P2-P3 junction aneurysm of the posterior cerebral artery [Neurosurgery Wiki]

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====== P2-P3 junction aneurysm of the posterior cerebral artery ======

{{ ::p2.jpg?300|}}

Aneurysms in the [[P2 segment]] arise between the junction of the [[posterior communicating artery]] (PCoA) with the [[PCA]] and the posterior part of the [[midbrain]]. The [[pterional]], [[subtemporal]], temporopolar, transpetrous and transcortical transchoroidal fissure are the surgical approaches which have been used to gain access to [[P2 segment]] aneurysms. 

Endovascular coil occlusion has rapidly evolved as a competing therapeutic alternative to surgical clipping in the treatment of P2 segment aneurysms. 

However, surgery is still a well-established option for P 2 segment aneurysms and complete closure of the aneurysm can be achieved by surgical clipping
((Zhitao J, Yibao W, Anhua W, Shaowu O, Yunchao B, Renyi Z, Yunjie W.
Microsurgical subtemporal approach to aneurysms on the P(2) segment of the
posterior cerebral artery. Neurol India. 2010 Mar-Apr;58(2):242-7. doi:
10.4103/0028-3886.63806. PubMed PMID: 20508343.
)).

====Treatment====
Proximal occlusion of PCA represents a treatment option. However, this procedure carries a high risk of ischemic complication

The STA-P3/PTA bypass through the subtemporal approach is a feasible option to maintain blood flow in cases of PCA fusiform aneurysms requiring trapping of the P2 segment
((Kawashima A, Andrade-Barazarte H, Jahromi BR, Oinas M, Elsharkawy A, Kivelev
J, Kubota Y, Kawamata T, Hernesniemi JA. Superficial Temporal Artery: Distal
Posterior Cerebral Artery Bypass through the Subtemporal Approach: Technical Note
and Pilot Surgical Cases. Oper Neurosurg (Hagerstown). 2017 Jun 1;13(3):309-316. 
doi: 10.1093/ons/opw033. PubMed PMID: 28521345.
)).
----
Progressive deconstruction with [[flow diversion]] using a [[Pipeline embolization device]] (PED; [[Medtronic]]) can be utilized to promote [[thrombosis]] of broad-based [[fusiform aneurysm]]s. Current [[flow diverter]]s require a 0.027-inch microcatheter for deployment. 
Vakharia et al., presented a patient with a fusiform [[P2]]-[[P3]] junction [[posterior cerebral artery aneurysm]] in which they demonstrate the importance of [[haptic]]s in microwire manipulation to recognize large-vessel anatomy versus perforator anatomy that may overlap, especially when access is needed in distal tortuous circulations. In addition, the authors demonstrate the need for appropriate visualization before PED deployment. Postembolization runs demonstrated optimal wall apposition with contrast stasis within the [[aneurysm dome]].The [[video]] can be found here: https://youtu.be/8kfsSvN3XqM

<html><iframe width="560" height="315" src="https://www.youtube.com/embed/8kfsSvN3XqM" frameborder="0" allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe></html>
((Vakharia K, Munich SA, Waqas M, Setlur Nagesh SV, Levy EI. Deployment of
distal posterior cerebral artery flow diverter in tortuous anatomy. Neurosurg
Focus. 2019 Jan 1;46(Suppl_1):V9. doi: 10.3171/2019.1.FocusVid.18481. PubMed
PMID: 30611181.
)).

===== References =====