case_images: PMC6238328_01
case_images: Admission computed tomographyscan
case_images: SNI-9-222-g001.jpg
case_images: PMC6238328_01_SNI-9-222-g001.jpg
case_images: F1
case_images: A non-contrast enhanced computed tomography (CT) scan confirmed severe orbital trauma with signs of ruptured globe and injury of the optic nerve; fractures of the medial wall and roof of the right orbit with bone fragments inside the frontal lobe; a small rounded blood effusion in the right paramedian frontal lobe and a slight interhemispheric bleed [Figure 1].
case_images: Computed tomography scan performed after delayed clinical deterioration showing right frontal hematoma
case_images: SNI-9-222-g002.jpg
case_images: PMC6238328_01_SNI-9-222-g002.jpg
case_images: F2
case_images: A CT scan revealed an intraparenchymal right frontal hematoma with moderate mass effect [Figure 2].
case_images: Magnetic resonance angiography showing anterior cerebral artery aneurysm (A2)
case_images: SNI-9-222-g003.jpg
case_images: PMC6238328_01_SNI-9-222-g003.jpg
case_images: F3
case_images: CT scan revealed a rounded, slight hyperdense, lesion in the right frontal lobe; MRA showed the presence of an aneurysm of right anterior cerebral artery (A2) partially thrombosed [Figure 3]. Considering the risk of re-bleeding we decided to treat the patient.
case_images: Intraoperative photographs. Panel A: aneurysm completely dissected before clipping. Panel B: aneurysm excluded (using two straight clips) and partially opened. Panel C: enlarged view after clipping, note pericallosal and calloso-marginal artery. (White dotted arrow: aneurysm; black arrow: right pericallosal artery; black asterisk (*): right calloso-marginal artery)
case_images: SNI-9-222-g004.jpg
case_images: PMC6238328_01_SNI-9-222-g004.jpg
case_images: F4
case_images: We performed a right paramedian frontal craniotomy and clipping the aneurysm with an interhemispheric approach [Figure 4].