PMC9610930_01
(a-d) T2-weighted axial magnetic resonance image (MRI) from 2013 showing chronic left pontine stroke and a dolichoectatic basilar trunk. (e-h) T2-weighted axial MRI from 2020 showing significant interval enlargement of the dolichoectatic basilar trunk now with periluminal thrombus and brainstem compression.
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F1
Repeat imaging demonstrated interval enlargement of the aneurysm with significant periluminal thrombosis causing mass effect on the optic chiasm, brainstem, and cerebral aqueduct resulting in obstructive hydrocephalus [Figures 1e-g, Figures 2 and 3].
PMC9610930_02
(a-d) T2-weighted axial magnetic resonance image (MRI) from 2013 showing chronic left pontine stroke and a dolichoectatic basilar trunk. (e-h) T2-weighted axial MRI from 2020 showing significant interval enlargement of the dolichoectatic basilar trunk now with periluminal thrombus and brainstem compression.
SNI-13-434-g001.jpg
PMC9610930_02_SNI-13-434-g001.jpg
F1
Repeat imaging demonstrated interval enlargement of the aneurysm with significant periluminal thrombosis causing mass effect on the optic chiasm, brainstem, and cerebral aqueduct resulting in obstructive hydrocephalus [Figures 1e-g, Figures 2 and 3].
(a-e) T1-weighted axial magnetic resonance image showing massive partially thrombosed enlargement of the aneurysm with hydrocephalus and brainstem/optic chiasm compression and (f) associated 3D rotational angiography.
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F2
Repeat imaging demonstrated interval enlargement of the aneurysm with significant periluminal thrombosis causing mass effect on the optic chiasm, brainstem, and cerebral aqueduct resulting in obstructive hydrocephalus [Figures 1e-g, Figures 2 and 3].
(a) Coronal and (b) sagittal T1-weighted magnetic resonance image showing massive partially thrombosed enlargement of the aneurysm, marked by the dashed lines, with hydrocephalus and brainstem/optic chiasm compression. (c) AP and (d) lateral left vertebral angiogram demonstrating mildly increased caliber of the patent portion of the aneurysm when compared to 2013.
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F3
Repeat imaging demonstrated interval enlargement of the aneurysm with significant periluminal thrombosis causing mass effect on the optic chiasm, brainstem, and cerebral aqueduct resulting in obstructive hydrocephalus [Figures 1e-g, Figures 2 and 3].
PMC9610930_03
(a and b) 3D computed tomography reconstructions of the telescoping stent construct. (c) AP and (d), lateral plane X-rays demonstrating placement of the stents within the aneurysm. (e) AP and (f) lateral left vertebral artery angiograms demonstrating patency of the stents without distal emboli after deployment.
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F4
After the patient consented to the procedure, 6 mm x 50 mm stents were deployed in a telescoping fashion to provide coverage across the entire lesion [Figure 4].
PMC9610930_04
Follow-up T2-weighted axial magnetic resonance image at 1 year demonstrating stability in size of the aneurysm.
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F5
At nearly 1-year follow-up, the aneurysm was relatively stable in size and the patient remained at his neurologic baseline [Figure 5].