PMC7193255_01
Head computed tomography diagnosed diffuse subarachnoid hemorrhage (a and b). Computed tomography angiography revealed multiple cerebral aneurysms at the right distal anterior cerebral artery (rt. DACA) of 2.4 mm in diameter (red circle in c), left middle cerebral artery (lt. MCA) of 2.3 mm (green circle in c), and right internal carotid artery-posterior communicating artery bifurcation (rt. IC-PC) of 2.1 mm (circle in d). Intraoperative findings of the rt. DACA aneurysm (e) and the lt. MCA aneurysm (f), which seemed unruptured either. Intraoperatively, the IC-PC aneurysm had fibrin cap (arrow in g) and seemed as ruptured (g). After clipping these aneurysms, we closed the cranium with metal plates, and these procedures were performed as a single-stage operation (h). Schematic illustration of the Sugita head holding system (Mizuho Co., Ltd., Tokyo). It allowed turning the head of the patient toward the right and left with single fixation and performing this single-stage operation (i).
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F1
Head computed tomography (CT) diagnosed SAH [Figure 1a and b] (Hunt and Kosnik Grade II). DACA) of 2.4 mm in diameter (red circle in Figure 1c), left middle cerebral artery (lt. MCA) of 2.3 mm [green circle in Figure 1c], and right internal carotid artery-posterior communicating artery bifurcation (rt. IC-PC) of 2.1 mm [circle in Figure 1d]. However, it seemed unruptured [Figure 1e]. However, it was unruptured [Figure 1f]. The aneurysm had fibrin cap [arrow in Figure 1g] and seemed ruptured. We closed the cranium with metal plates [Figure 1h].