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Case Presentation: ACOM Anuerysm with subarachnoid hemorrhage - Case 3
History and Physical
- 66 year old left-handed lady who presented to the hospital with severe headache.
- On physical examination she had no neurological deficit. She, however, had significant neck pain and meningismus.
Imaging
- MRA (Magnetic Resonance Angiography) of brain demonstrates an acom (anterior communicating) aneurysm (circled in red)
- Cerebral angiography confirmed the diagnosis of acom aneurysm. This aneurysm is circled in red in lateral (left) and AP view (right).
- 3D cerebral angiography showing the anatomy of the aneurysm.
Surgical Procedure
- An attempted coil embolization of the aneurysm was attempted and failed due to unfavorable aspect ratio of the aneurysm. Therefore, she instead underwent right supraorbital skull base supraorbital craniotomy with micro-clipping of the aneurysm in the operating room utilizing intra-operative neurophysiological monitoring and brain mapping.
- Computer simulation and modeling was utilized for precise localization of aneurysm and its vascular supply: (depicted in pink)
- Computer simulation and modeling was utilized for precise localization of aneurysm and its vascular supply: (depicted in pink)
- Exposure of the dura after removal of the orbital roof and wall.
- Dura opened and orbital content is advanced anteriorly.
- View through the microscope: micro-clipping of the aneurysm.
Post op MRA
- Post op MRA shows complete treatment of the aneurysm with no evidence of filling.
- Patient returned to complete normal function and was discharged home
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Last Updated on Sunday, 08 January 2012 18:34 |
