PMC9899450_01
(a) Computed tomography (CT) showing a hyperdense lesion suspected to be a thrombosed aneurysm on the quadrigeminal cistern (arrow). (b) Magnetic resonance angiography (MRA) demonstrating partial blood flow in the aneurysm (arrow). (c) Left vertebral angiography image showing an aneurysm located in the P3 segment of the left posterior cerebral artery (arrow). (d) Enlargement of the aneurysm on CT (arrowhead). (e and f) MRA and left vertebral angiography showing decreased blood flow into the aneurysm compared to 1 month before (arrowheads).
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Brain computed tomography (CT) and magnetic resonance imaging (MRI) revealed a thrombosed aneurysm on the quadrigeminal cistern [Figures 1a and b]. A cerebral angiogram revealed a partially thrombosed aneurysm in the left PCA P3 segment [Figure 1c]. CT scans demonstrated an enlarged thrombosed aneurysm without subarachnoid hemorrhage [Figure 1d], while MRI and cerebral angiography revealed that the blood flow into the aneurysm had changed [Figures 1e, f, and 2a], indicating the progression of thrombosis in the aneurysm.
(a) Three-dimensional rotational angiography showing the proximal (arrow) and distal arteries (arrowheads). (b) The schematic drawing of the case during the coil embolization (orange line: microcatheter, blue mass: embolized coil, arrow: proximal artery, arrowheads: distal artery). (c) Left vertebral angiography at the end of coil embolization showing the disappearance of blood flow into the aneurysm.
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CT scans demonstrated an enlarged thrombosed aneurysm without subarachnoid hemorrhage [Figure 1d], while MRI and cerebral angiography revealed that the blood flow into the aneurysm had changed [Figures 1e, f, and 2a], indicating the progression of thrombosis in the aneurysm. The aneurysm was roughly packed only near the proximal neck so that the coil would not interfere with the thrombectomy [Figure 2b]. Cerebral angiography after embolization showed the disappearance of blood flow into the aneurysm [Figure 2c].
Intraoperative views. (a) Embolized coils the day before in the distal artery (arrow). (b) Clips are applied to the proximal (white arrow) and distal (black arrow) arteries of the aneurysm. (c) Embolized coils the day before in the aneurysm not interrupting the thrombectomy (arrowheads). (d) Vessels feeding the wall of the aneurysm (arrowheads). (e) The aneurysm removed in one lump. (f) Postoperative magnetic resonance imaging showing no residual lesion and no ischemic change.
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Intraoperative findings exhibited that the coils of the distal vessel embolized the previous day were visible during the approach to the aneurysm, which were good landmarks [Figure 3a]. Due to the disappearance of the blood flow into the aneurysm, we could retract the aneurysm effectively to confirm the proximal vessel and trapping of the aneurysm [Figure 3b]. The coils in the aneurysm were observed; however, were not disturbed during partial thrombectomy [Figure 3c]. Endodecompression and detachment from the surrounding tissue revealed some blood vessels through nearby arteries feeding the wall of the aneurysm [Figure 3d]. All arteries coagulated and the aneurysm was completely removed [Figure 3e]. Postoperative MRI showed no residual lesions or ischemic changes [Figure 3f].