A case of ruptured “true” posterior communicating artery distal portion aneurysm due to the ipsilateral internal carotid artery occlusion

Abstract

A 65-year-old man developed sudden-onset consciousness disturbance and was diagnosed as having subarachnoid hemorrhage. Cerebral angiography and three-dimensional computed tomography demonstrated an aneurysm arising from the distal portion of the posterior communicating artery. Neck clipping of the aneurysm was performed with accidental proximal ligation via ipsilateral pterional craniotomy. It is well known that patients who have experienced long-term hemodynamic stress have a risk of developing an aneurysm. However, an aneurysm arising from the posterior communicating artery itself is rare, especially in the distal portion. Here, we discuss a variety of pitfalls of direct surgery. We report a rare case and review the related literature.