caa a22 4500 477107206 CHVBK 20180405111557.0 cr unu---uuuuu 170330e19960701xx s 000 0 eng 10.1007/BF01411264 doi (NATIONALLICENCE)springer-10.1007/BF01411264 Posterior communicating artery section during surgery for basilar tip aneurysm [Elektronische Daten] [S. Inao, H. Kuchiwaki, N. Hirai, T. Gonda, M. Furuse] Summary: Although dividing the posterior communicating artery (PComA) during surgery has been criticized for increasing the risk of ischaemia, this procedure increases working space improving visibility and the ability to manipulate during treatment of basilar tip aneurysms via the pterional approach. We divided a hypoplastic PComA in 4 of our cases of basilar tip aneurysm. This was necessary because either (1) the length of the PComA and intracranial internal carotid artery (ICA) limited medial retraction of the ICA and access to the basilar bifurcation region, or (2) the PComA and its perforators ran just in front of the aneurysm, interfering with its exposure. We were able to clip the aneurysm neck in all four patients, three of whom had complications including temporary impairment of consciousness, ocular movement disorders and altered sensation in the extremities. Patients with complications showed transient hypersomnolence immediately after surgery; computed tomography showed small thalamic infarctions. However, in two of three patients the ischaemic events occurred contralateral to the side of PComA section. All patients regained consciousness within a week and were discharged with mild ocular movement palsies. In our cases except one with ischaemic complications, thalamic infarction probably resulted from thalamo-perforating artery injury when the aneurysm neck was clipped, rather than tuberothalamic artery injury due to section of the PComA. Taking previous reports and our results into consideration, we believe that division of a hypoplastic PComA is a safe procedure in particular cases when the grade of subarachnoid haemorrhage is not poor and there are no cerebrovascular risk factors, although we realize it is desirable to preserve normal blood flow. Springer-Verlag, 1996 Basilar tip aneurysm nationallicence perforating branches nationallicence posterior communicating artery nationallicence thalamic infarction nationallicence Inao S. Department of Neurosurgery, Nagoya University School of Medicine, Japan aut Kuchiwaki H. Department of Neurosurgery, Nagoya University School of Medicine, Japan aut Hirai N. Department of Neurosurgery, Kohseiren Showa Hospital, Japan aut Gonda T. Gonda Neurosurgical Clinic, Japan aut Furuse M. Department of Neurosurgery, Nakatsugawa Municipal General Hospital, Japan aut Acta Neurochirurgica Springer-Verlag 138/7(1996-07-01), 853-861 0001-6268 138:7<853 1996 138 701 https://doi.org/10.1007/BF01411264 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/BF01411264 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Inao S. Department of Neurosurgery, Nagoya University School of Medicine, Japan aut NATIONALLICENCE 700 1- Kuchiwaki H. Department of Neurosurgery, Nagoya University School of Medicine, Japan aut NATIONALLICENCE 700 1- Hirai N. Department of Neurosurgery, Kohseiren Showa Hospital, Japan aut NATIONALLICENCE 700 1- Gonda T. Gonda Neurosurgical Clinic, Japan aut NATIONALLICENCE 700 1- Furuse M. Department of Neurosurgery, Nakatsugawa Municipal General Hospital, Japan aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer-Verlag 138/7(1996-07-01), 853-861 0001-6268 138:7<853 1996 138 701 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer