case_images: PMC11722517_01
case_images: Preoperative cerebral angiography. (A,C) Right middle cerebral artery (MCA) aneurysm marked by red arrows, located at the MCA bifurcation. (B) Aneurysm in the right M2 segment. (D) Aneurysm located in the right pericallosal artery.
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case_images: Preoperative cerebral angiography (Figure 1) revealed three intracranial aneurysms, all located in the right hemisphere.
case_images: Preoperative 3D angiography reconstructions: (A) 3D vascular reconstruction showing the arterial tree of the right hemisphere; (B) right MCA bifurcation aneurysm, with a volume of 279.34 mm3, height of 6.92 mm, and neck width of 3.17 mm; (C) right M2 segment aneurysm, with a volume of 55.43 mm3, height of 5.34 mm, and neck width of 4.51 mm; (D) right pericallosal aneurysm, with a volume of 55.57 mm3, height of 3.76 mm, and neck width of 4.06 mm.
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case_images: The largest aneurysm, located at the bifurcation of the right MCA, was clearly visualized in angiography reconstructions (Figure 2), specifically in panel B. The second aneurysm, found in the right M2 segment of the MCA (Figure 2, panel C), measured 55.43 mm3. The third aneurysm, located in the right pericallosal artery (Figure 2, panel D), was measured at 55.57 mm3.
case_images: The intraoperative images demonstrate the step-by-step microsurgical management of intracranial aneurysms in a patient with cerebral atherosclerosis. (A) Initial visualization of the aneurysms located at the MCA bifurcation and along the M2 segment, highlighting the exposure of the vascular anatomy. The green arrow indicates the aneurysm neck at the MCA bifurcation. (B) Clipping of the aneurysm along the M2 segment, with meticulous preservation of the emerging vascular branches to maintain distal perfusion and vessel patency. The yellow arrow points to the applied clip securing the M2 segment aneurysm. (C) Clipping of the MCA bifurcation aneurysm, emphasizing the preservation of bifurcation anatomy and normal blood flow through the MCA branches. The green arrow shows the clipped aneurysm at the MCA bifurcation. (D) Identification of the right pericallosal artery aneurysm at the emergence of the callosal marginal artery, demonstrating the challenges posed by its deep-seated location. The red arrow highlights the aneurysm neck, and the yellow arrow points to the parent vessel. (E) Successful clipping of the pericallosal artery aneurysm, with precise attention to preserving the integrity and blood flow of the callosal marginal artery. The blue arrow marks the applied clip on the pericallosal aneurysm.
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case_images: The intraoperative images presented in Figure 3 highlight critical steps in the microsurgical clipping of the three intracranial aneurysms.
case_images: Three-month postoperative non-contrast CT scan. (A) Postoperative CT showing the aneurysm clips at the middle cerebral artery bifurcation (upper arrow) and the distal M2 segment (lower arrow), demonstrating proper placement without evidence of migration or residual filling. (B) Postoperative CT highlighting the aneurysm clip at the pericallosal artery, showing accurate positioning with no surrounding ischemic changes.
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case_images: The CT scan (Figure 4) demonstrated optimal placement of all three aneurysm clips.