PMC6675932_01
Case 1 aneurysms with their sizes:- 1,2 - bilateral MCA bifurcation aneurysms(right- 2 mm, left- 0.4 mm); 3,4 - bilateral Anterior choroidal artery aneurysms(right-3 mm, left- 2 mm); 5 - basilar top (6.4 mm); 6 - left M1 aneurysm(3 mm).
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She underwent CT angiogram of the brain with three-dimensional reconstructions and a 4-vessel DSA which demonstrated the following aneurysms: - basilar top, bilateral M1, bilateral MCA bifurcation and bilateral anterior choroidal artery aneurysms (Fig. 1, Fig. 2).
PMC6675932_02
Case 2 aneurysms with their sizes:-Bilateral MCA aneurysms (1-2.3 mm, 2- 2.6 mm, 3- 2.4 mm, 4 - 3.2 mm).
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She underwent CT angiogram of the brain with three- dimensional reconstructions and a 4-vessel DSA which demonstrated the following aneurysms:- Acom, 2 sets of bilateral M1 and a right cavernous ICA aneurysms (Fig. 3, Fig. 4).
PMC6675932_03
A) Pre clipping DIVA showing the aneurysm and the adjacent vessels. B) Post clipping DIVA shows no residual aneurysms with intact adjacent vessels.
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Intraoperatively, we used electrophysiological monitoring like MEP, indocyanine green videoangiography with DIVA (Fig. 5) for an intraoperative assessment of the occlusion of the aneurysms and the preservation of the blood flow in parent/ branching vessels and doppler in all the cases.