Microsurgical Clipping of a Posterior Communicating Artery–Incorporated Internal Carotid-Posterior Communicating Artery Aneurysm using Patient-Specific Three-Dimensional Aneurysm Models
Satoshi Matsuo, Koki Mizukami, Kimihiro Igata, Kotaro Ono, Shintaro Nagaoka, Yoshio Suyama, Hidefuku Gi, Yukihide KanemotoAbstract:
Background and Introduction:
Posterior communicating artery (PCoA)-incorporated aneurysms, in which the PCoA originates from the dome, have a higher recurrence rate after endovascular treatment. Clipping is effective but technically demanding as the PCoA origin is frequently obscured by the internal carotid artery (ICA).
Objective:
We present a video demonstrating microsurgical clipping of a posteriorly projecting PCoA-incorporated aneurysm using a patient-specific 3D-printed model.
Surgical Technique:
Preoperative simulation predicted ICA obstruction of the PCoA origin. The aneurysm was dissected through the retrocarotid and opticocarotid spaces, and clips were sequentially applied, preserving the PCoA and its perforators. Indocyanine green videoangiography confirmed complete obliteration with PCoA patency.
Result:
The postoperative course was uneventful, and angiography confirmed successful clipping.
Conclusion:
Microsurgical clipping is a promising, safe, and effective alternative for PCoA-incorporated aneurysms.
Pearls and Pitfalls:
Preoperative simulation with a patient-specific 3D-printed model enables precise understanding of neurovascular relationships, contributing to safer microsurgical clipping.