A Patient with Eight Intracranial Aneurysms: Endovascular Treatment in Two Sessions

Figure 1

Nonenhanced axial CT slices ((a) and (b)) show three round hyperdensities: one adjacent to the sphenoid corpus on the left, another in front of the mesencephalon, and the third in the Sylvian fissure on the left, implying aneurysms of the internal carotid artery (ICA) cavernous segment (arrow, (a)), basilar tip (dashed arrow, (b)), and middle cerebral artery (white arrow, (b)), respectively. The DSA of the left carotid artery (c) reveals a small wide-necked aneurysm of the ICA lacerum segment (black dashed arrow, (c)), a fusiform aneurysm of the ICA cavernous segment (black arrow, (c)), and a middle cerebral artery bifurcation aneurysm (white arrows, (c) and (f)). A severe stenosis (white dashed arrow, (c)) adjacent to the fusiform aneurysm was also seen, resulting in reduced distal flow (c). 3D images ((d) and (e)) show the small saccular narrow-necked aneurysm of the anterior choroidal artery (white arrow, (d)) and the small saccular wide-necked aneurysm of the middle cerebral artery (e). A saccular wide-necked basilar tip aneurysm (f), a fusiform aneurysm of the anterior communicating artery (black arrow, (g)), and a saccular narrow-necked aneurysm (white arrows, (g) and (h)) and a blister-like (black arrows, (h)) aneurysm of the right ICA ophthalmic segment are seen in the DSA ((f) and (g)) and 3D (h) images. The ICA cervical segment dissection (i) possibly occurred during embolization of the aneurysms.

(a)

(b)

(c)

(d)

(e)

(f)

(g)

(h)

(i)