PMC10126509_01
(A) CTA obtained two years before this admission (posterior- anterior view). A left VA-PICA aneurysm and a right MCA aneurysm (arrowhead) were noted. The left VA-PICA aneurysm (arrow) was clipped at first admission. (B) The scaled-up version of CTA taken two years before this admission. The size of the right MCA aneurysm (arrowhead) was 3 mm. (C) CTA obtained at this admission. No de novo aneurysm was found. (D) The scaled-up version of CTA obtained at this admission. The aneurysm size was 4 mm, and bleb formation was observed (arrowhead).
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F1
The patient had a history of subarachnoid hemorrhage caused by a ruptured left vertebral artery-posterior inferior cerebellar artery (VA-PICA) aneurysm two years prior to admission (Figure 1A). A 3-mm aneurysm of her right middle cerebral artery (MCA) had been detected (Figure 1B), and the patients had been followed up by MRI every six months at a local hospital. However, brain MRI (Figure 2B) revealed the presence of a FLAIR hyperintense lesion adjacent to the aneurysm, while CT angiography (Figures 1C,D) showed aneurysm growth with bleb formation at the posterior site.
(A) MRI-FLAIR image taken six months before this admission. (B) MRI-FLAIR image taken at this admission. A FLAIR hyperintense lesion was detected in the inner temporal lobe. (C) MRI-FLAIR image taken at post-operative day 7. The FLAIR hyperintense lesion persisted. (D) MRI-FLAIR image taken eight months after discharge. The FLAIR hyperintense lesion disappeared.
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F2
There was no FLAIR hyperintense lesion adjacent to the MCA aneurysm at six months prior to admission (Figure 2A). However, brain MRI (Figure 2B) revealed the presence of a FLAIR hyperintense lesion adjacent to the aneurysm, while CT angiography (Figures 1C,D) showed aneurysm growth with bleb formation at the posterior site. MRI scans (Figure 2C) on post-operative day 7 revealed that the FLAIR hyperintense lesion had almost disappeared. MRI scans (Figure 2D) taken eight months after clipping demonstrated complete regression of the FLAIR hyperintense lesion around the aneurysm.
(A) The aneurysm was detected on the right M2/3 bifurcation. There were no hemosiderin deposits around the aneurysm and brain parenchyma. (B) The aneurysm enhanced with indocyanine green. (C) The aneurysm was clipped with Sugita mini side angle blade 6 mm no.104.
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F3
During the procedure, there was no evidence of subarachnoid hemorrhage, hemosiderin deposits around the aneurysm, and brain parenchyma (Figures 3A-C).