PMC4728148_01
Dose distribution of planning axial T1-weighted magnetic resonance images with gadolinium for the left vestibular schwannoma. The tumor margin was covered by the 50% isodose line, and 18 Gy was delivered to the margin (white line).
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F1
The tumor margin was covered by the 50% isodose line, and a dose of 18 Gy was delivered to the margin (Fig. 1).
a: Computed tomography scan on admission revealed diffuse subarachnoid hemorrhage and b: no aneurysms were found on initial conventional angiogram.
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F2
Diagnostic computed tomography (CT) revealed a diffuse subarachnoid hemorrhage with a predominance of bleeding in the left posterior fossa cisterns (Fig. 2a). The subsequent three-dimensional CT angiogram and conventional angiograms showed no vascular lesions (Fig. 2b).
The second vertebral angiogram, performed 10 days after admission, revealed a round aneurysm of the distal anterior inferior cerebellar artery, which was not located at a branching site.
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F3
The second conventional angiogram, performed 10 days after admission, demonstrated a round aneurysm 3.0 mm in diameter at the lateral pontine segment of the left AICA (Fig. 3).
Angiogram immediately after embolization of the left anterior inferior cerebellar artery.
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F4
After a micro-catheter (Marathon, Covidien, Irvine, California, USA) was positioned over the AICA orifice under transient occlusion of the basilar artery using a balloon (HyperGlide 4 mm x 10 mm, Covidien, Irvine, California, USA), the AICA was occluded with one coil (ED coil 1.5 mm x 1 cm, Kaneka, Osaka) (Fig. 4). Anticoagulation therapy via intravenous administration of unfractionated heparin was used to maintain an activated coagulation time over 200 seconds until 24 hours after embolization in order to avoid retrograde thrombosis.
T2-weighted magnetic resonance imaging revealed an infarction on the left side of the pons and brachium pontis.
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F5
Postoperative MRI revealed an infarction on the left side of the pons and brachium pontis (Fig. 5), causing mild cerebellar ataxia, moderate left facial nerve palsy (House-Brackmann Grade III), and abducens nerve palsy.