Clinical Analysis of Embryonic Posterior Cerebral Artery

Objective:To understand the clinical characteristics of patients with embryonic posterior cerebral artery and its correlation with abnormal vascular development.Methods:The clinical data of 396 patients with embryonic posterior cerebral artery confirmed by magnetic resonance angiography(MRA)and computed tomography angiography(CTA)were analyzed.Results:Two-hundred patients had clinical manifestations of posterior circulation ischemia,including recurrent dizziness,vertigo,and tinnitus;45 had headaches,97 had limb weakness,and 16 patients had syncope or impaired consciousness.Seventy-six patients with circulatory infarction were admitted to the hospital.There were 251 patients with history of hypertension,74 with diabetes,113 with hyperlipidemia,13 with dominant vertebral artery,10 with intracranial aneurysm,and 19 with absence of A1 segment of the anterior cerebral artery(considering developmental variation).Conclusion:Embryonic posterior cerebral artery develops abnormally during the embryonic period,often accompanied by abnormal vascular access.Due to abnormal hemodynamics,the incidence of posterior circulation ischemia,aneurysm,and infarction increases in such patients.

Microvascular decompression for a patient with oculomotor palsy caused by posterior cerebral artery compression:A case report and literature review

BACKGROUND Aneurysm compression,diabetes,and traumatic brain injury are well-known causative factors of oculomotor nerve palsy(ONP),while cases of ONP induced by neurovascular conflicts have rarely been reported in the medical community.Here,we report a typical case of ONP caused by right posterior cerebral artery(PCA)compression to increase neurosurgeons’awareness of the disease and reduce misdiagnosis and recurrence.CASE SUMMARY A 54-year-old man without a known medical history presented with right ONP for the past 5 years.The patient presented to the hospital with right ptosis,diplopia,anisocoria(rt 5 mm,lt 2.5 mm),loss of duction in all directions,abduction,and light impaired pupillary reflexes.Magnetic resonance angiography and computed tomography venography examinations showed no phlebangioma,aneurysm,or intracranial lesion.After conducting oral glucose tolerance and prostigmin tests,diabetes and myasthenia gravis were excluded.Cranial nerve magnetic resonance imaging showed that the right PCA loop was in direct contact with the cisternal segment of the right oculomotor nerve(ON).Microvascular decompression(MVD)of the culprit vessel from the ON through a right subtemporal craniotomy was carried out,and the ONP symptoms were significantly relieved after 3 mo.CONCLUSION Vascular compression of the ON is a rare pathogeny of ONP that may be refractory to drug therapy and ophthalmic strabismus surgery.MVD is an effective treatment for ONP induced by neurovascular compression.

Clinical features and outcomes of PComA aneurysms originating from fetal posterior communicating arteries in a single institution

Background:The aim of this study was to retrospectively analyze our experience with the patients who underwent surgical treatment of posterior communicating artery(PComA)aneurysms originating from fetal posterior cerebral artery(fPCA)and analyze the risk factors for the postoperative radiological infarction and outcome.Methods:From 2011 to 2020,we retrospectively reviewed 74 PComA aneurysms originating from fPCA in terms of the clinical and radiological features and obtained the follow-up data from the Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University.The relationships between these features and follow-up data were assessed with the univariate and multivariate analysis.Results:In this series,74 aneurysms were occurring at the origin of fPCAs.All the patients showed complete obliteration of their aneurysms.Full fPCA type tends to be a predictive factor for radiological infarction(univariateχ^(2)=5.873,P=0.027;multivariate OR=0.264,P=0.060).Postoperative radiological infarction(univariateχ^(2)=12.611,P=0.001;multivariate OR=6.033,P=0.043),rupture(univariateχ^(2)=4.514,P=0.047;multivariate OR=57.966,P=0.044),and hypertension(univariateχ^(2)=5.301,P=0.024;multivariate OR=24.462,P=0.029)tend to be the independent predictive factors for poor prognosis at 3 months after discharge.Conclusions:In conclusion,we report a series of patients harboring aneurysms originating from the fPCA.Surgical clipping is a reliable strategy.Full fPCA type is related to postsurgical infarction.Postoperative radiological infarction,rupture,and hypertension tend to be the independent predictive factor for poor prognosis at 3months after discharge.