PMC3114369_01
CT angiogram demonstrates a large suprasellar bilobulated aneurysm with a larger distal lobule and a small left middle cerebral bifurcation aneurysm (a, axial; b, coronal; c, sagittal)
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F1
Computed tomographic angiography (CTA) demonstrated a large suprasellar aneurysm [Figure 1].
Digital subtraction mask with balloon inflated. The tail of the balloon is the wire in the larger distal lobule
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F2
A follow-up imaging run demonstrated appropriate coil positioning, sparing the distal lobule [Figure 2].
Artist illustration of the intra-aneurysmal balloon-assisted coiling technique. (a) Inflated Hyperform balloon at the entrance of the larger distal aneurysmal lobule, limiting coiling to the proximal lobule. (b) A Hyperglide balloon is inflated across the aneurysm neck as the deflated intra-aneurysmal balloon is slowly removed to prevent coil mass disturbance (Artist: W. Kyle Cunningham, Medical Illustrator at the University of Mississippi Medical Center)
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F3
Next, the Prowler Select Plus was withdrawn and the distal lobule deflated by deflating and back bleeding the intra-aneurysmal balloon [Figure 3a].
Digital subtraction angiogram 3 years after embolization demonstrates complete occlusion of the proximal lobule and a stable small left middle cerebral bifurcation aneurysm (a, anteroposterior; b, lateral; c, oblique)
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F4
Three years after treatment, her angiogram revealed a stable coil mass and persistent aneurysmal obliteration [Figure 4].