case_images: PMC11717119_01
case_images: Pre-operative CT angiogram demonstrates normal appearances of the (1) MCA, (2) ACA with, (3) laterally projecting terminal carotid sidewall aneurysm. (4) R ICA.
case_images: rjae841f1.jpg
case_images: PMC11717119_01_rjae841f1.jpg
case_images: f1
case_images: CT angiogram showed a right supraclinoid internal carotid artery (ICA) aneurysm (Fig. 1). CT Angiogram also showed an unruptured left posterior communicating which was thought not to be related to this patient's presentation and managed conservatively with serial imaging.
case_images: Axial post-operative CT angiogram demonstrating the (1) encircling clip occlusion of the terminal internal carotid artery aneurysm with a relatively normal calibre of (2) A1 and, (3) M1.
case_images: rjae841f2.jpg
case_images: PMC11717119_01_rjae841f2.jpg
case_images: f2
case_images: Post-operative day 1 CT angiogram demonstrated relatively normal calibre of the right A1 portion of anterior cerebral artery (ACA) and M1 portion of middle cerebral artery (MCA), in the terminal carotid region (Fig. 2).
case_images: Sagittal DSA demonstrating (1) Clip is in position across the terminal carotid. The frontal branch of the right MCA is supplied by collaterals from the (2) right ophthalmic artery (hypertrophied recurrent meningeal artery), right middle meningeal artery and right superficial temporal artery (via craniotomy site as pial synangiogenesis). There is collateral vessel formation consistent with Moyamoya phenomenon (4). (3) ICA. The A1 is not opacified likely due to the anterior communicating (ACOM) collateralisation.
case_images: rjae841f3.jpg
case_images: PMC11717119_01_rjae841f3.jpg
case_images: f3
case_images: There was diffuse small vessel formation in this same area (Fig. 3).