PMC7656031_01
(a) Three-dimensional CT angiography showing the aneurysm (7 mm, arrow) when the patient was 75 years old. The aneurysm originated from the distal side of the bifurcation of the left internal carotid artery and posterior communicating artery. (b) The aneurysm enlarged to 10 mm at the age of 78 years (arrow). (c) CT showing the posterior communicating artery appearing to arise from the aneurysmal body (arrow heads)
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F1
Three-dimensional computed tomography (CT) angiography revealed an irregularly shaped aneurysm measuring 7 mm [Figure 1a]. The aneurysm gradually grew to 10 mm in size by the time she was 78 years old [Figure 1b]. We planned to clip the neck of the aneurysm to firmly preserve the fetal-type PcomA, which seemed to arise from the aneurysmal body, due to an increased risk of rupture [Figure 1c].
(a) Intraoperative photograph of the left pterional approach. Splitting of the oculomotor nerve by the aneurysm (dotted line). (b) Schematic illustration depicting the aneurysm splitting the oculomotor nerve. (c) The aneurysm is resected. (d) Schematic illustration of the resected aneurysm.
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F2
We clipped the neck of the aneurysm [Figure 2a and b] followed by careful separation of the aneurysmal wall and inspection of the oculomotor nerve. We observed that the dome of the aneurysm was splitting the oculomotor nerve [Figure 2c and d] (Video 1).