Abstract
We report a case of bilateral posterior cerebral artery (P1-P2 junction) giant aneurysms associated with bilateral internal carotid artery occlusions that were treated by surgery and endovascular procedure.
A 51-year-old man suffered from dysarthria and left hemiparesis in June 1997. He was referred to our facility from another hospital for left hemiparesis caused by brain tumor. The patient was admitted to our facility on July 24, 1997. He was alert on admission and neurological examination disclosed dysarthria and mild hemiparesis with sensory loss including the face on the left side. CT-scan revealed high-density mass in the right cerebral peduncle. Cerebral angiography demonstrated 2 large aneurysms arising from the bilateral P1-P2 junction. Bilateral carotid arteries were occluded at 2-3 cm distal from cervical carotid bifurcations. Anterior circulation was supplied with the vertebro-basilar system.
On September 18, neck clipping of the responsible right aneurysm was carried out through the right pterional approach. Postoperatively he had temporary worsening of left hemiparesis but improved. On December 3, embolization of the left PC aneurysm with detachable coils was performed. Postoperative angiography showed disappearance of the aneurysms and good patency of the parent arteries. He was discharged with paralytic gait.
We supposed the change of hemodynamics by the occlusion of internal carotid artery as the cause of the formation and growth of such aneurysms. We discuss the mechanism and therapeutic problems of aneurysmal formation following bilateral carotid occlusion.
