Surgical Revascularization of the Posterior Cerebral Artery in the Treatment of Unclippable Aneurysms of the Posterior Cerebral Artery

Treatment of unclippable posterior cerebral artery (PCA) aneurysms frequently requires revascularization of the PCA, especially in cases with poor collateral circulation flow. We report on the microsurgical revascularization of the PCA territories in 3 patients having PCA aneurysms. Case 1 involved a P2 partially thrombosed large aneurysm. The patient did not tolerate temporary balloon occlusion of the PCA. Case 2 had a P2 thrombosed fusiform aneurysm. Case 3 presented a P1/2 thrombosed giant aneurysm. A balloon occlusion test (BOT) was not used in Case 2 or 3. All patients underwent direct operation with revascularization: STA-PCA bypass and trapping of the aneurysms via combined approach, with favorable outcome. We discuss these operative approaches and procedures for microsurgical revascularization.