PMC9479575_01
Axial computed tomography at the level of the upper pons (a) and midbrain (b) diffuse subarachnoid hemorrhage with slight ventriculomegaly, but no abnormal findings identified in the midbrain.
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F1
No abnormal findings were observed in the midbrain [Figure 1].
Intraoperative photo showing a cisternal drain (arrows), placed with the tip at the medial aspect of the internal carotid artery and anterior clinoid process following application of a clip (arrowhead) to the neck of the middle cerebral artery aneurysm. D: Dura mater, FL: frontal lobe, and TL: temporal lobe. ACP: Anterior clinoid process; IC: Internal carotid artery.
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F2
After satisfactory clip application to the aneurysm neck, a commercially available silastic tube, 3.0 mm in an outer diameter, was placed in the basal cistern at the medial aspect of the clinoidal portion of the internal carotid artery and the anterior clinoid process [Figure 2].
Axial (a and b) and coronal (c and d) computed tomography performed immediately after surgery showing the tip of the cisternal drain (a, c, d, arrows) displaced to the lateral aspect of the anterior clinoid process (ACP). DS: Dorsum sellae; Arrowhead: A clip applied to the ruptured middle cerebral artery aneurysm; Dashed arrow: ventricular catheter.
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F3
Prompt CT revealed that the tip of the cisternal drain was displaced to the lateral aspect of the anterior clinoid process [Figure 3].
(a-i) Photos of the patient's ocular movements at postoperative day 3 showing ptosis, limitations of gaze in the lower and medial directions, and mydriasis in the left eye. POD: Postoperative day.
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F4
In contrast, recovery from restriction of extraocular movements was necessitated 50 days after surgery [Figure 4].
(a and b) Adjacent images of the axial constructive interference steady-state sequence performed on postoperative day 30, showing the cisternal portion of the left oculomotor nerve (III) coursing adjacent to the lateral wall of the clinoidal internal carotid artery (IC). ACP: Anterior clinoid process.
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F5
The constructive interference steady-state (CISS) sequence performed on postoperative day 30 detected the cisternal portion of the left oculomotor nerve coursing adjacent to the lateral wall of the clinoidal portion of the internal carotid artery [Figures 5 and 6].
(a-d) Serial images of the coronal constructive interference steady-state sequence performed on postoperative day 30, showing the cisternal portion of the left oculomotor nerve (III) coursing adjacent to the lateral wall of the clinoidal internal carotid artery (IC). a (anterior)  d (posterior).
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F6
The constructive interference steady-state (CISS) sequence performed on postoperative day 30 detected the cisternal portion of the left oculomotor nerve coursing adjacent to the lateral wall of the clinoidal portion of the internal carotid artery [Figures 5 and 6].