2012 Volume 40 Issue 6 Pages 409-413
Posterior communicating (PCoA) aneurysm is one of the most common microsurgically treated aneurysms, in which the risk of symptomatic ischemic complication is not emphasized unless the anterior choroidal artery (AchA) is involved. We report three cases of PCoA aneurysm in which the AchA was arising from the PCoA. Sixty-seven PCoA aneurysms were surgically clipped over the past three years, and the AchA was found to be arising from the PCoA in three of them (4.5%). In all the three cases, the origin of the AchA was documented by digital subtraction angiography pre- or postoperatively. The PCoA was the fetal type. During surgery, motor evoked potential (MEP) was monitored, and patency of AchA was confirmed by indocyanine-green (ICG) videoangiography. No patient suffered from ischemic complication.
We emphasize the importance of recognizing such anomalies in surgical treatment to avoid symptomatic ischemic complications. Routine use of MEP and ICG videoangiography is highly recommended even in surgery for PCoA aneurysms.
