PMC4443400_01
(a and b) Axial T2-weighted MR images showing an increase of the right middle cerebral artery aneurysm diameter from 2.5 to 4 cm in 2 years. (c) Intraoperative photograph of the aneurysm. (d) The aneurysm was clipped using two clips
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F1
MR imaging demonstrated a round and partially thrombosed aneurysm of the MCA [Figure 1a]. When she revisited our hospital for worsening headache 2 years after her last visit, the aneurysm had grown in size from 2.5 to 4.0 cm, with the development of a significant perifocal edema [Figure 1b]. The aneurysm was buried in the temporal lobe [Figure 1c]. Two clips were then applied in an angioplastic fashion [Figure 1d].
(a and b) Axial diffusion-weighted MR images obtained 1 day after surgery revealing no acute ischemia. (c) Axial T2-weighted MR image performed 1 day after surgery showing no new changes other than the preexisting edema around the aneurysm. (d) Preoperative angiogram demonstrating a giant MCA aneurysm. (e) Postoperative angiogram showing the complete obliteration of the aneurysm with preservation of the parent artery. Note the remarkable increase of the arterial flow in the MCA territory (arrowheads). (f) Right lateral carotid angiogram demonstrating that the bypass flow covered only a small area of the frontal lobe distal to the site of anastomosis (arrow)
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F2
MR images obtained 1 day after surgery did not reveal any new hemorrhage or infarction [Figure 2a-c]. However, the arterial flow in the peripheral MCA territory obviously increased, compared with preoperative findings [Figure 2d and e]. Although STA-MCA bypass flow was also confirmed, the flow via the bypass was only toward the distal portion of the cortical temporal artery [Figure 2f].
(a) 99mTc-ECD SPECT performed 3 days after surgery revealing hyperperfusion in the frontal cortex (arrowheads). There was also slight hypoperfusion in the right basal ganglia including the subthalamic nucleus (arrows). (b) 99mTc-ECD SPECT obtained 8 weeks after surgery showed the resolution of hyperperfusion in the right frontal cortex (arrowheads) with the resolved laterality of the perfusion in the subthalamic regions (arrows)
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F3
The 99mTc-ECD SPECT obtained 3 days after surgery demonstrated hyperperfusion of the MCA territory [Figure 3a]. SPECT obtained 8 weeks after surgery revealed that CBF had been normalized in the right frontal cortex with the resolved laterality of the perfusion in the thalamic regions [Figure 3b].