case_images: PMC9127294_01
case_images: PMC9127294_02
case_images: Preoperative and postoperative imaging examinations of the patient: (A-C) DSA imaging showing the right internal carotid artery communication segment considering an aneurysm; (D,E) DSA imaging showing intracranial occlusion of the left internal carotid artery; (F) DSA imaging showing the posterior circulation is clearly compensated to the left brain; (G,H) PWI indicates the left frontotemporal lobe TTP and MTT extension; (I,J) PWI indicates the CBV of the left frontal lobe increased and the CBV of the left temporal lobe decreased, but the bilateral CBF did not change significantly; (K,L) the results of the patient's head CT on the first day after surgery, with aneurysm clippings.
case_images: fsurg-09-863718-g0001.jpg
case_images: PMC9127294_04_fsurg-09-863718-g0001.jpg
case_images: F1
case_images: After admission, head and neck CTA showed the following (Figure 3B): (1) The thickness of the right middle cerebral artery M1 segment was uneven, and local nodular protrusion was considered.
case_images: PMC9127294_03
case_images: Preoperative and postoperative imaging examinations of the patient: (A) CTA showing occlusion of the right middle cerebral artery with the formation of small collateral vessels and the M1 segment of the left middle cerebral artery aneurysm; (B,C) DSA imaging showing that the cavernous sinus of the right internal carotid artery was occluded at the distal end, and the surrounding smoke-like blood vessels were formed; (D-F) DSA imaging showing that the end of the left middle cerebral artery M1 was an irregular aneurysm; (G) MRI indicates the right basal ganglia and corona demalaciasis; (H,I) PWI indicates bilateral oval center, radiated coronal area, temporoparietal occipital lobe, right frontal lobe and basal ganglia, and cerebellar hemisphere TTP and MTT prolongation; (J,K) PWI indicates a decrease in local CBF and no significant change in CBV; (L) the results of head CT on the first day after surgery.
case_images: fsurg-09-863718-g0002.jpg
case_images: PMC9127294_03_fsurg-09-863718-g0002.jpg
case_images: F2
case_images: After admission, the ambulatory blood pressure was improved (arterial pressure 130-150 mmHg); head and neck CT angiography (CTA) showed the following: the right internal carotid artery was slender, and the end was occluded; the right middle cerebral artery was occluded with small collateral vessels; the left middle cerebral artery M1 segment was tumor-like protrusion, possibly aneurysm (6.2 x 4.4 mm); the initial segment of the left internal carotid artery, the hard plaque of segment C6-7, and the lumen slightly narrowed (Figure 2A); head DSA showed the following: the right internal carotid artery cavernous sinus was distally occluded, and the left brain artery M1 end had an irregular aneurysm (Figures 2B-F); head MRI showed the right basal ganglia and corona infarction (Figure 2G); PWI showed a slight decrease in delayed perfusion in the bilateral hemispheres of the semicovale, radiographic coronal region, temporoparietal occipital lobe, right frontal lobe and basal ganglia region, and cerebellar hemisphere, suggesting hypoperfusion (Figures 2H-K). Postoperative: head CT examination on the first day after surgery (Figure 2L); ECG monitoring for the first 3 days after surgery to maintain the cuff arterial pressure fluctuating in the range of 130-150 mmHg.
case_images: PMC9127294_04
case_images: Preoperative and postoperative imaging examinations of the patient: (A-C) DSA imaging showing the right internal carotid artery communication segment considering an aneurysm; (D,E) DSA imaging showing intracranial occlusion of the left internal carotid artery; (F) DSA imaging showing the posterior circulation is clearly compensated to the left brain; (G,H) PWI indicates the left frontotemporal lobe TTP and MTT extension; (I,J) PWI indicates the CBV of the left frontal lobe increased and the CBV of the left temporal lobe decreased, but the bilateral CBF did not change significantly; (K,L) the results of the patient's head CT on the first day after surgery, with aneurysm clippings.
case_images: fsurg-09-863718-g0001.jpg
case_images: PMC9127294_04_fsurg-09-863718-g0001.jpg
case_images: F1
case_images: After admission, head and neck CTA showed the following (Figure 3B): (1) The thickness of the right middle cerebral artery M1 segment was uneven, and local nodular protrusion was considered.
case_images: Preoperative and postoperative imaging examinations of the patient: (A) MRI showing space-occupying lesions in the left cerebellopontine area; (B) CTA showing the right middle cerebral artery M1 aneurysm; (C,D) CT results of the head of the patient on the first day after the operation. Aneurysm clippings can be seen.
case_images: fsurg-09-863718-g0003.jpg
case_images: PMC9127294_04_fsurg-09-863718-g0003.jpg
case_images: F3
case_images: Eleven days ago, due to dizziness, as visual rotation:without facial numbness, pain and cough:she visited a local hospital, and the head MRI showed the following: (1) the left cerebellopontine angle area occupying lesions, considering acoustic neuroma; (2) multiple luminal infarcts in the right lateral frontal lobe and the semi oval center of the double basal ganglia (Figure 3A). After admission, head and neck CTA showed the following (Figure 3B): (1) The thickness of the right middle cerebral artery M1 segment was uneven, and local nodular protrusion was considered. Key points for patient management during the perioperative period were as follows: Three days before surgery, infusion therapy was given to improve circulation, nourish brain nerves, and protect brain function; intraoperative: during the beginning of anesthesia, surgical operation, and postoperative recovery, the cuff should be maintained in conjunction with the blood pressure monitoring value; in the ward, arterial pressure fluctuates in the range of 120-140 mmHg to prevent violent blood pressure fluctuations and cerebrovascular accidents; postoperative: head CT examination on the first day after surgery (Figures 3C,D); ECG monitoring for the first 3 days after surgery, with 3,000-3,500 ml rehydration volume; fluid volume was gradually reduced on the fourth day after surgery, and the patient was discharged on the eighth day after surgery.