PMC3144608_01
Admission axial CT showing 3 x 2 cm2 region of evolving low attenuation within the deep white matter of the right temporoparietal junction, at the posterior margin of the sylvian fissure, containing a 7 mm high attenuation nidus anteriorly
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F1
This lesion was surrounded by vasogenic edema [Figure 1].
Angiography showing a peripheral right middle cerebral artery aneurysm arising from a peri-sylvian branch of the posterior division in the mid M3 deep sylvian segment
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F2
The filling portion of the aneurysm measured 2 x 2.2 x 1.5 mm3 [Figure 2].
(a) Intraoperative photomicrographs demonstrating the first anastomosis, partially completed, and (b) the completed short jump graft
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F3
A segment of the STA was harvested, and then 10-0 suture was utilized to anastomose this short segment to both the involved and normal cortical arteries, both as end-to-side grafts [Figure 3].
Intraoperative angiographic image confirming the patency of a jump graft (arrow) extending between two right middle cerebral artery branches
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F4
Intraoperative angiogram after completion of the bypass demonstrated patency of the jump graft [Figure 4].
(a) Pre-embolization angiogram demonstrating the patent short jump graft between MCA branches (arrow) and (b) postembolization imaging showing the sacrifice of the aneurysmal distal MCA segment (arrowhead) with preservation of distal flow via the short jump graft
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F5
Following surgery, the patient was taken directly to the biplane-suite for coil embolization of the parent right MCA-M3 posterior division at the level of the aneurysm [Figure 5].