case_images: PMC11021097_01
case_images: Radiological findings after the initial treatment (a and b) and at the time of recurrence (c and d). (a) MRA image demonstrating blood flow in the aneurysm at the basilar tip. (b) T2WI shows a flow void in the aneurysm, but no thrombus is observed. (c) MRA image showing enlargement of both blood flow in the aneurysm and the surrounding thrombus. (d) T2WI illustrates midbrain compression as a result of the thrombus in the basilar tip. MRA: Magnetic resonance angiography, T2WI: T2-weighted image.
case_images: SNI-15-103-g001.jpg
case_images: PMC11021097_01_SNI-15-103-g001.jpg
case_images: F1
case_images: Ten years later, final postoperative follow-up magnetic resonance angiography (MRA) and T2-weighted imaging (T2WI) of the head revealed blood flow within the aneurysmal sac, but no evidence of enlargement [Figure 1a and b], and outpatient follow-up was concluded. Head MRA revealed apparent enlargement of the basilar artery aneurysm [Figure 1c], and T2WI showed a mass measuring 18.6 mm x 17.0 mm x 16.8 mm within the interpeduncular fossa which exhibited the target sign and partial flow void [Figure 1d].
case_images: Cerebral angiographic findings after coil embolization. (a) Angiographic image showing the region of blood flow in the basilar tip aneurysm. (b) The frame was created by the Target 3D Coil with balloon assistance. (c) Final image obtained after coil embolization. (d) Final angiographic image showing the disappearance of the aneurysmal sac. BA: Basilar artery, PCA: Posterior cerebral artery.
case_images: SNI-15-103-g002.jpg
case_images: PMC11021097_01_SNI-15-103-g002.jpg
case_images: F2
case_images: Cerebral angiography demonstrated an inflow of contrast agent into the neck portion of the PTIA (presumed to be the aneurysmal sac) measuring 3.4 mm x 3.0 mm and extending from the basilar tip to the left posterior cerebral artery [Figure 2a]. Fremont, CA, USA). To prevent embedding of the coil in the thrombus, we used a soft 3-mm x 6-cm Target 3D device as the framing coil; this consisted of closed-loop secondary coils, allowing the formation of a well-constructed frame within the aneurysmal sac [Figure 2b]. Five detachable coils (Target 360 UltraSoft 3 mm x 6 cm; Target helical Nano 2 mm x 2 cm x 2; and Target helical Nano 1.5 mm x 2 cm x 2) were then inserted into the frame. After that, the intra-aneurysmal blood flow disappeared, and the surgery was concluded [Figure 2c and d].
case_images: Radiological findings at 2 months (a and b), 6 months (c and d), and 5 years (e and f) after coil embolization. (a) MRA image revealing residual thrombus at the basilar tip. (b) T2WI showing that the thrombus has reduced in size, as has the midbrain compression. (c) MRA image indicating a significant reduction in thrombus at the basilar tip. (d) T2WI confirms the further reduction in midbrain compression as a result of thrombus. (e) MRA image demonstrating the complete disappearance of the thrombus. (f) T2WI shows complete resolution of the midbrain compression. MRA: Magnetic resonance angiography, T2WI: T2-weighted image.
case_images: SNI-15-103-g003.jpg
case_images: PMC11021097_01_SNI-15-103-g003.jpg
case_images: F3
case_images: Follow-up MRA two months after surgery revealed residual thrombus but no restoration of blood flow to the sac [Figure 3a]. T2WI showed a tendency for thrombus reduction and alleviation of midbrain compression [Figure 3b]. T2WI [Figure 3d]. The most recent radiological examination, performed at five years postoperatively, confirmed the complete disappearance of the thrombus [Figure 3e]. T2WI showed that the midbrain compression, once eliminated, remained resolved [Figure 3f].