2021 Volume 49 Issue 6 Pages 463-467
We report a rare case of a ruptured internal carotid-posterior communicating artery (IC-PC) aneurysm forming kissing aneurysms with an unruptured C2 aneurysm. A 60-year-old woman was transferred to our hospital due to subarachnoid hemorrhage (Hunt & Kosnik Grade I, WFNS Grade I). At the time of admission, she had a mild headache for ten days and no neurological abnormality. Three-dimensional computed tomographic angiography (3D-CTA) revealed a right IC-PC and C2 aneurysm, which were observed to be in contact with each other. After the right internal carotid artery was exposed in the neck, right frontotemporal craniotomy was performed to obliterate the aneurysms on the day after admission. Intraoperative findings demonstrated a ruptured right IC-PC aneurysm adhered to an unruptured C2 aneurysm. Neck clipping was performed with meticulous dissection, especially between both aneurysmal domes. She was discharged without any neurological deficits 2 weeks postoperatively and has since resumed her previous work. Due to the difficulty in dissecting fibrous adherence, the operation for kissing aneurysms has been recognized as challenging. We emphasize that sufficient preoperative discussion, careful intraoperative observation, and meticulous dissection with temporary occlusion of the parent artery are necessary to have good outcomes.
