PMC3927081_01
(a) NCCT Head showing SAH and IVH, (b) 3D CT angiography seen from anterior aspect and above showing dilated vascular structure (shown by arrow) near posterior CVJ, (c and d) CT angiography coronal and sagittal reconstruction, showing dilated vascular structure (shown by arrow) near CVJ, (e) DSA in arterial phase does not show any aneurysm, (f) DSA in early venous and late arterial phase showing venous aneurysmal dialatation (arrow), (g and h) postoperative DSA showing nonfilling of aneurysm both in the arterial phase and (g) venous phase, (h) Aneurysm clip is seen
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F1
Computed tomography (CT) head revealed subarachnoid hemorrhage (SAH) with intraventricular hemorrhage (IVH) [Figure 1a]. Computerized tomography angiography (CTA) [Figure 1b-d] and digital substraction angiography (DSA) [Figure 1e and f] revealed a saccular contrast filling pouch in the left lateral aspect of CMJ.
Intraoperative images showing: (a) a large pliable vascular lesion (marked with star), (b) dissection being done to identify the neck, (c) the feeding vein (dialated) being skeletonized and (d) aneurysm clip applied at the feeding vein. Aneurysm partially (hidden from view) marked with a star
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F2
This aneurysm was clipped and excised [Figure 2a-d].
(a) Cut section of thin walled Aneurysm with partial thrombus. No arterial ostia was found, (b) Wall of the aneurysm (x10) in elastic van geison stain does not show elastic fibers and (c) Wall of the aneurysm (x10) in H and E stain showing absence of elastic fiber layer
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F3
HPR revealed a single layer of fibromuscular tissue lined [Figure 3a] by a flat endothelium. There was no muscle layer [Figure 3b and c].