PMC3114371_01
3D reconstruction of the initial cerebral angiogram discloses a small anterior communicating artery aneurysm with two small lobules and a common neck
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F1
A 66-year-old man with an acute onset of headache and a brief period of loss of consciousness was diagnosed with acute subarachnoid hemorrhage and his cerebral angiogram revealed a small ACoA aneurysm [Figure 1].
A CT angiogram [axial (a) and sagittal images (b)] 3 days after surgery, as part of the work-up to assess for worsening confusion, revealed mild anterior circulation vasospasm without any evidence of residual or recurrent aneurysm
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F2
A CT angiogram done 3 days later, as part of the work-up to assess for worsening confusion, revealed mild anterior circulation vasospasm without any evidence of residual or recurrent aneurysm [Figure 2].
A repeat four-vessel cerebral angiogram [anteroposterior (a) and oblique (b) views] without 3D reconstructions 9 days after the initial surgery revealed mild right A1 and A2 vasospasm without any evidence of residual or recurrent aneurysm. A potential aneurysmal abnormality was retrospectively detected (arrow)
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F3
A repeat four-vessel cerebral angiogram without 3D reconstructions 9 days later revealed mild right A1 and A2 vasospasm without any evidence of residual or recurrent aneurysm [Figure 3]. In retrospective review, this pseudoaneurysm may have been present on the angiogram completed on day 9 [Figure 3].
A subsequent cerebral angiogram revealed a relatively large pseudoaneurysm originating from the anterior communicating artery adjacent to the neck of the previously clipped aneurysm and projecting superiorly
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F4
A subsequent cerebral angiogram revealed a relatively large pseudoaneurysm originating from the ACoA adjacent to the neck of the previously clipped aneurysm and projecting superiorly [Figure 4].
A follow-up angiogram disclosed no further growth of the pseudoaneurysm
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F5
Two weeks after the second surgery, a repeat cerebral angiogram revealed no significant residual aneurysm [Figure 5].