PMC6238328_01
Admission computed tomographyscan
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F1
A non-contrast enhanced computed tomography (CT) scan confirmed severe orbital trauma with signs of ruptured globe and injury of the optic nerve; fractures of the medial wall and roof of the right orbit with bone fragments inside the frontal lobe; a small rounded blood effusion in the right paramedian frontal lobe and a slight interhemispheric bleed [Figure 1].
Computed tomography scan performed after delayed clinical deterioration showing right frontal hematoma
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F2
A CT scan revealed an intraparenchymal right frontal hematoma with moderate mass effect [Figure 2].
Magnetic resonance angiography showing anterior cerebral artery aneurysm (A2)
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F3
CT scan revealed a rounded, slight hyperdense, lesion in the right frontal lobe; MRA showed the presence of an aneurysm of right anterior cerebral artery (A2) partially thrombosed [Figure 3]. Considering the risk of re-bleeding we decided to treat the patient.
Intraoperative photographs. Panel A: aneurysm completely dissected before clipping. Panel B: aneurysm excluded (using two straight clips) and partially opened. Panel C: enlarged view after clipping, note pericallosal and calloso-marginal artery. (White dotted arrow: aneurysm; black arrow: right pericallosal artery; black asterisk (*): right calloso-marginal artery)
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F4
We performed a right paramedian frontal craniotomy and clipping the aneurysm with an interhemispheric approach [Figure 4].