Dividing the Posterior Communicating Artery in Approaches to the Interpeduncular Fossa: Technical Aspects and Safety

Abstract

Abstract Objective: Cutting the posterior communicating artery (PComA) can improve the neurosurgeon's view and maneuverability while performing surgery within the interpedun-cular fossa. Although mentioned in some reports, its technique and safety have not been studied in detail thus far. Methods: Patients undergoing surgery for vascular and neoplastic lesions in the interpeduncular fossa in which the PComA was cut were retrospectively analyzed regarding the location where the PComA was divided, the size of the PComA in relation to the posterior cerebral artery, and the vascular risk factors. Clinical and radiological outcomes and the related complications were recorded and analyzed. Results: The PComA was divided in 25 patients, and was operated on for vascular (in 23 patients) and neoplastic (in 2 patients) lesions. The PComA was divided at a perforator-free-zone. This zone was most commonly located at the junction of the PComA and the posterior cerebral artery (88% of patients). One patient had delayed postoperative bleeding from the divided PComA stump. There were no ischemic complications either in the territory of the PComA perforator or in the posterior cerebral artery. Conclusion: This is the largest reported experience with dividing the PComA. It shows that this surgical step is safe and that it constitutes an important option to help improve the exposure, maneuverability, and safety of surgery in the region of the interpeduncular fossa.