PMC9610211_01
Illustrative case (a) A right frontobasal hematoma with ventricular extension is seen on noncontrast Computed tomography (CT) scan. (b and c) Cerebral DSA with rotational 3-D show the presence of a saccular aneurysm in the middle of the vascular network. (d) Intraoperative view. After evacuating the hematoma, the vascular network is exposed (T-MCA). Under the superficial vessels of the anomaly, the dome of the aneurysm is just visible. Distal M2 segment seems normal. (e) Postoperative DSA. The aneurysm is not visible. (f) CT-angio displays the clip position and the complete exclusion of the aneurysm. (g) Perfusion MRI showing the mean transit time (MTT) and regional cerebral blood volume (rCBV) images without ischemic areas (h) Illustration of the Ap/T MCA anomaly depicting the plexiform arterial network replacing the proximal M1 segment.
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Computed tomography (CT) revealed a frontobasal hematoma with ventricular disruption [Figure 1a]. A CT angiography (CT-Angio) and a cerebral digital subtraction angiography (DSA) were completed, revealing an abnormal network of plexiform vessels with a "twig-like" appearance and the presence of a saccular aneurysm of 9 mm of diameter at the M1 segment of the right MCA [Figures 1b and c]. After opening the Sylvian fissure, the vessels network was visualized, formed by numerous tinny and fragile vessels, with the aneurysm located in the middle of this network with old clots and hemosiderin surrounding the lesion [Figure 1d]. Postoperative cerebral DSA and CT- angio showed the disappearance of the aneurysm without associated low-density areas [Figures 1e and f] and the perfusion MRI did not show any ischemic area [Figure 1g].