Abstract
We report a case of true posterior communicating artery (Pcom) aneurysm associated with carotid rete mirabile presenting subarachnoid hemorrhage.
A 77-year-old woman was admitted to our hospital because of disturbance of consciousness. Computed tomography showed subarachnoid hemorrhage. Cerebral angiography demonstrated 2 aneurysms arising from the left Pcom and left posterior cerebral artery (P1–P2 junction). The right carotid angiography demonstrated an abnormal vascular network around the cavernous portion of internal carotid artery (ICA), so-called “carotid rete mirabile.” The right ICA was aplastic and the left ICA was hypoplasic. Two days after onset, coil embolization was performed. As a result, the left P1–P2 junctional aneurysm was almost completely occluded, but it was impossible to occlude the left Pcom aneurysm.
Twenty-four days after onset, neck clipping of the responsible left Pcom aneurysm was carried out through the left subtemporal approach. Postoperatively, the patient experienced temporary left oculomotor nerve palsy but improved. Follow-up angiography revealed disappearance of the left Pcom aneurysm and almost complete obliteration of the left P1–P2 junction aneurysm.
