Tandem straight fenestrated clipping for posterior communicating artery aneurysm with fetal-type posterior cerebral artery.

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.