Aneurysms of the posterior cerebral artery: retrospective review of surgical treatment.

A series of 10 cases of posterior cerebral artery (PCA) aneurysms were retrospectively reviewed. There were five men and five women aged 38 to 68 years (mean 57.5 years). Seven patients presented with subarachnoid hemorrhage. Two aneurysms were found incidentally during clinical examination for stroke. One aneurysm was associated with moyamoya disease. All aneurysms were saccular. The aneurysms arose from the P1 segment in three patients, the P1/P2 junction in three patients, the P2 segment in three patients, and the P3 segment in one patient. Two patients died before operation and one patient refused surgery. Aneurysmal clipping was performed for seven patients. All aneurysms except the P2 and the P3 aneurysms were treated via the pterional approach. Four patients had excellent outcome, but one patient with a P3 aneurysm developed homonymous hemianopsia due to thrombosis of the parent vessel and another patient with a P2 aneurysm had moderate disability from the initial insult. Coil embolization has been indicated as the first choice of therapy, but PCA aneurysms are good candidates for direct clipping.