What Is a Posterior Communicating Aneurysm?

The internal carotid artery is sent under the optic tract and anastomates with the posterior cerebral artery to realize the communication between the internal carotid artery and the vertebral-basal artery and nourish the back of the brain. However, the posterior communicating artery has more changes, such as: the posterior communicating artery on both sides is not large, one side is thicker and the other is thinner; there are also one posterior communicating artery absent.

The internal carotid artery is sent under the optic tract and anastomates with the posterior cerebral artery to realize the communication between the internal carotid artery and the vertebral-basal artery and nourish the back of the brain. However, the posterior communicating artery has more changes, such as: the posterior communicating artery on both sides is not large, one side is thicker and the other is thinner; there are also one posterior communicating artery absent.

Chinese name

Posterior communicating artery

Foreign name

posterior communicating artery

Department

Anatomy

Overview of posterior communication artery

Posterior communication aneurysms can compress the oculomotor nerve. The central branch of the posterior communicating artery supplies the hind limbs of the inner capsule, the front of the optic tract, and the hypothalamus on the ventral side of the thalamus.

Anatomy and clinical characteristics of posterior communicating artery :

The posterior communication artery originates from the posterior wall of the internal carotid artery, walks deep on the shallow side of the interdural process dura mater, passes through the Liniquist membrane, enters the interpodal cistern, and stops the posterior cerebral artery. The posterior communication aneurysm is also located in the carotid arteries. During the operation, the arachnoid of the carotid arteries should be dissected sufficiently to separate the arteries from the aneurysms and to avoid misclamping of PcoA.

The perforating branch of the posterior communicating artery travels inward and upward, towards the bottom of the third ventricle, the pituitary stem, and the optic cross, and is therefore closely related to the posterior communicating aneurysm. The oculomotor nerve is on the outside of the posterior communicating artery for a long period of time, and the relationship between the two is very close; the inside of PcoA is the pituitary stem and pituitary portal system, and fiber trabeculae; be careful not to accidentally injure when looking for and separating PcoA during surgery .

Posterior communication artery observation:

(I) Observation via the wing point keyhole approach:

The trans-wing point keyhole approach is faintly visible under the operating microscope, and the starting point of the posterior communicating artery is parallel to the deep. The starting point cannot be seen through neuroendoscopy through the gap 2 (optic nerve-internal carotid artery space), but through the gap 3 (internal carotid artery- Eye movement nerve gap) can clearly observe the origin of the posterior communicating artery. Under the operating microscope, it is necessary to change the angle and retract the internal carotid artery to directly observe the stroke of the posterior communicating artery. However, using neuroendoscopy, the entire length of the posterior communicating artery can be directly observed through the gaps 2, 3. Under the operating microscope, the internal carotid artery is distracted, and the perforating branch of the posterior communicating artery can be seen through the gap 2, but its stopping point cannot be seen; these branches cannot be observed through the gap 3. Using neuroendoscopy, the branches of the posterior communicating artery can be clearly seen through the gap 2; a 30 ° endoscope can be used to observe a part of the perforating branch entering the bottom of the third ventricle. Under the microscope, through the gap 1 (pre-optic interstitial space), the contralateral optic nerve can be pulled to observe the origin of the contralateral posterior communicating artery and the origin of some perforating branches. PcoA runs backward along the interdural process dura mater; Through the gap 1, the origin of the contralateral posterior communicating artery and more perforating branches can be seen without distracting the optic nerve, but its full length cannot be seen; through the gap 2, a 30 ° endoscope is used to pass through the vascular network and fibers around the pituitary handle. The beam can be seen on the contralateral posterior communicating artery and part of its branches.

(B) Observation through the subtemporal keyhole approach:

The origin of the posterior communicating artery can be clearly observed under the operating microscope through the ipsilateral subtemporal approach. The oculomotor nerve does not block the field of vision, and is the best angle for observing the full length of the communicating arteries. The perforating branch of the communication artery can be seen after distraction. With neuroendoscopy, it can be observed that the perforating branch mainly originates in the first half of PcoA and goes to the bottom of the third ventricle. Using 30 ° endoscope can clearly observe the penetration of the perforating branch into the bottom of the third ventricle. After the neuroendoscopy is deep into the saddle area, the contralateral posterior communicating artery and its perforating branch can be clearly observed, and the perforating branch enters the brain more clearly.

(Three) observation through the keyhole approach behind the ear:

The posterior keyhole approach requires dissection of the arachnoid membrane, especially the Liniquist membrane, to reveal the saddle area. The starting point of the posterior communicating artery cannot be observed with a surgical microscope, and the end of the posterior communicating artery and the posterior cerebral artery can be seen with neuroendoscopy. Entering the bottom of the third ventricle is the best angle to observe where the PcoA penetrating branch enters the brain