after contrast infusion, although no blood density in the basal cisterns was detected. Angiography revealed a large aneurysmal dilatation, measuring 15×25 mm in diameter, at the junction of the right posterior cerebral and the posterior temporal arteries. One month later, clipping of the partially thrombosed aneurysm with a broad based neck was carried out through the zygomatic approach. Postoperatively the patient’s condition was complicated by embolism of the pulmonary artery and thrombosis of the right posterior cerebral artery distal to the aneurysmal neck. However, she eventually returned home with residual neurological deficits of left-sided hemianopia and hemihypesthesia. The surgical approach to aneurysms of this region is discussed and the importance of minimizing retraction of the temporal lobe and preserving the vein of Labbé is emphasized. The zygomatic approach is considered to be suitable for aneurysms in this location. © 1987, The Japan Neurosurgical Society. All rights reserved.