PMC8769453_01
Initial coronal CTA (A) showing a giant aneurysm of the V1 segment of the left vertebral artery. Axial CTA (B) showing bone erosion in the transverse foramen of the cervical vertebra. Repeated coronal CTA 10 days later (C) showing a thrombosed giant aneurysm of the left V1. CTA: computed tomography angiography.
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F1
Computed tomography angiography (CTA) showed a giant aneurysm measuring 47 x 58 x 47 mm3 in the left neck (Fig. 1A). CT showed bone erosion of the left transverse foramen at the C6 level (Fig. 1B). Repeated CTA showed that the aneurysm was partially thrombosed (Fig. 1C).
Three-dimensional digital subtraction angiography (A) showing two fusiform aneurysms located in the V1 to V2 segments of the left VA (proximal aneurysm: thrombosis [asterisk] with MaxD 5.8 mm, distal aneurysm: no thrombus with MaxD 14 mm). Left VAG (B) showing no findings of VA dissection and leakage of the contrast medium. Right VAG (C) showing retrograde blood supply to the left PICA and the aneurysm in the left V2 segment beyond the VA union. Bilateral VAG (D and E) showing complete obliteration of the aneurysm. The arrow: the inflow zone of the proximal giant aneurysm, the arrowhead: VA. MaxD: maximum diameter, PICA: posterior inferior cerebellar artery, VA: vertebral artery, VAG: vertebral angiography.
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F2
Three-dimensional digital subtraction angiography showed two fusiform aneurysms located in the V1 to V2 segments of the left VA (proximal aneurysm: maximum diameter [MaxD] 58 mm, distal aneurysm: MaxD 14 mm) (Fig. 2A). There were no findings suggestive of VA dissection and leakage of the contrast medium (Fig. 2B). After confirming dominancy of the right VA with retrograde blood supply to the left posterior inferior cerebellar artery (PICA) and the aneurysm of the left V2 segment (Fig. 2C), the aneurysm was trapped. Coils (Target; Stryker) were loosely packed into the proximal aneurysm for scaffolding and back into the vascular lumen proximal to the aneurysm, where the VA was tightly packed to block blood flow (Fig. 2D). Coils (Target) were loosely packed into the aneurysm for scaffolding and back into the vascular lumen distal to the aneurysm, where the VA was tightly embolized with coils to block blood flow (Fig. 2E).
Pretreatment (A) coronal CTA and at one year after treatment (B) T1-weighted MRI showing the reduction in aneurysm size. Photographs of the preoperative (C) and postoperative (D) anterior cervical region. Note that subcutaneous swelling has disappeared dramatically one year after treatment (white arrow). CTA: computed tomography angiography, MRI: magnetic resonance imaging.
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F3
One year after the operation, MRI of the neck showed that the size of the aneurysm was 27 x 36 x 27 mm3, which was smaller than before treatment (Fig. 3).