• Kuniaki Tanahashi, Yoshio Araki, Kenji Uda, Shinsuke Muraoka, Kazuya Motomura, Chalise Lushun, Toshihiko Wakabayashi, and Atsushi Natsume.
• Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
• World Neurosurg. 2019 Jun 1; 126: 24-29.

BackgroundPosterior cerebral artery (PCA) aneurysms are relatively rare, and neck clipping is often difficult due to their fusiform shape. We report a case of a thrombosed aneurysm of the distal PCA for which curative trapping and parent artery reconstruction by in situ bypass were performed through an occipital transtentorial approach (OTA).Case DescriptionA 67-year-old woman had been suffering from numbness in the right face and limbs for 4 months. Radiologic imaging demonstrated a thrombosed aneurysm on a distal portion of the left PCA. Curative trapping of the aneurysm and in-situ bypass between the distal PCA and superior cerebellar artery were performed through the OTA. Before surgery, we had evaluated access to the PCA and feasibility of the bypass in a cadaveric simulation. The PCA was well exposed in the posterior half of the ambient cistern, and the proximity of the distal PCA to the superior cerebellar artery through a tentorial incision was confirmed.ConclusionsThis OTA could represent a useful option for definitive treatment of distal PCA aneurysms.Copyright © 2019 Elsevier Inc. All rights reserved.

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