• K Matsumoto, M Kuriyama, T Tamiya, and T Ohmoto.
• Department of Neurological Surgery, Okayama University Medical School, Japan.
• Neurosurgery. 1997 Oct 1;41(4):939-42; discussion 942-3.

Objective And ImportanceA review of the literature documents that giant posterior communicating artery (PCoA) aneurysms are rare. To our knowledge, this report is the first to describe a ruptured giant aneurysm arising from a PCoA that was successfully clipped.Clinical PresentationA 27-year-old man had a left oculomotor palsy and then suffered a subarachnoid hemorrhage. Cerebral angiography and three-dimensional computed tomographic angiography revealed a giant fusiform aneurysm of the left PCoA. These imaging techniques documented the rapid growth of the aneurysm from a moderate to a giant size in fewer than 3 days.InterventionThe patient underwent a left subtemporal craniotomy. The neck was constructed and was successfully clipped, and the PCoA was reconstructed with five sequentially placed fenestrated clips in a tandem fashion. The patient experienced a good recovery.ConclusionThis report describes the usefulness of three-dimensional computed tomographic angiography in planning the surgical approach to giant aneurysms originating from the PCoA and the use of fenestrated clips to obliterate giant fusiform aneurysms.

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