[Aneurysm at the PCA posterior temporal artery junction: a case report]

Area of Science:

• Neurosurgery
• Vascular Neurology
• Neuroradiology

Background:

• Posterior cerebral artery (PCA) aneurysms are rare, accounting for 1% of all cerebral aneurysms and 15% of posterior circulation aneurysms.
• Most PCA aneurysms occur proximally at the PCA-anterior temporal artery or PCA-posterior lateral choroidal artery junctions.
• Aneurysms at the distal PCA-posterior temporal artery junction are exceptionally rare, with only a few cases reported in the literature.

Observation:

• A 35-year-old male presented with intracerebral hematoma, somnolence, oculomotor palsy, homonymous hemianopsia, and hemiparesis.
• Left vertebral angiography identified a saccular aneurysm at the right PCA's quadrigeminal segment.
• Initial treatment involved hematoma evacuation, followed by aneurysm trapping surgery three weeks later.

Findings:

• Surgical treatment of the distal PCA aneurysm was performed with a subtemporal approach.
• Postoperative recovery was uneventful, with complete resolution of somnolence, oculomotor palsy, and hemiparesis.
• Persistent left homonymous hemianopsia was the sole remaining neurological deficit.

Implications:

• This case underscores the rarity and potential for significant neurological deficits associated with distal PCA aneurysms.
• Review of literature suggests neck clipping may offer better outcomes regarding new neurological deficits compared to trapping or proximal clipping for PCA aneurysms.
• Further research into optimal surgical strategies for these rare distal aneurysms is warranted to minimize postoperative morbidity.