PMC3872649_01
CT scan of the head in axial cuts showing diffuse subarachnoid hemorrhage, intraventricular hemorrhage and hydrocephalus
SNI-4-150-g001.jpg
PMC3872649_03_SNI-4-150-g001.jpg
F1
The aneurysm clip was identified and found to be protruding through the layer of Duragen (Integra LifeSciences Corporation, NJ) previously used to cover the remaining dural defect [Figure 1e]. Postoperative angiogram demonstrated a patent anastomosis and good filling of the distal PICA [Figure 1f].
PMC3872649_02
CT scan of the head in axial cuts showing diffuse subarachnoid hemorrhage, intraventricular hemorrhage and hydrocephalus
SNI-4-150-g002.jpg
PMC3872649_03_SNI-4-150-g002.jpg
F2
Following visualization of the aneurysm, the left PICA was noted to be going into and out of the aneurysm, thus forming a separate inlet and outlet [Figure 2d]. After this, the edges of the inlet and outlet vessels were trimmed and fish-mouthed, and an end-to-end PICA anastomosis was performed as described in the first case [Figure 2e]. A postoperative angiogram performed the same day showed no aneurysmal remnant and a patent left PICA [Figure 2f and g].
PMC3872649_03
CT scan of the head in axial cuts showing diffuse subarachnoid hemorrhage, intraventricular hemorrhage and hydrocephalus
SNI-4-150-g001.jpg
PMC3872649_03_SNI-4-150-g001.jpg
F1
The aneurysm clip was identified and found to be protruding through the layer of Duragen (Integra LifeSciences Corporation, NJ) previously used to cover the remaining dural defect [Figure 1e]. Postoperative angiogram demonstrated a patent anastomosis and good filling of the distal PICA [Figure 1f].
CT scan of the head in axial cuts showing diffuse subarachnoid hemorrhage, intraventricular hemorrhage and hydrocephalus
SNI-4-150-g002.jpg
PMC3872649_03_SNI-4-150-g002.jpg
F2
Following visualization of the aneurysm, the left PICA was noted to be going into and out of the aneurysm, thus forming a separate inlet and outlet [Figure 2d]. After this, the edges of the inlet and outlet vessels were trimmed and fish-mouthed, and an end-to-end PICA anastomosis was performed as described in the first case [Figure 2e]. A postoperative angiogram performed the same day showed no aneurysmal remnant and a patent left PICA [Figure 2f and g].
Digital subtraction angiogram (DSA) in AP projection demonstrating the presence of a right PICA aneurysm measuring approximately 2-2.5 mm in diameter with a broad neck (black arrow)
SNI-4-150-g003.jpg
PMC3872649_03_SNI-4-150-g003.jpg
F3
A four vessel cerebral angiogram was performed, which showed an 8 x 6 mm fusiform left PICA aneurysm at the tonsillomedullary segment (caudal loop) behind the arch of C1, not amenable to endovascular coiling [Figure 3a-c]. A postoperative angiogram showed robust filling of the anastomosis and no evidence of aneurysmal remnant [Figure 3d].