PMC9560476_01
a: Anteroposterior, b: lateral and c: oblique projections of the preoperative DSA depicting a right vertebrobasilar junction aneurysm. d: Right internal carotid artery and e: left internal carotid artery, both showing little opacification of Posterior Communicating Arteries.
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fig1
a, b, c, d, e, Picture of the hybrid operation room setting. The angiography arc must be placed in a way that the surgeon is able to perform the aneurysm clipping. During intraoperative control angiographic series, the surgical field is covered with sterile fluoroscopic protectors and caution must be taken in order not to collide with the Mayfield clamp.
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The arm of the angiography system was placed in an oblique position in such a way that allowed the surgeon to work with the microscope while keeping the same angiographic view and position, thus without interfering with the endovascular maneuvers and images (Fig. 2).
a: intraoperative DSA showing the aneurysm deflated due to a reactive vasospasm at the Vertebral Artery; b: intraoperative DSA after 2 clips were placed showing a small remnant of aneurismal sac; c: intraoperative DSA after the third clip was placed showing complete exclusion of the aneurysm, and vertebral artery vasospasm solved; d: intraoperative angiography showing complete exclusion of the aneurysm without subtraction so the clips can be seen.
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One of the straight clips was repositioned achieving complete aneurysm obliteration (Fig. 3).