PMC9805604_01
(a) Preoperative plain axial computed tomography scan showing subarachnoid hemorrhage in the interhemispheric fissure. (b) Preoperative sagittal magnetic resonance imaging shows the inferiorly directing aneurysm, the hyperintense lesion above it is a hematoma, while the hyperintense horizontal line below it is the optic chiasm. (c) Preoperative sagittal section cranial computed tomographic angiography showing the inferiorly directed anterior communicating artery aneurysm.
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F1
An imaging assessment was performed initially, her computed tomography (CT) scan showed an interhemispheric SAH, and the CT angiography showed a medium-sized inferiorly directing (AcomA) aneurysm [Figure 1].
An intraoperative image showing the relationship between the right optic nerve (blue star) with the inferiorly directing anterior communicating artery aneurysm (black star) adhering to the optic chiasm.
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F2
During surgery, it was observed that the inferiorly directing aneurysm was adherent to the optic chiasm, and the optic nerve had normal vascularity [Figure 2].
Diagnostic catheterization angiography 3 months after the operation showing the internal carotid arteries with intact ophthalmic arteries, visualized retinal blush (green and blue arrow) on both sides. (a) Right side. (b) Left side.
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F3
Three months after surgery, a diagnostic catheterization angiography revealed the complete aneurysm clipping without any residual neck; both ophthalmic arteries are visualized, and a bilateral retinal blush [Figure 3].