PMC6763671_01
Anteroposterior view, digital subtraction angiography through vertebral artery injection delineating the wide neck of the multilobulated ruptured basilar tip aneurysm.
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F1
Anteroposterior view, digital subtraction angiography through vertebral artery injection demonstrating the residual neck of the partially coiled basilar tip aneurysm.
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F2
The aneurysm had a wide neck, so we performed partial embolization leaving a residual neck [Figure 2] with the plan to complete treatment with stent-assisted coiling after initial recovery.
Noncontrast computed tomography, axial view demonstrating no evidence of intraparenchymal hemorrhage postshunt placement.
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F3
A parietal VPS was placed in standard fashion using the neuro-PEN endoscope (Medtronic PS Medical, CA, USA) and laparoscopy [Figure 3].
Noncontrast computed tomography, axial view showing (a) right parietal intraparenchymal hemorrhage along tract of the right parietal ventriculostomy catheter, as well as (b) intraventricular hemorrhage and associated hydrocephalus.
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F4
On arrival, her neurologic examination was nonfocal, but she rapidly became obtunded with worsening intraparenchymal and intraventricular hemorrhage [Figure 4].
Lateral view, digital subtraction angiography through the right internal carotid artery injection revealing (a) cortical pseudoaneurysm contiguous to the ventricular catheter (b) magnified.
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F5
Emergent ventriculostomies were placed, and the patient was taken for angiography which revealed a cortical pseudoaneurysm contiguous to the ventricular catheter [Figure 5].
Intraoperative imaging (a) after disconnecting the shunt and extending the burr hole, (b) after opening the dura, and (c) after removal of the ventricular catheter and trapping of the associated cortical pseudoaneurysm (magnified).
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F6
Given the cortical location and the need for shunt removal, we treated the aneurysm with open microsurgical excision [Figure 6].