2020 年 48 巻 5 号 p. 365-369
We report a case of collaborative treatment using surgical and radiological approaches for a ruptured dissecting aneurysm around the proximal posterior cerebral artery (P1-P2) and the posterior communicating artery. A 37-year-old woman was admitted to our hospital with a severe headache for 3 days. On admission, a computed tomography scan revealed a subarachnoid hemorrhage and a cerebral angiogram showed a dissecting aneurysm involving the proximal posterior cerebral artery (P1-P2) and posterior communicating artery. Although parent artery occlusion was indispensable for complete treatment, it posed the risk of ischemic complications in the right posterior cerebral artery distribution. A preoperative assessment of her three-dimensional digital subtraction angiogram enabled the consideration of a more feasible approach of collaborative treatment using surgical and radiological techniques. A successful outcome was obtained at the right P1 occlusion using coils and by the placement of the superficial temporal artery-posterior temporal artery bypass, followed by proximal clipping of the right posterior communicating artery. She was discharged without any neurological complications after 38 days.
The information obtained from the angiogram was accurate and aided us in determining the appropriate approach to treatment. In this case, collaborative therapy was appropriate. Such procedures may be considered under certain circumstances and collaborative treatment using surgical and radiological approaches may be necessary for anatomically complex diseases.
