case_images: PMC10126509_01
case_images: (A) CTA obtained two years before this admission (posterior- anterior view). A left VA-PICA aneurysm and a right MCA aneurysm (arrowhead) were noted. The left VA-PICA aneurysm (arrow) was clipped at first admission. (B) The scaled-up version of CTA taken two years before this admission. The size of the right MCA aneurysm (arrowhead) was 3 mm. (C) CTA obtained at this admission. No de novo aneurysm was found. (D) The scaled-up version of CTA obtained at this admission. The aneurysm size was 4 mm, and bleb formation was observed (arrowhead).
case_images: fsurg-10-1134231-g001.jpg
case_images: PMC10126509_01_fsurg-10-1134231-g001.jpg
case_images: F1
case_images: The patient had a history of subarachnoid hemorrhage caused by a ruptured left vertebral artery-posterior inferior cerebellar artery (VA-PICA) aneurysm two years prior to admission (Figure 1A). A 3-mm aneurysm of her right middle cerebral artery (MCA) had been detected (Figure 1B), and the patients had been followed up by MRI every six months at a local hospital. However, brain MRI (Figure 2B) revealed the presence of a FLAIR hyperintense lesion adjacent to the aneurysm, while CT angiography (Figures 1C,D) showed aneurysm growth with bleb formation at the posterior site.
case_images: (A) MRI-FLAIR image taken six months before this admission. (B) MRI-FLAIR image taken at this admission. A FLAIR hyperintense lesion was detected in the inner temporal lobe. (C) MRI-FLAIR image taken at post-operative day 7. The FLAIR hyperintense lesion persisted. (D) MRI-FLAIR image taken eight months after discharge. The FLAIR hyperintense lesion disappeared.
case_images: fsurg-10-1134231-g002.jpg
case_images: PMC10126509_01_fsurg-10-1134231-g002.jpg
case_images: F2
case_images: There was no FLAIR hyperintense lesion adjacent to the MCA aneurysm at six months prior to admission (Figure 2A). However, brain MRI (Figure 2B) revealed the presence of a FLAIR hyperintense lesion adjacent to the aneurysm, while CT angiography (Figures 1C,D) showed aneurysm growth with bleb formation at the posterior site. MRI scans (Figure 2C) on post-operative day 7 revealed that the FLAIR hyperintense lesion had almost disappeared. MRI scans (Figure 2D) taken eight months after clipping demonstrated complete regression of the FLAIR hyperintense lesion around the aneurysm.
case_images: (A) The aneurysm was detected on the right M2/3 bifurcation. There were no hemosiderin deposits around the aneurysm and brain parenchyma. (B) The aneurysm enhanced with indocyanine green. (C) The aneurysm was clipped with Sugita mini side angle blade 6 mm no.104.
case_images: fsurg-10-1134231-g003.jpg
case_images: PMC10126509_01_fsurg-10-1134231-g003.jpg
case_images: F3
case_images: During the procedure, there was no evidence of subarachnoid hemorrhage, hemosiderin deposits around the aneurysm, and brain parenchyma (Figures 3A-C).