Seven cases of posterior cerebral artery aneurysms

In a period of ten years, since January 1996, we have encountered seven cases of posterior cerebral artery aneurysms (0.58% of surgically treated 1,027 aneurysms in our hospital). Six of these cases were females (from 39 years old to 73 years old, average 54.5 years old). In five of the cases, neck clippings were performed, using the pterional approach for one P1 and one P2a aneurysm, the remaining three were clipping using the subtemporal approach for one P2a and two P2p aneurysms. In one case diagnosed as "unknown SAW by typical findings of the CT scan and normal four-vessel study at the time of admission. The second vertebral angiography (two weeks later) revealed a P2a aneurysm. Such a case attracted our interest in the clinic, because many similar cases might have been diagnosed as "unknown SAH". In the case of a 42-year-old male with intracerebral hematoma, four-vessel study made a definite diagnosis as moyamoya disease and revealed a P2a aneurysm, which we cured by embolization of GDC for the preservation of anastomosis networks which had already been formed. Intravascular embolization is very effective, but sufficient studies are required before applying it in the cases of large and/or thrombosed aneurysms. We described surgical approaches about pterional, subtemporal and transchoroical approaches and discussed some of the differences in the classification methods of Pia, Yasargil, Zear & Rhoton and Seoane. In particular, attention is necessary because we have confused Yasargil's classification with Zeal & Rhoton's classifications by using of the same notation, "Pn".