PMC5234295_01
(a) Axial MRI (FLAIR sequence) showing the lesion's hypersignal located at the sphenoidal segment of the right sylvian fissure. (b) Contrast CT scan demonstrating a homogeneous lesion in the proximal segment of the sylvian fissure
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F1
Computed tomography (CT) scan and magnetic resonance imaging (MRI) of the brain showed a cerebral aneurysm located at the sphenoid segment of the right lateral fissure [Figure 1].
DSA at the anteroposterior (a) and lateral (b) positions showing a saccular aneurysm that is difficult to differentiate from the parent vessel. Three-dimensional CT angiography at the anterior-oblique (c) and posterior-oblique (d) positions confirming the diagnosis of an aneurysm with an undefined neck on the right MCA
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F2
Digital subtraction angiography (DSA) together with CT angiography revealed a saccular aneurysm with 21 mm in length in its largest diameter and an undefined neck (extensive involvement of the walls of the afferent vessel) on the M1 segment of the MCA [Figure 2].
Intraoperative DSA. (a) The position of the balloon catheter together with guiding catheter coiled within the aneurysm (arrows). (b) Control DSA with absence of blood flow (arrow) in the aneurysm and distally. (c) Control DSA after aneurysm clipping
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F3
A 5 x 15 mm Copernic  balloon catheter (Balt Extrusion, Montmorency, France) was subsequently navigated under fluoroscope control through a right femoral puncture and, with the help of a 6F guiding catheter, placed on the right MCA and positioned alongside the aneurysm neck [Figure 3a]. The balloon catheter was briefly inflated to verify its position and DSA was performed to confirm the absence of blood flow in the occluded segment [Figure 3b]. At the end of microsurgery, an intraoperative cerebral DSA was performed demonstrating the complete exclusion of the aneurysm and preservation of the parent blood vessel without signs of stenosis [Figure 3c].
Late control angiography. (a) The preserved size throughout the course of the MCA and no residual aneurysm. (b) Several clips rebuilding the arterial anatomy of the patient
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F4
Late control angiography (performed one year after surgery) shows the preservation of the sphenoid segment of the middle cerebral artery (without stenosis) and complete exclusion of the aneurysm [Figure 4].