case_images: PMC10783681_01
case_images: Angiography after flow diverter placement with coiling of bilateral carotid artery aneurysms. (ac) Left internal carotid artery. (d-f) Right internal carotid artery. (a and d) Three-dimensional rotational angiography. (b and e) Cone-beam computed tomography. (c and f) Angiography at the 6-month follow-up.
case_images: SNI-14-417-g001.jpg
case_images: PMC10783681_01_SNI-14-417-g001.jpg
case_images: F1
case_images: An 80-year-old male underwent coiling of bilateral carotid artery aneurysms [Figures 1a-f].
case_images: Perioperative lumbar images when lumboperitoneal (LP) shunt placed. (a) computed tomography showed no scoliosis, hypertrophy of spinous processes, and/or marked calcification of interspinous ligament. (b) X-ray after LP shunt placement. (c) showed a shunt catheter inserted cephalad through the L2-L3 level.
case_images: SNI-14-417-g002.jpg
case_images: PMC10783681_01_SNI-14-417-g002.jpg
case_images: F2
case_images: To reduce the risk of dual antiplatelet therapy (i.e., aspirin and clopidogrel) and intracranial hemorrhage associated with placing a VP shunt, the patient received an LP shunt (i.e., at the CT-documented "wider" L2/L3 level) [Figures 2a-c].
case_images: Brain computed tomography (CT). (a) Preoperative-flow diverters. (b) CT Image after recurrent worsening of normal pressure hydrocephalus symptoms/signs following bilateral flow diverter placement; enlarged lateral ventricles/periventricular lucency-anterior horns. (c) Image when symptoms improved after lumboperitoneal shunt. (d) Six months later, the patient deteriorated.
case_images: SNI-14-417-g003.jpg
case_images: PMC10783681_01_SNI-14-417-g003.jpg
case_images: F3
case_images: However, six months later, symptoms recurred, and the CT once again showed enlarged ventricles/ periventricular lucency, plus L2 intrathecal migration of the lumbar catheter [Figures 3a-d and 4a-d].
case_images: Lumbar spine images after shunt retraction. (a) Computed tomography (CT) showed that the shunt catheter retracted/migrated intrathecally. (b) X-ray at the site of catheter retraction. The arrow indicates the location. (c) Sagittal bone window CT scan. (d) Coronal CT of spinous processes.
case_images: SNI-14-417-g004.jpg
case_images: PMC10783681_01_SNI-14-417-g004.jpg
case_images: F4
case_images: However, six months later, symptoms recurred, and the CT once again showed enlarged ventricles/ periventricular lucency, plus L2 intrathecal migration of the lumbar catheter [Figures 3a-d and 4a-d].