True Pcom Artery Aneurysm s Allan Taylor David Le

True Pcom Artery Aneurysm’s Allan Taylor David Le. Feuvre University of Cape Town

Carotid Pcom

Differentiation Aneurysm neck from pcom Expanded neck

UCT Cases Age / Sex WFNS Grade Size Pcom - P 1 Treatment 70 f 3 4 mm R Y coil 43 m 1 2 mm L Balanced coil 49 m IIIn palsy 4 mm R Y coil 45 m 2 3 mm R Y coil - clip 33 f IIIn palsy 4 mm R Y coil 55 m 2 4 mm L Y coil 27 f 1 3 mm Y coil Incidence 0. 1 - 3% all aneurysms

Difference ? • Technical treatment aspects • IIIn injury / rebleeding • Anatomy • Embryology • Peri-aneurysmal environment • Physiology • Pathology

Technical Treatment Aspects • • Timothy J et al. Perils of a true posterior communicating aneurysm: Br J Neurosurg. 1995; 9(6) 789 Kudo T. An operative complication in a patient with a true posterior communicating artery aneurysm: Neurosurgery 1990 Oct 27(4): 650 Surgery Endovascular -IIIn injury -small -rupture -unstable catheter -coil displace

Anatomy -Embryology Carotid CD = Pcom Redrawn from Surgical Neuroangiography

CD - tectal to telencephalic Redrawn from Surgical Neuroangiography

Anatomy - Perianeurysmal From Rhoton: Neurosurgery Microsurgical Anatomy

Physiology • Pcom flow volume and direction • Peforators Wenzhuan H. True posterior communicating aneurysms: are they more prone to rupture? J Neurosurg 112: 611 -615 Larger Pcom vessels Smaller aneurysms Flow reversal

Pathology Dissecting PCom. A aneurysm: Spontaneous regression Y Nakao et al Acta Neurochir 2004 146: 1365

Summary • Rare but important • Formation • • Embryology Environment Flow change Dissection • Endovascular - safe