PMC3917415_01
Pre-operative images. (a) Plain computed tomography shows subarachnoid hemorrhage in the right Sylvian fissure. (b) Maximum intensity projection image of magnetic resonance angiography suggests the presence of a ruptured aneurysm at the right proximal M1 portion (arrow). (c) Volume rendering image of magnetic resonance angiography shows the aneurysm arising at the fenestration of M1 (arrow). (d) Different angle of the volume rendering image shows the anatomical relationship between the fenestration and the aneurysm (arrow). R, Right side; L, Left side.
1752-1947-8-30-1.jpg
PMC3917415_01_1752-1947-8-30-1.jpg
F1
Computed tomography (CT) demonstrated SAH in her right Sylvian fissure (Figure 1a). MRA was performed (Figure 1c,d) in addition to the usual maximum intensity projection (MIP) image (Figure 1b). MRA revealed a fenestration at the M1 portion of her right MCA and a small saccular aneurysm at the proximal end of the fenestration (Figure 1c,d).
Intra-operative images. (a) Intraoperative view of the ruptured aneurysm arising at the proximal portion of the middle cerebral artery fenestration. (b) Intraoperative view after clipping of the aneurysm. (c) Intraoperative indocyanine green video angiography shows the middle cerebral artery fenestration and complete disappearance of the aneurysm.
1752-1947-8-30-2.jpg
PMC3917415_01_1752-1947-8-30-2.jpg
F2
The fenestration and ruptured aneurysm were confirmed under surgical microscopy, and the aneurysm was successfully occluded (Figure 2a,b). Intraoperative indocyanine green videoangiography confirmed this result (Figure 2c).