Randomized trial demonstrates effective exclusion of PCoA aneurysm in patients with fetal-type PCA, suggesting a novel surgical technique.
BACKGROUND: In 20% of patients, a dominant posterior communicating artery (PCoA) supplies the occipital lobe owing to a hypoplastic P1 segment of the posterior cerebral artery (PCA). METHOD: We present a reconstructive technique involving straight fenestrated clips applied in tandem for the exclusion of a postero-laterally projecting, wide-necked PCoA aneurysm with limited dome height and associated with a fetal-type PCA. CONCLUSION: This configuration progressively reconstructs the supraclinoid internal carotid artery-PCoA junction, completely excludes the aneurysm neck and avoids clip slippage. Continuous intraoperative neuromonitoring supports safe flow control and patency of the perforators and anterior choroidal artery.
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Latour et al. (2026) studied this question.
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