Posterior Cerebral Artery Aneurysms: Treatment and Outcome Analysis in 121 Patients

Objective Aneurysms of the posterior cerebral artery (PCA) are uncommon. Because of their low incidence, only 5 series with more than 30 patient cases have been reported. The treatment of PCA aneurysms is challenging because of the high frequency of fusiform aneurysms and closeness to important neuroanatomic structures. Methods A total of 121 patients with 135 PCA aneurysms were reviewed. The clinical and radiologic data, treatment strategies, and 1-year outcomes were analyzed. Patients with giant aneurysms, associated aneurysms, and aneurysms on arteriovenous malformation-feeding PCAs were considered as complex cases. Outcomes were categorized into 3 groups: good (modified Rankin Scale [mRS], score 0–1), moderate (mRS score, 2–4), and poor (mRS score, 5–6). Results There were 52 ruptured (39%) and 83 unruptured (61%) PCA aneurysms in 121 patients, with the following distribution: P1 ( n  = 53), P1/2 ( n  = 39), P2 ( n  = 28), and P3 ( n  = 15). The incidence of fusiform PCA aneurysms was high (24%). Microsurgical treatment was applied to 63 aneurysms and endovascular treatment to 19 aneurysms; 55 aneurysms were treated conservatively. The following treatment results were achieved: for patients with unruptured PCA aneurysms, n  = 19; 12 good outcomes, 63%; 6 moderate, 31%; 1 poor, 1%; for patients with ruptured PCA aneurysms, n  = 27; 10 good, 37%; 9 moderate, 33%; 8 poor, 30%; and for patients with complex neurovascular diseases and PCA aneurysms, n  = 96; 42 good, 43%; 40 moderate, 42%; 14 poor, 15%. Conclusions Aneurysms of the PCA are infrequent and often associated with other vascular diseases. Microsurgery and endovascular treatment are effective for the occlusion of PCA aneurysms. The preservation or reconstruction of the parent vessel is crucial for favorable treatment outcomes.