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Richard K. Simpson Jr. and Warren D. Parker

P osterior cerebral artery (PCA) aneurysms are a rather uncommon entity. 1, 17, 22 Fox 8 described approximately 50 PCA aneurysms in his recent review. Zeal and Rhoton 22 reviewed approximately 118 aneurysms of this type, although only 55 cases were found to have been reported in sufficient detail to merit comment. Posterior cerebral artery aneurysms represent a very small proportion (0.26% to 1.0%) of the total reported cases of intracranial aneurysms. 12, 17 Distal PCA aneurysms are exceedingly rare. Only 13% of all PCA aneurysms are considered to be

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Arnold A. Zeal and Albert L. Rhoton Jr.

T he posterior cerebral artery (PCA) supplies not only the posterior part of the cerebral hemispheres, as its name implies, but also sends critical branches to the thalamus, midbrain, and other deep structures including the choroid plexus and walls of the lateral and third ventricles. Embryologically, it arises as a branch of the internal carotid artery, but by birth its most frequent origin is from the basilar artery. 46, 66 Its proximal part is one of the most difficult sites to approach surgically because of its frequent origin in the midline, the complex

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Han Soo Chang, Takanori Fukushima, Shinichiro Miyazaki and Teruaki Tamagawa

T reatment of fusiform cerebral aneurysms is a controversial subject. To prevent ischemic complications after excision or a trapping procedure, some investigators have recently described microvascular anastomosis techniques for restoration of the distal perfusion of the occluded artery. 3, 4, 17 In this report, we present a case with a ruptured fusiform aneurysm located in the P 2 segment of the posterior cerebral artery (PCA). The aneurysm was excised and the proximal and distal ends of the parent vessel were successfully anastomosed to reconstitute the

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Xuanfeng Qin, Feng Xu, Yashengjiang Maimaiti, Yongtao Zheng, Bin Xu, Bing Leng and Gong Chen

A neurysms involving the posterior cerebral artery (PCA) are relatively rare, accounting for approximately 0.7% to 2.3% of all intracranial aneurysms. 13 , 15 , 18 , 35 Surgical treatment of PCA aneurysms is complicated and often associated with high rates of morbidity because of the complexity of the perforating branches from the PCA and their relationship with the cranial nerves and upper brainstem. 6 , 22 , 32 , 33 Selective catheterization of the PCA and endovascular occlusion of the aneurysm is technically feasible, offering an alternative to

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Tomomi Kimiwada, Toshiaki Hayashi, Reizo Shirane and Teiji Tominaga

cerebral blood flow (CBF) and prevent cerebral infarction. 8 , 9 , 14–16 However, some patients with MMD present with stenoocclusive posterior cerebral artery (PCA) lesions, 20 followed by cerebral infarction after anterior circulation revascularization surgery. Recent studies emphasized PCA involvement in MMD as an important factor related to poor prognosis. 4–7 , 12 , 22–24 However, few reports have detailed posterior circulation revascularization surgery. 3 , 12 , 18 The current study reviewed 62 pediatric patients with MMD and retrospectively assessed PCA

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Christopher L. Taylor, Thomas A. Kopitnik Jr., Duke S. Samson and Phillip D. Purdy

diagnostic tool prior to permanent sacrifice. Also, safe methods must be found to bypass into the PCA when sacrifice is needed. Acknowledgments We thank Suzanne Truex and Jerri Thomas for their assistance in the preparation of this manuscript. References 1. Atkinson JL , Lane JI , Colbassani HJ , et al : Spontaneous thrombosis of posterior cerebral artery aneurysm with angiographic reappearance. Case report. J Neurosurg 79 : 434 – 437 , 1993 Atkinson JL, Lane JI, Colbassani HJ, et al: Spontaneous thrombosis of

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Takeshi Funaki, Jun C. Takahashi, Yasushi Takagi, Kazumichi Yoshida, Yoshio Araki, Takayuki Kikuchi, Hiroharu Kataoka, Koji Iihara and Susumu Miyamoto

stenoocclusive lesion in the posterior circulation, especially in the posterior cerebral artery (PCA), is a relatively specific finding in juvenile-onset moyamoya disease. 19 The PCA usually provides much collateral flow to the anterior circulation in moyamoya disease, and recent studies revealed a higher prevalence of ischemic and hemorrhagic stroke in patients with such PCA involvement. 7 , 22 However, any association between long-term outcomes and PCA involvement in moyamoya disease has not yet been closely examined. We hypothesized that PCA involvement in pediatric

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Nancy McLaughlin, Radoslav Raychev, Gary Duckwiler and Neil A. Martin

1 Abe T , Singer RJ , Marks MP , Kojima K , Watanabe M , Uchida M , : Arterial vascular abnormality accompanying cerebral cortical dysplasia . AJNR Am J Neuroradiol 18 : 144 – 146 , 1997 2 Caplan LR : Dilatative arteriopathy (dolichoectasia): what is known and not known . Ann Neurol 57 : 469 – 471 , 2005 3 Chao KH , Riina HA , Heier L , Steig PE , Gobin YP : Endovascular management of dolichoectasia of the posterior cerebral artery report . AJNR Am J Neuroradiol 25 : 1790 – 1791 , 2004 4 Doran SE , Deveikis

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Jing Xu, Liang Xu, Ziheng Wu, Xianyi Chen, Jun Yu and Jianmin Zhang

. References 1 Bisaria KK : Anomalies of the posterior communicating artery and their potential clinical significance . J Neurosurg 60 : 572 – 576 , 1984 2 Chang HS , Fukushima T , Miyazaki S , Tamagawa T : Fusiform posterior cerebral artery aneurysm treated with excision and end-to-end anastomosis. Case report . J Neurosurg 64 : 501 – 504 , 1986 3 Ciceri EF , Klucznik RP , Grossman RG , Rose JE , Mawad ME : Aneurysms of the posterior cerebral artery: classification and endovascular treatment . AJNR Am J Neuroradiol 22 : 27 – 34

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Mandy J. Binning and William T. Couldwell

The authors report a case of a posterior cerebral artery aneurysm arising from an aberrant arterial branch that was found to be splitting the oculomotor nerve. This 63-year-old man presented with headaches, and CT imaging revealed subarachnoid hemorrhage primarily within the basilar cisterns. Formal angiography and CT angiography revealed a saccular aneurysm arising from the posterior cerebral artery. Intraoperatively, the third cranial nerve was found to be fenestrated with the artery and aneurysm.