PMC4508689_01
Preoperative neuroradiological findings. A and B: The preoperative skull X-ray (A: antero-posterior view, B: lateral view). The metal rod penetrating the skull base. C and D: Translucent 3D computed tomography (CT) of the head. This examination showed that the tip of the metal rod was located in the right frontal lobe, compressing the right internal carotid artery (ICA) and right side of the chiasma.
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F1
The length of the rod was about 50 cm, with a 5-mm diameter, and about 12 cm penetrated the patient's head (Fig. 1). Partially translucent 3D CT revealed fine anatomical bone structure and the metal rod (Fig. 1).
Digital subtraction angiography. A: Right carotid angiogram. Right internal carotid artery (ICA) is occluded at level C5. B: Left carotid angiogram. Blood flow of right anterior cerebral artery and middle cerebral artery are fed via the anterior communicating artery. C: Left vertebral angiogram. Blood flow of right middle cerebral artery is supplied via the posterior communicating artery.
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F2
Digital subtraction angiography showed complete occlusion of the right ICA, and well-developed collateral circulation via the circle of Willis (Fig. 2).
Intraoperative view. (1) Metal rod. (2) Partially dissected right ICA. (3) Compressed right optic nerve. (4) Anterior clinoid.
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F3
The tip of the rod lodged under the right ICA of segment C2 and the right optic nerve, compressing them (Fig. 3).