November 04, 2015
Rarely PCoA Aneurysms can actually project inferior to the tentorium. Let's go ahead and review a configuration of the PCoA Aneurysm in this position. This is a 64 year-old female who presented with an Unruptured eight-millimeter left-sided PCoA Aneurysm. Preoperative angiogram demonstrated the configuration of neck of the aneurysm in relationship to the fetal PCoA and again, very inferior pointing PCoA aneurysm. I suspected that the dormant of the aneurysm is more slightly inferior to the edge of the tentorium. Patient underwent the Left Front Temporal Craniotomy, Sylvian fissure, temporal lobe, frontal lobe. Upon dissection of the fissure, The anatomy is apparent, here is the ICA, the neck of the aneurysm, the edge of the tentorium lateral more position of the ICA, allowed identification of the PCoA and its associated perforating vessels. Another view of the rot neck of the aneurysm in relationship to the tentorium. Again, the majority of the aneurysm is located underneath the in such a lobe. Here's the origin of the internal carotid artery. I released just the medial edge of the tentorium while carefully looking for the trochlear nerve, tamper clip was used. The origin of PCoA was identified along the proximal neck of aneurysm. You can see it here. An angle of clip was used to close the neck of the aneurism. This clip configuration is quite effective for inferiorly pointing PCoA aneurysms. Here is the origin of the anterior cranial again, you can see Intraoperative Florescence Angiograms, both Fluorescein and ICG, both modalities demonstrated occlusion of the aneurysm and preservation of the PCoA and other regional vasculature. Again, here's the PCoA, which is quite dominant in this case. Here's the vessel itself, posterior cranial whose derives also fluorescent. Here's the condition of the brain at the end of the operation without using fixed retractors. And post operative angiogram confirmed, complete exclusional aneurysm without any complicating feature. Thank you.
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