PMC5791514_01
Initial three-dimensional enhancement computed tomography demonstrates a right vertebral artery dissection (a). Angiography shows normal appearance of the left vertebral artery and basilar artery, indicating that the dissection was limited at the right vertebral artery (b)
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F1
He was subsequently diagnosed with subarachnoid hemorrhage due to a ruptured right VA dissecting aneurysm [Figure 1a]. Although the range of dissection was limited at the right VA because angiography demonstrated normal shape of the contralateral VA and basilar artery [Figure 1b], the aneurysm originated from the PICA [Figure 2a] and extended from the jugular foramen [Figure 2b] to the internal acoustic canal [Figure 2c].
Enhancement computed tomography demonstrates a right vertebral artery dissection, which involves the posterior inferior cerebellar artery origin (arrow) (a). The level of the aneurysm extends from the jugular foramen (b) to above the internal acoustic canal (c); the distal edge of the dissection extends contralaterally because of the tortuosity of the right verterbral artery (c)
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F2
Although the range of dissection was limited at the right VA because angiography demonstrated normal shape of the contralateral VA and basilar artery [Figure 1b], the aneurysm originated from the PICA [Figure 2a] and extended from the jugular foramen [Figure 2b] to the internal acoustic canal [Figure 2c]. Moreover, the distal edge of the dissection extended contralaterally because of the tortuosity of the right VA [Figure 2c].
The distal section of the aneurysm and anterior spinal artery (arrowhead) observed at the contralateral vertebral artery (VA) during post direct surgery angiography (a). Retrograde placement of the coil performed at the proximal origin of the anterior spinal artery via the contralateral VA (b). The postoperative three-dimensional computed tomography demonstrates occipital artery to posterior inferior cerebellar artery bypass and the disappearance of the dissecting aneurysm via clip and coil (c). OA, occipital artery; PICA, posterior inferior cerebellar artery
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F3
The distal part of the aneurysm was observed on angiography [Figure 3a]; therefore, retrograde placement of a coil was continuously performed up to the proximal origin of the anterior spinal artery via the contralateral VA [Figure 3b]. The postoperative three-dimensional computed tomography demonstrated OA to PICA bypass and the disappearance of the dissecting aneurysm via clip and coil [Figure 3c].