PMC9682165_01
NCCT: subarachnoid hemorrhage in the basal and sylvian cistern >1 mm thick and in the 4th ventricle; a round mass with peripheral calcification is seen (white arrow) (A); CTA and VRT display 2 aneurysms, one on the right supraclinoid ICA, the second on the left MCA bifurcation (white arrows) (B,C).
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F1
Non-contrast head CT and CT angiography revealed subarachnoid and intraventricular hemorrhage (modified Fisher 4) and two saccular aneurysms, one located on the right supraclinoid ICA with peripheral calcifications, measuring 20 x 12 mm, the second on the left MCA bifurcation, 6 x 4 mm (Figure 1).
3D Angio in oblique views show the fenestration arising distal to the OA and ending proximal to a fetal type PCom (A); DSA in working projection depicts the aneurysm before and after endovascular coil embolization with near complete obliteration of the sac (Raymond-Roy Occlusion Classification IIIb) (B,C).
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F2
The proximal part of the fenestration harbored a large saccular aneurysm projecting superiorly with the neck engulfing the origin of the fenestration (Figure 2A); due to the favorable neck and geometry of the aneurysm, endovascular coil occlusion was chosen as a treatment option without balloon or stent assistance. Alameda, California) until almost complete obliteration was achieved assessed by Raymond-Roy occlusion classification as IIIb (Figures 2B,C).