PMC7326191_01
Initial non-enhanced brain CT showing basal SAH.. Notes: (A) Diffuse and thick SAH at the base of brain including the basal cistern, (B, C) accompanying IVH and hydrocephalus, and (D) the pneumocephalus (white arrow) suggesting basal skull fracture.. Abbreviations: CT, computed tomography; SAH, subarachnoid hemorrhage; IVH, intraventricular hemorrhage.
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Initial CT of the brain disclosed diffuse SAH of the basal cistern, accompanying intraventricular hemorrhage (IVH), and hydrocephalus, which are common in nontraumatic aneurysmal SAH (Figure 1).
Subsequent DSA disclosing the rupture point at the mid-portion of the right PCoA.. Notes: (A, B) A pseudoaneurysm (black arrow) of the right PCoA and the extravasation of contrast media (black arrowhead) (A) oblique view, (B) lateral view. (C, D) Three-dimensional DSA showing a pseudoaneurysm (white arrow), 1.8 mm in diameter (C) oblique view, (D) lateral view).. Abbreviations: DSA, digital subtraction angiography; PCoA, posterior communicating artery.
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The DSA disclosed a 1.8 mm sized traumatic pseudoaneurysm at the mid-portion of the right PCoA that was inapparent on CT angiography (Figure 2). We observed extravasation of contrast media from it, resulting in basal SAH (Figure 2B).
Endovascular surgery and postoperative DSA.. Notes: (A, B) Trapping of the right PCoA using coils (A) oblique view, (B) lateral view. (C) Complete occlusion of the right PCoA after the trapping and (D) intact flow of the right posterior cerebral artery after the trapping (C) lateral view, (D) anteroposterior view).. Abbreviations: DSA, digital subtraction angiography; PCoA, posterior communicating artery.
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After confirming adequate blood flow of the right posterior cerebral artery through the posterior circulation, we performed endovascular trapping from the mid- to distal portion of the right PCoA using coils (Figure 3A and B).