PMC8516352_01
Preoperative imaging studies. (A) Diffusion-weighted image on MRI showed a small high-intensity lesion on left paramedian pons. (B,C) Anterior-posterior view (B) and right lateral view (C) of left vertebral artery multiplanar 3D rotational angiography revealed a giant fusiform basilar artery aneurysm. (D) A fluid-attenuated inversion recovery image on MRI revealed that the aneurysm was partially thrombosed. (E) CT showed diffuse subarachnoid hemorrhage incredibly thick in the right prepontine cistern. (F) Right lateral view of left vertebral artery multiplanar 3D rotational angiography revealed a bleb (white arrowhead) on the right shoulder of the fusiform basilar artery aneurysm.
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F1
His initial diagnosis was acute cerebral infarction (Figure 1A). He had been pointed out to have a partially thrombosed giant fusiform basilar artery aneurysm 3 months ago and we decided to follow up with imaging studies because the patient was asymptomatic and refused the treatment (Figures 1B-D). His plain computerized tomography (CT) of the head showed diffuse subarachnoid hemorrhage (SAH), which was relatively thick in the right anterior pontine cistern (Figure 1E). Scale (GCS) of nine points. Subsequent digital subtraction angiography (DSA) revealed a newly formed bleb on the right shoulder of the previously noted fusiform basilar artery aneurysm (Figure 1F).
(A,B) The intraoperative findings. (A) The aneurysm was observed via the anterior transpetrosal approach. The white arrowhead indicates a bleb on the right shoulder of the aneurysm, which was covered by hematoma, indicating the bleb was the rupture point. (B) The aneurysm, including the bleb, was partially occluded with a combination clip using three clips. The photograph shows the third clip is being applied. (C) Postoperative CT showed no complication. (D) Postoperative 3D CT angiography showed the disappearance of the bleb. (E) A remarkable regression of the aneurysm was observed on 3D CT angiography 1 year after the surgery.
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F2
As expected by the preoperative imaging studies, we found the bleb on the right shoulder of the aneurysm to be the rupture point (Figure 2A). After a temporary occlusion of the basilar artery, we occluded the rupture point with three aneurysm clips in an angioplastical fashion to the basilar artery (Figure 2B). His postoperative plain CT showed no additional lesions, and 3-dimension CT angiography (3D-CTA) revealed a disappearance of the bleb of the fusiform aneurysm (Figures 2C,D). One year after the surgery, his 3D-CTA revealed a remarkable shrinkage of the aneurysm (Figure 2E).