Posterior communicating artery section during surgery for basilar tip aneurysm

Area of Science:

• Neurosurgery
• Vascular Neurosurgery
• Cerebrovascular Surgery

Background:

• Surgical division of the posterior communicating artery (PComA) is controversial due to potential ischemic risks.
• However, PComA division can enhance surgical working space and visualization for complex aneurysm treatment.
• Basilar tip aneurysms often require specific approaches for safe and effective clipping.

Purpose of the Study:

• To evaluate the safety and necessity of dividing a hypoplastic PComA in pterional approach for basilar tip aneurysms.
• To assess the outcomes and complications associated with PComA division in this specific surgical context.

Main Methods:

• Retrospective analysis of four cases involving basilar tip aneurysms treated via pterional approach.
• Division of a hypoplastic PComA was performed when it limited surgical access or obscured the aneurysm.
• Clinical outcomes, including neurological deficits and imaging findings, were documented post-operatively.

Main Results:

• Successful clipping of the aneurysm neck was achieved in all four patients.
• Three patients experienced post-operative complications, including altered consciousness, ocular movement disorders, and sensory disturbances.
• Thalamic infarctions were observed in three patients, likely due to thalamo-perforating artery injury during clipping, not PComA division.

Conclusions:

• Division of a hypoplastic PComA can be a safe and necessary adjunct in specific basilar tip aneurysm surgeries.
• Complications observed were not consistently linked to PComA section, suggesting alternative injury mechanisms.
• Careful patient selection, considering subarachnoid hemorrhage grade and cerebrovascular risk factors, is crucial.