PMC4771686_01
Axial non-contrast CT scan showed diffuse SAH in the basal cisterns, anterior interhemispheric fissure and sylvian fissures (a). CT angiography demonstrated ruptured aneurysm of the anterior communicating artery (b). Intraoperative photograph and post-operative CT scan showed the clipped aneurysm without any complications (c, d)
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Fig1
A right fronto-temporal craniotomy was done and the ruptured aneurysm was clipped via the pterional approach without any observed complications (Fig. 1).
On post-operative Day 3, (a, b) head CT scan and CT angiography revealed no evidence of re-bleeding, hydrocephalus or vasospasm but showed an elongated midbrain. On post-operative Day 5 (c, d), head CT scan showed small lateral ventricles and effacement of the cisterns
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Fig2
CT angiography was performed but there was no evidence of re-bleeding, vasospasm, hydrocephalus or infarction (Fig. 2a, b). This scan showed small lateral ventricles, effacement of the cisterns and elongated brain stem suggesting brain sag (Fig. 2c, d).
On post-operative Day 7, the hematoma was nearly absorbed and ambient cistern was visible (a). But ventricles were enlarged compared with the previous CT scan (b) and CT angiography demonstrated significant vasospasm at both distal portions of the anterior cerebral arteries (c, d)
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Fig3
Also, the ventricles were enlarged compared with the previous CT scan (Fig. 3).
A follow-up CT scan showed a communicating hydrocephalus (a) and a ventriculo-peritoneal shunt were placed 3 months after surgery (b)
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Fig4
A ventriculo-peritoneal shunt was performed to treat hydrocephalus secondary to SAH 3 months after the operation (Fig. 4).