PMC9842405_01
Homonymous hemianopsia was confirmed at the preoperative examination.
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A 60-year-old man had complained of deteriorating visual loss and homonymous hemianopia 6 months before ( Fig. 1 ).
Neurofibromatosis and cafe-au-lait spots were found on the front and back of the whole body and limbs.
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Physical examination found cafe-au-lait spots and neurofibromatosis over the entire body ( Fig. 2 ).
(
A
) Preoperative angiogram, anteroposterior view, showing the internal carotid artery (ICA) anterior wall aneurysm with wide neck including the middle cerebral artery (MCA) and posterior communicating artery (PcomA). (
B
) Preoperative angiogram, lateral view, showing the ophthalmic artery branching off proximal to the aneurysm.
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The right middle cerebral artery (MCA) and the posterior communicating artery branched from the dome of the aneurysm ( Fig. 3 ).
Sagittal computed tomography (CT) scans demonstrating very severe calcifications (white arrow) around the aneurysm neck. Thrombotic aneurysm (asterisks) compressed and thinned the optic nerve.
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Calcifications around the aneurysm neck were very severe ( Fig. 4 ), so we considered that direct neck clipping was probably impossible, and planned trapping of the ICA including the aneurysm neck after external carotid artery (ECA)-MCA bypass using the radial artery (RA) as an intergraft.