Abstract
Serpentine aneurysms of the posterior cerebral artery (PCA) treated by the internal maxillary artery (IMA) bypass are rare. Here, the authors report the case of a 34-year-old male patient who presented with a half-year history of gradual severe headache and right-sided limb monoparesis and paresthesia lasting for 1 week. Preoperative angiograms showed a serpentine aneurysm in the left distal PCA, which was treated with internal maxillary artery-radial artery-posterior cerebral artery (IMA-RA-PCA) bypass followed by parent artery occlusion (PAO). The postoperative course was uneventful; radiological images revealed that the aneurysm disappeared, and there was good graft patency and excellent perfusion of the distal PCA territories. To the authors’ knowledge, this is the first and only case of distal PCA serpentine aneurysm to be treated by IMA-RA-PCA bypass followed by proximal PAO. These findings suggest that IMA bypass surgery is a good and feasible treatment option for serpentine aneurysms of the PCA that can preserve the parent artery. Moreover, the anatomic segments of the PCA and different treatment options available for PCA serpentine aneurysms are also discussed in this study.
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Funding
Beijing Municipal Science and Technology Commission provided financial support in the form of Natural Science Foundation of Beijing Municipality funding (grant no. 7161005 to Xiang’en Shi) and Capital Foundation of Medical Development (grant no. Z161100000516019 to Xiang’en Shi). The sponsor had no role in the design or conduct of this research.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Beijing Municipal Science and Technology Commission) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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This is a case report of a serpentine aneurysm of the PCA treated by an internal maxillary PCA bypass using a radial artery interposition graft, and proximal artery occlusion. The authors are to be congratulated for tackling such a complicated aneurysm. This case is another example of the current role of bypass surgery in dealing with such complex aneurysms. The treatment options discussed are a nice addition and have an educational value to the reader.
Georgios A. Zenonos
Jacques J. Morcos
FL, USA
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This article is part of the Topical Collection on Vascular Neurosurgery—Aneurysm
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Zhang, J., Shi, X., Liu, F. et al. Serpentine aneurysm of the posterior cerebral artery treated by internal maxillary artery bypass followed by parent artery occlusion: a case report and literature review. Acta Neurochir 161, 1183–1189 (2019). https://doi.org/10.1007/s00701-019-03902-8
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DOI: https://doi.org/10.1007/s00701-019-03902-8